Presented at the 2012 AAPM Annual Meeting « Back

Clinical Assessment of Physical and Psychosocial Pathology in Pain Medicine

Fred N. Davis, MD, fdavis@procaresystems.com¹, Jana M. Mossey, PhD MPH MSN², Mark L. Gostine, MD¹, Rebecca Risko, BSN RN¹, Chris Cubbage, MA¹, (1) ProCare Research, Grand Rapids, Michigan, (2) Drexel University, Philadelphia, Pennsylvania

Introduction/Statement of the Problem: The relationship between anatomical pathology and psychosocial dysfunction is known to affect the clinical course and outcomes of chronic pain patients. Assessment is hampered by the absence of brief, valid, and reliable tools for use by physicians (1). To assess this relationship, physicians from ProCare Research, LLC developed a two dimensional Patient Assessment Matrix (PAM) disease burden scoring system. Physicians were instructed to assign a PAM, score using a four point rating scale, [(1) Low physical and psychosocial pathology; (2) High physical pathology only; (3) High psychosocial pathology only; (4) High physical and psychosocial pathology], at the first visit based on impressions from the history and physical examination. Material and Methods: To evaluate physician sensitivity, pain physicians assigned PAM scores for 7,950 de-identified pain patients who had agreed with IRB approved informed consent. Self-rated physical and psychosocial dysfunction was assessed prior to seeing the physician and was used as the ‘standard of accuracy'. The top tertiles of a 6 item scale and a 13 item depression/anxiety scale adapted from the TOPS (2) were utilized. Results: For anatomical/physical dysfunction, PAM sensitivity equaled 80.6% with specificity at 26.5%. In contrast, for psychosocial/psychiatric dysfunction PAM sensitivity was 34.6% and specificity 80.9%. Conclusions: The low sensitivity for psychosocial dysfunction suggests that pain physicians may have limited ability to recognize such dysfunctions in their patients. If true, development of patient generated psychosocial dysfunction indices to inform the physician is warranted. References: 1)Henkel V Mergl R, Kohnen R, et al. Identifying depression in primary care: a comparison of different Methods in a prospective cohort study BMJ 2003, 326:200-201. 2)Rogers WH, Wittink H, Ashburn MA, et al. Using the

Funding: None