DANARD-LILLY, CORPORATION

Pain Assessments are unique diagnostic screening tools, which enable Health Care Practitioners, Insurance Companies, Workman Compensation Providers, personal injury law firms and individuals to evaluate pain as part of any injury or medical condition and include that evaluation as part of treatment strategies, and compensation evaluation.

Pain Assessments provide a method to quantify and assess the emotional and psychological dynamics of pain. Having the ability to measure and identify the impact of pain on an individual can enhance effectiveness in planning strategies for a successful treatment outcome. Computerized Pain Assessments provides an objective and comprehensive supportive assessment of the existence, nature and intensity of a patient’s pain.

• Patient Input:

  Standard forms that are completed by the patient in the patients own words and descriptions eliminate the probability of erroneous interpretations that accompanies subjective verbal evaluations.

• Patient Care:

  Pain Assessment can evaluate the treatment strategies being followed by the patient’s practitioner as to their effectiveness in getting the patient whole.

• Objective:

  Computerized Pain Assessments eliminate the subjective interpretations of pain that can be assessed with different practitioners and the same practitioners at different times

• Fraud Reduction:

  A Pain Assessment evaluation required of the patient on a forty-five day evaluation cycle will quickly point out discrepancies and inconsistencies in patient’s claims.

RESEARCH RATIONALE

• The attention focused on the psychological impact associated with most pain from traumatic injuries and medical conditions.  This attention suggests that there is an existing problem needing new solutions.

• A compilation of published articles by respected authors in well-read professional journals underscores the value and demonstrates the benefit of incorporating information on a patients' psychological status or pain behavior as a factor in successful treatment strategy.

• The significance and value of Pain Assessments are identified, explained and confirmed extensively through numerous pertinent articles published in highly reputable professional journals by well-respected authors of prominent academic standing.

• The articles selected present a summary review of pertinent research studies, peer review and comparative analysis of current psychological test instruments endorsed for use in a medical clinic setting.  An evaluation of results,  support conclusions and documented validation for reliability and value of use in predicting treatment outcomes of patients in pain.

• Titles and authors listed demonstrate the content and subject matter embraced by each contributing author, highlight the variety of respected professionals interested and devoted to enhanced care and progressive treatment of pain patients.

• The results overwhelmingly demonstrate the need for a diagnostic tool to determine the psychological status and emotional ramifications of pain for patients in the early stages of diagnosis to support treatment planning and strategy.

• The results also conclude the need for a simple, non-threatening method to assess a patients' status, which can be used as a screening device in the medical clinic setting.

The significance and value of psychological instruments incorporated into a Pain Assessment ® are identified and explained in the following collection of articles that are obtained from professional journal publications. This selection presents a summary review and comparison analysis relating pertinent research studies, evaluation of results, validation and documentation of reliability.

RESEARCH RESOURCES

Title of Article

(followed by Journal, Authors and Affiliated University)

McGill Pain Questionnaire Major Properties and Scoring Methods

Pain #1 Melzack, Pain Research Unit McGill University, Canada

Test-retest reliability of the pain drawing instrument

Pain #33 Margolis, Chibnall, Tait St. Louis Univ. Schl of Medicine

Psychologic Classification of Back Pain Patients: A Prognostic Tool

Spine Vol 11 #9 McNeill, Sinkora, LeavittRush Medical College, St. Luke's Med Cntr

Low-Back Pain - Factors of Value in Predicting Outcome

Spine Vol 15 #6 Lacroix, Powell, Lloyd, Doxey, Mitson, Aldam York University, Canada

Prediction of Chronicity in Acute Low Back Pain

Phys Med Rehab Vol 65Murphy, CornishV A Adm Med Cntr, Minnesota

MBHI: A New Inventory for Psychodiagnosticians in Medical Settings

Professional Psychology, Millon, Green, Meagher, Jr.Univ. Miami/Chicago

Current Concepts Review: Psychological Tests in Evaluation of Back Pain

Journal of Bone and Joint Surgery,Southwick, WhiteYale & Harvard Univ Med Schl

Comparison of Three Measures for Detecting Psychological Disturbance in Back Pain Patients

Pain #13 Leavitt Rush Medical College

Validity of Back Pain Classification Scales in Detecting Psychological Disturbance as Measured by MMPI

Journal of Clinical Psychology Vol #36 Leavitt, GarronRush Presbyterian St Luke's Med Cntr, Chicago

On the Language of Pain

Anesthesiology, 1/71 Melzack, Torgerson McGill Univ., Canada, John Hopkins Univ., Maryland

