Psychosocial assessment

A comprehensive pain assessment should include a psychosocial assessment exploring the patient’s2:

  • mood
  • coping skills
  • family support structure
  • signs and symptoms of anxiety and depression
  • expectations regarding pain management
  • quality of life

Co-morbid psychological disorders

    • Depression
    • Anxiety and other psychological disorders

Co-morbid psychological disorders
Persistent pain is highly associated with depression, anxiety and other psychological disorders, which can amplify the experience of pain, reduce compliance and impede treatment success. Psychological diagnoses related to chronic pain can be grouped into three main categories:

  1. Pre-existing conditions such as depression or personality disorders that were present prior to pain onset.
  2. Reactive conditions that occur as a result of chronic pain such as depression, anxiety, or adjustment problems.
  3. Conditions related to the pain itself, such as Fictitious Disorder15.
  • - Depression.

    • It is well known that persistent pain is highly associated with depression. Studies have shown that depressive disorders occur in a large proportion of patients with persistent pain3, 16, 17.   Depression may arise as a complication of persistent pain or it may be the primary cause of persistent pain3.

  • - Anxiety and other psychological disorders.

    • Anxiety disorders comprise a significant subset of psychological disorders seen in patients with chronic pain15. Other psychological disorders that occur with greater frequency in patients with persistent pain include: post-traumatic stress disorder, psychoactive substance use disorders, personality disorders and rarely factitious disorders or malingering (i.e. the intentional production of false or grossly exaggerated symptoms, motivated by obvious external incentives)15.

Quality of Life
Persistent pain commonly undermines mood, vitality, function and other dimensions of health-related quality of life (HRQoL)2. Thus it is important to monitor how pain and its treatment affect function, daily activities, mood, sleep pattern and other aspects of HRQoL.

Quality of life questionnaires for people with chronic non-malignant pain have been specifically developed to better assess how pain and pain treatments affect HRQoL2. Some examples include:

  • (i) SF-12 Health Survey

    • The SF-12 was developed as a measure of disability or functioning and is applicable to people with any illness, physical or mental18.

    Appendix 5: SF-12 Health Survey
    Adapted from SF-12® Health Survey © 1994, 2002 by Medical Outcomes Trust and QualityMetric Incorporated.

  • (ii) Kessler Psychological Distress Scale (K10)

    • This questionnaire can be used to screen for psychological disorders in general practice. The K10 has the advantage of a simple scoring system19.

    Appendix 6: Kessler Psychological Distress Scale (K10)
    Adapted from Kessler et al. Short screening scales to monitor population prevalences and trends in non-specific psychological distress. Psychol Med. 2002;32(6):959-76.