A very thorough explanation of psychosocial assessment for pain

I happened upon the Australian and New Zealand College of Anaesthetists website recently, and amongst some of the many resources found there, I located a very thorough description of psychosocial assessment for chronic pain. It’s a synthesis of many authors and resources and despite the orientation to medical assessment, and some of the discussion around ‘malingering’, it offers some very useful advice and content for anyone working in this field.

Here’s the document in its entirety – please make sure you acknowledge the source, as the authors do indicate that the work is not original and is drawn from multiple references.

Something to consider when you’re developing an assessment format, eg a semi-structured interview or even general headings for use during an assessment – make sure you operationalise and anchor the words you use to the underlying constructs.

What I mean is, if you want to explore ‘social relationships’, what areas need to be looked at? In chronic pain this means probably looking at not just the impact of pain on interpersonal relationships, but also the way in which other people reinforce pain behaviour, the social systems that maintain the person’s disability, the community responses to individuals with chronic pain, the legislative framework that supports disability (or not), as well as the effect on intimacy, family roles and the quality and stability of the relationships.

While you as an individual may today know what you mean by ‘social relationships’ as humans we drift over time from our original conceptualisation, leading us away from the original interpretation. This problem becomes worse as new people are introduced to the structure, and as they bring their interpretation of ‘what is important to consider’ under that heading or domain.

I’ve linked this post to the paper by Gask & Usherwood from the BMJ because this is a good starting point for anyone considering ‘psychological medicine’. Actually, because almost all medicine/health care involves people doing things for their long-term health (health behaviours), I think the term ‘psychological medicine’ is a complete misnomer! It’s simply the practice of good health care.

Anyway, the points made by this assessment description, while much more lengthy than most of us can manage in a one hour appointment, clarify some of the areas – and more importantly, clarify the constructs we’re trying to look at under each domain. The domains themselves probably haven’t changed terribly much over the past few years, but what has changed are the details of the constructs as new evidence is brought to light. So, if you’re going to develop an assessment process, and especially if other people will eventually use it, having a very clear description of the meanings of the terms used, and the constructs to which they refer, will help keep people from drifting off important material, while allowing new material to be added as the research is identified.

Happy reading!

Gask L, & Usherwood T (2002). ABC of psychological medicine. The consultation. BMJ (Clinical research ed.), 324 (7353), 1567-9 PMID: 12089097


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