Detecting Psychological Disturbance Using Verbal Pain Measurement

Pain Management &Assessment, Raven Press, Leavitt, Melzack Rush Medical College St. Lukes Med Cntr

Self Regulation of Pain: Use of Alpha Feedback and Hypnotic Training for the Control of Chronic Pain

Experimental Neurology, #46 Melzack, Perry McGill University, St. George Williams Univ, Quebec

Prediction of Outcome among Chronic Pain Patients

Behavioral Response Therapy Vol #24 Dolce, Crocker, Doleys Univ. Alabama,/ Pain Mngmnt Cntr, Brmnghm

Exercise Quotas, Anticipatory Concern & Self-Efficacy Expectancies in Chronic Pain: Preliminary Report

Pain #24, Dolce, Crocker, Moletteire, DoleysUniv. Alabama,/ Pain Mngmnt Cntr, Birmingham

Detection of Simulation Among Persons Instructed to Exaggerate Symptoms of Low Back Pain

Journal of Occupational Medicine Vol 29 #3, F Leavitt, Rush Medical College, Chicago

Cross Validation of Back Pain Classifications Scale with Chronic, Intractable Pain Patients

Pain #22,S SandersUniv of Utah Medical Center, Pain Center, Salt Lake City, UT

Management of Chronic Pain

Carrier Foundation Letter #114 - F.J. EvansRutgers Med School

Additional Researched Articles are available with extensive coverage on the subject of Pain, Pain Measurement, and Pain Management.

DANARD LILLY'S PAIN ASSESSMENT SOFTWARE

New mandatory rulings
The Joint Commission on Accreditation of Healthcare Institutions (JCAHO) pain standards is incorporated into seven accreditation manuals that cover the direct provision of care.

Healthcare organizations can effectively implement the JCAHO standards through a “Ten Steps process for Compliance. The steps are:

1) Recognize patients' rights to pain control.
2) Screen for pain.
3) Perform a complete assessment when pain is present.
4) Record the assessment in a way that facilitates regular reassessment and follow up.
5) Set a standard for monitoring and intervention.
6) Educate providers and assure staff competency.
7) Establish policies that support appropriate prescription or ordering of pain medicines.
8) Educate patients and families.
9) Include patient needs for symptom control in discharge planning.
10) Collect data to monitor the effectiveness and appropriateness of pain management.

Danard-Lilly Corporation’s Psychological Pain Assessment Software meets the JCAHO requirement for compliance of a complete Pain Assessment.

DOCUMENTING MEDICAL NECESSITY THROUGH OUTCOME ASSESMENT

Outcomes:
Outcomes assessment: Collection and recording of information relative to health process.

Outcome Management:
Using information in a way that enhances patient care.
(Hansen DT, Mior S. Mootz RD in Yeomans SG: The Clinical Application of Outcome Assessment, Stamford Connecticut, Appleton & Lang, 2000)

Health Policy:
With the dawning of the "era of accountability," there are new social mandates directed toward the healthcare providers and health-related facilities. Measurement of quality, satisfaction, efficacy, and effectiveness now serve as essential elements for health care decisions and matters of health policy.

(Hansen DT, Mior S. Mootz RD in Yeomans SG: The Clinical Application of Outcome Assessment, Stamford Connecticut, Appleton & Lang, 2000)

Back To Top

Outcome Measures Appropriate for Clinical Use:

Questionnaires

• General health status
• Pain
• Functional Status
• Patient Satisfaction
• Physiological Outcomes
• Utilization Measures
• Cost Measures

Subjective Questionnaires

Subjective outcomes assessment information is gathered by the patient in self-administered questionnaires and scored by either the:

• Health care provider
• Staff Member

Objective Questionnaires

Objective outcomes assessment information is gathered by the patient inself-administered questionnaires and scored by:

• A Computer

Outcomes Assessment tools:

It is important to remember to utilize the same outcome assessment tool throughout the course of case management with each patient.

Pain Perception:

Visual Scales

• Reliable and Valid
• Advantages of measurement methods

(Scott and Huskisson 1976, Price, et al 1994)

Pain Assessment Offers:

Four specific factors:

1. Current pain level
2. Average of typical pain level
3. Pain level at its best
4. Pain leven at its worst

(Von Korff et al, 1992)

Guidelines:

Chronic Patient:

Average pain = last 6 months.

Frequency:

Every 45 to 60 days since a patient's failure to progress may indicate A need for a change in management approaches.

