Baseline History Essentials

Patients with chronic non-cancer pain should be asked about pain severity and pain interference at baseline and follow up. Pain Interference is the key outcome that should be targeted.

Severity: During the past week, what number best describes your pain, on average?¹    (0 = no pain, 10 = pain as bad as you can imagine)

Interference: During the past week, what number best describes:¹

• How pain has interfered with your enjoyment of life?
• How pain has interfered with your general activity?
  • (0 = does not interfere, 10 = completely interferes)

These questions should be asked at baseline to identify key treatment targets that can contribute significantly to pain interference.

Treatment Expectations: What are your pain management goals?

~ 30% pain reduction (or 2 points less) and significantly improved function is realistic.

Mood Symptoms:²

^{PHQ4, i.e., PHQ2 + GAD2 calculator}

(0 = not at all, 1 = several days, 2 = more than half the days, 3=nearly every day. Screen is + if D or A total score >3.)

Depression (D): Over the past 2 weeks, how often have you been bothered by:

1. Little interest or pleasure in doing things?
2. Feeling down, depressed or hopeless?

If score is 3 or more, do PHQ9 (see Other Tools)

Anxiety (A): Over the past 2 weeks, how often have you been bothered by:

1. Feeling nervous, anxious or on edge?
2. Not being able to stop or control worrying?

If score is 3 or more, do GAD7 (see Other Tools)

Social Support:

1. How often do you talk/text/visit with friends and family?
   1. Daily / Weekly / Monthly / Not at All
2. Do you see and talk to friends and family as much as you would like?
   1. Yes / No
3. How easy is it to get help from friends and family if you need it?
   1. Very Easy / Somewhat Easy / Not Easy at All

Pain Coping:³ Ask if patient agrees or disagrees: “I feel that my pain is terrible and it’s never going to get any better.”

Fear Avoidance:³ Agree or disagree: “It’s not really safe for a person with my pain problem to be physically active.”

Pain Self-Efficacy:⁴ How confident are you that:

1. You can do some form of work (e.g., housework, paid/unpaid work) despite the pain?
2. You can live a normal lifestyle despite the pain?

(0 = not confident at all and 6 = completely confident; total score of 8 or higher is desirable. Total score of 5 or less implies that patient needs help with self-efficacy.)

Sleep: Do you feel that you get good quality sleep?

Widespread Pain:⁵ Do you often feel that you have pain all over?

If “yes” and patient has fatigue, morning stiffness and/or non-restorative sleep, consider fibromyalgia (FM). Numerous drug allergies also may support possible FM.

A score of at least 5 on the Fibromyalgia Rapid Screening Tool makes it possible to detect fibromyalgia with a sensitivity of 90.5% and a specificity of 85.7%.

If patient denies pain all over, but has pain in multiple body areas, consider completing Fibromyalgia Survey (see Other Tools).