MEASUREMENTS OF CHRONIC PAIN AND FUNCTION - continued
Back Pain Function: The disability caused by back pain and progress with therapy can be assessed by a number of measures. The Quebec Back Pain Scale (Kopec et al 1995) is one example.
THE QUEBEC BACK PAIN DISABILITY SCALE:
Today, do you find it difficult to perform the following activities because of your back?
Response options (0 - 5):
0, not difficult at all
1, minimally difficult
2, somewhat difficult
3, fairly difficult
4, very difficult
5, unable to do
Not difficult Unable to
1. Get out of bed. 0 1 2 3 4 5
2. Sleep for at least 6 hours. 0 1 2 3 4 5
3. Turn over in bed. 0 1 2 3 4 5
4. Travel one hour in a car. 0 1 2 3 4 5
5. Stand up for 20-30 minutes. 0 1 2 3 4 5
6. Sit for 4 hours. 0 1 2 3 4 5
7. Climb one flight of stairs. 0 1 2 3 4 5
8. Walk a few blocks. 0 1 2 3 4 5
9. Walk several miles. 0 1 2 3 4 5
10. Reach up to high shelves. 0 1 2 3 4 5
11. Throw a ball. 0 1 2 3 4 5
12. Run two blocks. 0 1 2 3 4 5
13. Take food out of the fridge. 0 1 2 3 4 5
14. Make your bed. 0 1 2 3 4 5
15. Put on socks (pantyhose) 0 1 2 3 4 5
16. Bend over a sink for 10 mins. 0 1 2 3 4 5
17. Move a table. 0 1 2 3 4 5
18. Pull or push heavy doors. 0 1 2 3 4 5
19. Carry two bags of groceries. 0 1 2 3 4 5
20. Lift 40 lbs. 0 1 2 3 4 5
Sleep Disturbance: Difficulty in falling asleep, and number of awakenings because of pain and duration of sleep during a 24 hour period are all self report measures which should be asked. Improvements in sleep often correspond with improvements in pain and dysfunction. Early morning awakening may indicate significant depression.
Ambulation: Getting the patient to do a timed 50 yard walk can act as a guide for physical therapy success. As they cope more effectively with pain the patients tend to decrease both their time and the number of their pain behaviors.
Sit/Stand: This is another useful method of following physical improvement, in low back pain patients. The number of times the patient can stand from a sitting position, preferably from a chair without arms, in two minutes is recorded. As physical function improves the number of repetitions the patient is able to perform increases and the number of pain behaviors decrease.
Pain Diaries: Pain diaries can serve an important function in identifying food allergies, diurnal rhythms, external stressors and effectiveness of medication. Unfortunately they are seldom kept conscientiously and are usually only useful for a few days at a time for most patients Asking the patient to fill in their pain ratings at a regular time such as wake up, breakfast, lunch, evening meal and bedtime improves compliance. All medications taken and the time they are taken should also be noted. For intermittent chronic pain syndromes such as headaches the onset and offset time of the pain, and its maximum pain score should be recorded. It is also useful to ask the headache sufferer to note activities and food and drink consumed in the 24 hours prior to the headache.
Recommended reading.
I . Kopec JA, Esdaile JK Abrahamowicz K et aL The Quebec Back Pain Disability Scale. Spine; 3: 3410-352, 1995.
2. Van Korff M, Ormel J, Keefe FJ, Dworkin SF. Grading the severity of chronic pain. Pain 50; 133-149, 1992.
3. Williams RC. Toward a set of reliable valid measures for chronic pain assessment and outcome research. Pain; 35:239-251, 1988.
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