(Haldeman et al, 1993)

Prevailing Factors

Contemporary behavioral research on pain has placed increased emphasis on the role of psychological factors in pain response. Relevant studies have shed new light on the dynamics of pain behavior, pain response and the pain behavior cycle. Preliminary evidence reveals that early intervention programs with acute injury patients is effective in promoting a patients positive response to treatment and reduces the disabling patterns of pain. When initial exams include pain assessments that identify anxiety factors and measure a patients stress level, it allows the practitioner to address those needs and develop alternatives or options of therapeutic modalities for "patient-specific" treatment planning.

Research verified the need for an additional diagnostic tool that would be advantageous to patients and doctors in treatment planning. These tools are objective, computer-interpreted assessments that are sympathetic to problems inherent in pain patterns typical of injuries and trauma.

Synopsis:

Psychological Pain Assessments are derived from patient responses as reported on a comprehensive Pain Assessment Symptom Inventory which is comprised of well known and extensively validated instruments including a Pain History, Body Drawing, Pain Word Descriptors and Symptom Checklist. The various sections on the form collect an extensive range of multidimensional information that is essential for psychological screening in a number of highly relevant areas with relative ease. The psychometric properties and clinical sensitivity incorporated into a Pain Assessment Symptom Inventory has been extensively researched and examined for reliability.

A Pain Assessment is a sensitive distress measure proven highly accurate with individuals suffering pain, in detecting difficulties that may contribute to their pain management and timely recovery. When a patient’s pain environment is identified by their unique profile, a practitioner can determine the need for, and form of treatment and/or psychological intervention if necessary. In about 90% of patients, Pain Assessments provides an analysis of comparative measurements to document treatment progress or support decisions for specific therapy or modalities. Pain Assessments offer an opportunity to deliver the most complete treatment confidently in the acute stages of an injury or medical condition.

The Pain Assessment report simplifies identification and evaluation of physical symptoms, as well as the symptomatic levels of stress that contribute with other factors in each patient’s response to pain and trauma. Pain Assessments are extremely useful in medical clinic contexts relevant to the assessment of a wide range of pain characteristics, patterns and behaviors.

Pain Assessments reduce recovery time, gets the injured parties back to work and productive again, which creates a cost saving environment for all.

PAIN ASSESSMENT AS A DIAGNOSTIC TOOL:

Rationale:

A Pain Assessment directly addresses the pain issue by providing practitioners with a Pain Assessment Symptom Inventory, designed as a self-reporting, present pain checklist. Simplicity in the Symptom Inventory design facilitates ease for the practitioners' office and expedites honest, accurate completion of the form by individuals. Subjective patient responses are quantified and used as an objective method of measuring the emotional components. With the means to detect psychological distress associated with individual pain response it is possible to determine levels of anxiety contributing to patients' pain management.

A Pain Assessment Symptom Inventory uses only pain related words and images to provide verbal and visual documentation of symptoms for a patient. Verbal and non-verbal ranking scales are valuable for measurement of symptoms exposing different psychological areas and categorizing factors associated with fear, imagined disabilities or general life-style threats measured in relation to quantified real and organic factors.

A Pain Assessment Symptom Inventory uses only pain related words and images to provide verbal and visual documentation of symptoms for a patient. Verbal and non-verbal ranking scales are valuable for measurement of symptoms exposing different psychological areas and categorizing factors associated with fear, imagined disabilities or general life-style threats measured in relation to quantified real and organic factors. A Pain Assessment Symptom Inventory is objectively scored, statistically analyzed and interpreted by a computer software program that also performs comparative correlations, compiles and summarizes the raw data to supplement the information reported by a patient. Results of computer scoring and interpretation are documented in a narrative report by providing an objective Pain Assessment describing a patients’ subjective reaction to their pain experience. Pain Assessment Reports are brief, comprehensive, clearly written evaluations of the extent and range of a patient’s emotional reaction to their pain, accompanied by a comparison chart and graph.

Psychological Pain Assessments can provide additional validity and creditability to non-medical health care providers.

A Cost Cutting Tool:

Florida State Workers Compensation:
Analysis 1990 to 2003

Reviewing the Workers’ Compensation Claims Statistical Query for the State of Florida, 1990 – 2003, the total cost in dollars and lost productivity to the State of Florida, brings to light the necessity of providing a comprehensive plan for the reduction of these costs.

With a total cost of over eighteen billion dollars, ($18,771,389,384.00) and over one million (1,173,855) cases with an average cost per case of fifteen thousand dollars, ($15,991.00) the need for a comprehensive tool to reduce these costs is readily apparent.

Our Pain Assessment Software Analysis has a statistical history of reducing an individuals time to recovery by an average of 20% per case. By utilizing our Pain Assessment Software, the State of Florida would have realized a savings of three thousand, one hundred and ninety-eight ($3,198.00) per case or a total of three point seven billion dollars, ($3,754,277,876.00) over the statistical time period.

