PAIN & DISABILITY ASSESSMENT

| Oswestry Disability Index | Neck Disability Index | Roland-Morris Disability Questionnaire | Stanford Score

As a health-care provider, it is imperative that we have a standard means to assess a patients level of pain and disability. Or, to put that in 'plain English', us doctors need to have a way to measure peoples level of pain and inability to work and play in the world. To help us achieve this, there are some 'Classic' tools that are utilized.

FUNCTIONAL PAIN ASSESSMENT: How is the patient disabled from everyday work & life?

The Oswestry Disability Index (2) and the Roland-Morris Disability Questionnaire (22) are hands-down the most commonly used and recommened outcome measure tools used for assessing the disabling effects of lumbar spinal disorders. (28,34,53) The Stanford Score is an attempt to combine the level of the patients functional disability and subjective disability. It's a good idea but has really never caught on; however, I really like this scale and maybe can give it a 'push' into the lime light.

For the cervical spine, we have a tool called the Neck Disability Index that is hands down the most frequently used functional outcome tool for cervical related disabilities. This outcome assessement tool was created by modifing the Oswestry Disability Index and is extremely relialbe. (26)

SUBJECTIVE PAIN ASSESSMENT: How much pain is the patient experiencing?

A patients level of subjective 'PAIN' (what the patient feels) is best measured with a device called the 'Visual Analog Scale' (VAS). There are a few different versions of the VAS, but I prefer a simple '0 to 10' scale. Here's how it works: Simply ask the patient the following question regarding their pain: "Mrs. Smith, on a scale of 0 to 10, where 0 is no pain and 10 is the worst imaginable pain, where does your current level of pain fall." VAS does an nice neat job of assessing your patients pain levels and allows you to document their subjective improvement or lack of improvement.

| Oswestry Disability Index | Roland-Morris Disability Questionnaire | Stanford Score

References:

1) Fairbank JC, Pynsent PB, "The Oswestry Disability Index." Spine 2000; 25(22):2940-2952

2) Fairbank JCT, Couper J, Davies JB. "The Oswestry low Back Pain Questionnaire." Physiotherapy 1980; 66: 271-273.

26) Vernon H, Mior S. "The Neck Disability Index: a study of reliability and validity." J Manipulative Physiol Ther. 1991 Sep;14(7):409-15.

28) Deyo RA, Battie M, et al. "Outcome measures for low back pain research: a proposal for standardized use." Spine 1998;23:2003-13

34)Doleys DM et al. "Psychological evaluation in spinal cord stimulation therapy." Pain Rev 1997; 4:189-207

22) Roland M, Morris R. "A study of the natural history of low back pain. Part 1: Development of a reliable and sensitive measure of disability in low-back pain." Spine 1983;8:141-4

53) Turk DC, Marcus DA. "Assessment of chronic pain patients." Semin Neurol 1994; 14:206-12