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Prescribing drugs of dependence in general practice

Part C2 - The role of opioids in pain management

Appendix E

Last revised: 02 Jun 2020


The PEG is a practical tool to assess and monitor chronic pain by measuring three items: average pain intensity (P), interference with enjoyment of life (E), and interference with general activity (G).109

Table E1

Table E1

PEG pain tool
Figure E2

Figure E2

Brief pain inventory

Overview

The McGill pain questionnaire can be used to evaluate a person experiencing significant pain. It can be used to monitor the pain over time and to determine the effectiveness of any intervention. It was developed by Dr Ronald Melzack at McGill University in Montreal, Canada, and has been translated into several languages.

Sections:

  • What does your pain feel like?
  • How does your pain change with time?
  • How strong is your pain?

What does your pain feel like?

Statement: Some of the words below describe your present pain. Circle ONLY those words that best describe it. Leave out any category that is not suitable. Use only a single word in each appropriate category – the one that applies best.

Group

Descriptor

Points

1 (temporal)

flickering

1

 

quivering

2

 

pulsing

3

 

throbbing

4

 

beating

5

 

pounding

6

2 (spatial)

jumping

1

 

flashing

2

 

shooting

3

3 (punctate pressure)

pricking

1

 

boring

2

 

drilling

3

 

stabbing

4

 

lancinating

5

4 (incisive pressure)

sharp

1

 

cutting

2

 

lacerating

3

5 (constrictive pressure)

pinching

1

 

pressing

2

 

gnawing

3

 

cramping

4

 

crushing

5

6 (traction pressure) tugging 1
  pulling 2
  wrenching 3
7 (thermal) hot 1
  boring 2
  scalding 3
  searing 4
8 (brightness) tingling 1
  itchy 2
  smarting 3
  stinging 4
9 (dullness) dull 1
  sore 2
  hurting 3
  aching 4
  heavy 5
10 (sensory miscellaneous) tender 1
  taut 2
  rasping 3
  splitting 4
11 (tension) tiring 1
  exhausting 2
12 (autonomic) sickening 1
  suffocating 2
13 (fear) fearful 1
  frightful 2
  terrifying 3
14 (punishment) punishing 1
  gruelling 2
  cruel 3
  vicious 4
  killing 5
15 (affective-evaluative-sensory: miscellaneous) wretched 1
  blinding 2
16 (evaluative) annoying 1
  troublesome 2
  miserable 3
  intense 4
  unbearable 5
17 (sensory: miscellaneous) spreading 1
  radiating 2
  penetrating 3
  piercing 4
18 (sensory: miscellaneous) tight 1
  numb 2
  drawing 3
  squeezing 4
  tearing 5
19 (sensory cool 1
  cold 2
  freezing 3
20 (affective-evaluative: miscellaneous) nagging 1
  nauseating 2
  agonizing 3
  dreadful 4
  torturing 5
Pain score = SUM (points for applicable descriptors)

How does your pain change with time?

Question

Response

Points

Which word or words would you use to describe the pattern of your pain?

Continuous steady constant

1
  Rhythmic periodic intermittent 2
  Brief momentary transient 3

Do the following items increase or decrease your pain?

  • Liquor
  • Stimulants (eg coffee)
  • Eating
  • Heat
  • Cold
  • Damp
  • Weather changes
  • Massage or use of a vibrator
  • Pressure
  • No movement
  • Movement
  • Sleep or rest
  • Lying down
  • Distraction (eg tv, reading)
  • Urination or defecation
  • Tension
  • Bright lights
  • Loud noises
  • Going to work
  • Intercourse
  • Mild exercise
  • Fatigue

How strong is your pain?

Statement: People agree that the following five words (mild, discomforting, distressing, horrible, excruciating) represent pain of increasing intensity. To answer each question below, write the number of the most appropriate word in the space beside the question.

Question

Response

Points

Which word describes your pain right now?

mild

1
  discomforting 2
  distressing 3
  horrible 4
  excruciating 5
Which word describes it at its worst?

mild

1
  discomforting 2
  distressing 3
  horrible 4
  excruciating 5
Which word describes it when it is least?

mild

1
  discomforting 2
  distressing 3
  horrible 4
  excruciating 5
Which word describes the worst toothache you ever had?

mild

1
  discomforting 2
  distressing 3
  horrible 4
  excruciating 5
Which word describes the worst headache you ever had?

mild

1
  discomforting 2
  distressing 3
  horrible 4
  excruciating 5
Which word describes the worst stomach ache you ever had?

mild

1
  discomforting 2
  distressing 3
  horrible 4
  excruciating 5

Interpretation

  • Minimum pain score: 0 (would not be seen in a person with true pain)
  • Maximum pain score: 78
  • The higher the pain score, the greater the pain


To estimate the probability of neuropathic pain, please answer yes or no for each item of the following four questions.

Figure E4

Figure E4

Interview of the patient
Figure E5

Figure E5

Örebro musculoskeletal pain questionnaire484

Explanatory notes

The Örebro musculoskeletal pain questionnaire (ÖMPQ) is a ‘yellow flag’ screening tool that predicts long-term disability and failure to return to work when completed 4–12 weeks following a soft tissue injury.485 A cut-off score of 105 has been found to predict (with 95% accuracy) those who will recover, those who will have no further sick leave in the next six months (with 81% accuracy), and those who will have long-term sick leave (with 67% accuracy).484

The ÖMPQ predicted failure to return to work six months after compensable musculoskeletal injury in a NSW population of workers. The injuries in the study group were mixed, and the ÖMPQ was found to be more specific and sensitive for back injuries. In workers with back injuries screened at 4–12 weeks, a cut-off score of 130 correctly predicted 86% of those who failed to return to work.486

Identification through the ÖMPQ of workers at risk of failing to return to work due to personal and environmental factors provides the opportunity for treating practitioners to apply appropriate interventions (including the use of activity programs based on cognitive behavioural strategies) to reduce the risk of long-term disability in injured workers. Evidence indicates that these factors can be changed if they are addressed.487–489

Administering the questionnaire

The ÖMPQ is designed to be a self-administered tool completed by the worker in a quiet environment without assistance from any other person. A detailed explanation is provided by the person administering the questionnaire:

Information from this questionnaire helps us understand your problem better, and it especially helps us evaluate the possible long-term consequences your pain may have. It is important that you read each question carefully and answer it as best you can. There are no right or wrong answers. Please answer every question. If you have difficulty, select the answer that best describes your situation.

Where uncertainty or a request for more information is expressed, encouragement is provided to ‘answer as best you can’. The questionnaire item may be read aloud to assist; however, the question should not be rephrased. All questions should be answered, as missing values will reduce validity.490

Scoring instructions

  • For Question 5, count the number of pain sites and multiply by two – this is the score (maximum score allowable is 10).
  • For Questions 6 and 7 the score is the number bracketed after the ticked box.
  • For Questions 8, 9, 10, 11, 13, 14, 15, 18, 19 and 20 the score is the number that has been ticked or circled.
  • For Questions 12, 16, 17, 21, 22, 23, 24 and 25 the score is 10 minus the number that has been circled.
  • Write the score in the shaded area beside each item.
  • Add up the scores for Questions 5 to 25 – this is the total ÖMPQ score.

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