California State Workers Compensation

California’s workers compensation average value of medical claims has risen from $11,746 in 1995 to $35,201 in 2002. With the highest insurance rates in the nation of $5.85 per $100 in payroll it is reaching the breaking point for companies within California. Danard-Lilly Corporation’s Pain Assessment can reduce these costs by 20 to 30 percent.

HMOs, Institutional and Governmental Care:

Some of the benefits to managed health care provided by pain assessments are:

• Reduction in cases of healthcare fraud
• Getting patients back to work in a timely manner
• Substantial savings
• Better quality of health care

Supporting Factors:

Rising healthcare cost has had an impact on virtually every industry and most individuals. Skyrocketing cost in the medical industry has crippled many companies and forced many to revise hiring practices and cut employee hours and benefits.

Some factors contributing to the rise in health care cost are fraud and the continuation of psychosomatic pain treatment. The need exists for quantitative objective pain assessments. As a result, many physicians have come to realize that it only makes sense for doctors to incorporate Pain Assessments into their standard clinical practice.

There is an enormous body of research that shows psychosocial factors play a dominant role in injury rehabilitation, and disability. Incontrovertible evidence suggests that addressing psychosocial factors should be an integral part of the rehabilitation process for pain and injury. A few examples are listed below.

• Psychosocial factors have been used to predict up to 91% of the time which pain patients recover from an acute pain condition, and those who go on to become disabled, without researchers looking at medical diagnoses (Gatchel, et al., 1995).
• Many commonly used medical tests have not demonstrated much predictive validity—meaning tests do not accurately predict the course of your illness. For example, a positive bulging disk on an MRI does not determine who will end up with clinically significant pain (Jensen, et al., 1994).
• A World Health Organization study of 26,000 subjects in 14 countries found that physical disability was more closely associated with psychological factors than it was with medical diagnosis (Ormel, et al., 1994).
• Psychosocial factors play a major role in surgical outcome (Schofferman, et al., 1992).
• Psychosocial factors strongly influence the role of symptoms (Swartzman, et al., 1996).
• Psychosocial factors decrease the effectiveness of medical interventions (Rohling et al., 1995).

When depression and anxiety undermine a patient’s ability to tolerate pain, surgery is unlikely to help, as surgery does not change psychology. Psychological treatment for such cases is far less expensive than surgery and does not have any risks for serious complications; it has a better chance of treating the real source of magnified pain and disability.

Psychological evaluations also can help determine:

• The approach to which a particular patient will most likely respond. Some patients work best with authoritative physicians, but this approach with others may foster resistance. Some patients depend on professionals to motivate them and do better when pushed, while others resent this and do best when left alone.
• Patients’ levels of motivation and underlying causes behind low motivation
• Low motivation can be the result of depression, not wanting to return to work or other factors. Determining the underlying cause is critical for intervening in cases of noncompliance or limited effort. If a patient is at high risk for becoming dependent on substances then it’s important information to know if narcotic pain-relieving medication is being considered.

Psychologists also can train patients in the use of biofeedback to help patients control the intensity of the pain experience. Biofeedback is commonly used and particularly is useful for people who do not want to take medication.

Overall, psychological evaluations are a part of “holistic” treatment, where the whole person is treated not just the injured body part. Research has shown that medical and psychological factors often are inseparably linked, and successful treatment cannot take place without addressing both areas of concern.

PAIN WORD INVENTORY

• The Pain Word Inventory consists of 85 pain descriptor words, divided into 20 categories, or groups, which are divided into 3 classifications. First 13 groups are Sensory, next 2 groups are Evaluative, and the next 5 groups are Affective. Words are scored by rank and by scale values.
• The Pain Word Inventory has become established as the standard by which other psychological instruments for pain measurement are compared.
• The Pain Word Inventory has been more extensively reviewed with favorable outcomes than any other pain measurement instrument available.
• Test/Retest reliability and comparison studies with numerous other test instruments from the MMPI, MBHI to the Cornell Medical Index have strengthened the status of the Pain Word Inventory.
• The Pain Word Inventory has been highly recommended after extensive use in medical clinic settings.

PAIN DRAWING

• Developed by Danard Lilly Corporation consists of an outline drawing of the front and back view of a human body on which patients map the nature and distribution of their pain via a location numbering system.
• Test/Retest studies have demonstrated the effectiveness of the Pain Drawing as a measure of pain and documentation of any changes.
• Reveals patient’s accuracy of understanding their medical condition to guide compliance with treatment regimen.