• Pain Audit
  • Background
  • What is OA?
  • What is the impact of OA?
  • The need for improved care in OA
  • Audit objectives
• Assessment Tools
  • A comprehensive pain assessment
  • Pain location
  • Pain intensity
  • Causes & Classification of pain
  • Assessing neuropathic pain
  • Other types of pain
  • Neurological examination
  • Psychosocial assessment
  • Diagnostic testing
  • Physical risk factors
  • Psychosocial risk factors
  • Ongoing assessment and review
  • References
  • Appendices
  • Appendix 1: Assessment of patient's pain history
  • Appendix 2: Body map
  • Appendix 3: DN4 Neuropathic Pain Diagnostic Questionnaire
  • Appendix 4: (LANSS) Pain Scale
  • Appendix 5: SF-12 Health Survey
  • Appendix 6: Kessler Psychological Distress Scale
  • Appendix 7: Orebo Musculoskeletal Pain Screening Questionnaire
• Management Tools
  • AIMS OF TREATING PERSISTENT PAIN
  • GENERAL PAIN MANAGEMENT PRINCIPLES
  • TREATMENT PLAN
  • PHARMACOLOGICAL TREATMENTS
  • (WHO) – ANALGESIC LADDER
  • COMMONLY PRESCRIBED ANALGESICS
  • ASSESSING INEFFECTIVE TREATMENT
  • NON-PHARMACOLOGICAL TREATMENTS
  • PATIENT/FAMILY EDUCATION
  • PREVENTING DECONDITIONING WITH "PACED" PHYSICAL EXERCISE
  • PSYCHOLOGICAL INTERVENTIONS
  • ALLIED HEALTH PROFESSIONAL INTERVENTIONS
  • COMPLEMENTARY AND ALTERNATIVE TREATMENTS
  • SURGERY AND OTHER INVASIVE PROCEDURES
  • TREATMENT ALGORITHMS
  • MULTIDISCIPLINARY PAIN CENTRES
  • SUMMARY: PAIN TREATMENT
  • REFERENCES
  • APPENDICES
  • Appendix 1: Chronic Disease Management Plan for GPs
  • Appendix 2: A Team Care Arrangement for GPs
  • Appendix 3: NSW Therapeutic Advisory Group patient information leaflet on chronic pain
  • Appendix 4: Neuropathic pain treatment algorithm
  • ACKNOWLEDGEMENTS
  • DISCLAIMER
• Resources

World Health Organisation (WHO) – analgesic ladder

The World Health Organization (WHO) has produced an analgesic ladder to be used as a guide for prescribing analgesics. Analgesics are staggered according to pain severity: mild, moderate and severe pain9. If a patient does not experience pain relief on one step of the analgesic ladder, they should progress to the next step. Mild pain:                   Step 1: Simple analgesics (non-opioid) Initiate topical and/or simple oral non-opioid analgesics (e.g. paracetamol, NSAIDs) + adjuvant e.g. tricyclic antidepressants, anticonvulsants (pregabalin or gabapentin) for neuropathic pain. Moderate pain:           Step 2: Weak opioid Weak opioid (e.g. tramadol, codeine phosphate or dextropropoxyphene) + adjuvant e.g. tricyclic antidepressants, anticonvulsants Severe pain:                Step 3: Strong opioid Opioids (e.g. morphine, oxycodone) + adjuvant e.g. tricyclics, anticonvulsants Adapted from WHO. Cancer Pain Relief, World Heath Organisation. Geneva. 19861,9.