| SCORE |
FACTOR |
EXPLANATION |
| |
Diagnosis
|
1 = Benign chronic condition with minimal objective findings or no definite medical diagnosis. Examples: fibromyalgia, migraine headaches, nonspecific back pain.
2 = Slowly progressive condition concordant with moderate pain, or fixed condition with moderate objective findings. Examples: failed back surgery syndrome, back pain with moderate degenerative changes, neuropathic pain.
3 = Advanced condition concordant with severe pain with objective findings. Examples: severe ischemic vascular disease, advanced neuropathy, severe spinal stenosis. |
| |
Intractability
|
1 = Few therapies have been tried and the patient takes a passive role in his/her pain management process.
2 = Most customary treatments have been tried but the patient is not fully engaged in the pain management process, or barriers prevent (insurance, transportation, medical illness).
3 = Patient fully engaged in a spectrum of appropriate treatments but with inadequate response. |
| |
Risk
|
(R = Total of P + C + R + S below) |
| |
Psychological: |
1 = Serious personality dysfunction or mental illness interfering with care. Example: personality disorder, severe affective disorder, significant personality issues.
2 = Personality or mental health interferes moderately. Example: depression or anxiety disorder.
3 = Good communication with clinic. No significant personality dysfunction or mental illness. |
| |
Chemical Health: |
1 = Active or very recent use of illicit drugs, excessive alcohol, or prescription drug abuse.
2 = Chemical coper (uses medications to cope with stress) or history of CD in remission.
3 = No CD history. Not drug-focused or chemically reliant |
| |
Reliability: |
1 = History of numerous problems: medication misuse, missed appointments, rarely follows through.
2 = Occasional difficulties with compliance, but generally reliable.
3 = Highly reliable patient with meds, appointments & treatment. |
| |
Social Support: |
1 = Life in chaos. Little family support and few close relationships. Loss of most normal life roles.
2 = Reduction in some relationships and life roles.
3 = Supportive family/close relationships. Involved in work or school and no social isolation. |
| |
Efficacy score |
1 = Poor function or minimal pain relief despite moderate to high doses.
2 = Moderate benefit with function improved in a number of ways (or insufficient info – hasn’t tried opioid yet or very low doses or too short of a trial).
3 = Good improvement in pain and function and quality of life with stable doses over time. |