The guidelines provided by the New York State Workers Compensation Board offer fundamental principles for conducting evaluation and diagnostic procedures for non-acute pain. These directives are designed to assist healthcare professionals in identifying appropriate methods for assessing and diagnosing non-acute pain within the context of comprehensive care.
Healthcare professionals with expertise in evaluating and diagnosing non-acute pain can rely on the guidance outlined by the Workers Compensation Board to make well-informed decisions about the most suitable diagnostic approaches for their patients.
It is crucial to emphasize that these principles are not meant to replace clinical judgment or professional expertise. The evaluation and diagnostic procedures for non-acute pain should involve collaboration between the healthcare provider and the patient, considering individual circumstances and medical history.
Standardized Diagnostic Approach
- Employing a standardized approach is essential for diagnosing and evaluating work-related chronic pain complaints, ensuring accurate diagnosis and treatment planning.
History Taking and Physical Examination
- History taking and physical examination form the cornerstone of medical diagnosis and guide subsequent diagnostic and therapeutic procedures. Objective clinical findings should take precedence over other diagnostic procedures when they do not align.
Pain History, History of Present Illness
- A comprehensive pain history is integral to evaluating non-acute pain, aiding in treatment planning. Key elements to ascertain include:
- Pain localization and distribution.
- Onset and duration of pain.
- Characteristics of pain, such as quality, intensity, radiation, and timing.
- Utilization of pain assessment tools like the Visual Analog Scale.
- Activities that worsen, alleviate, or have no effect on pain.
- Associated symptoms, functional limitations, sleep disturbances, and fear avoidance.
Past Medical History
- Past medical history should include:
- Level of education and language barriers.
- Work history and occupation details.
- Current employment status and marital status.
- Family environment and cultural considerations.
- Belief systems and review of systems checklist.
- Pre-existing conditions and psychosocial history, including substance abuse and history of abuse (physical, emotional, sexual).
Diagnostic Tests and Treatment Expectations
- It’s crucial to review previous diagnostic tests, treatment interventions, surgeries, medications, and psychosocial functioning. Additionally, understanding the patient’s treatment expectations and beliefs about their pain and recovery is essential.
- The assessment should also encompass psychosocial factors, such as depression, anxiety, stressors, and social support systems, as well as cultural and spiritual beliefs that may influence treatment decisions and outcomes.
- Finally, it’s essential to consider any pre-existing conditions that may impact recovery from non-acute pain and address substance abuse and lifestyle factors like alcohol use and smoking history.
Physical Examination
- The physical examination should encompass accepted examination techniques and tests relevant to the area under examination:
Vital signs
- Essential vital signs should be assessed.
Accepted pain assessment tool
- Utilization of recognized pain assessment tools such as the Visual Analog Scale (VAS) or Numerical Rating Scale (NRS) is recommended.
General inspection
- This includes observing posture, stance, and gait.
General physical examination
- A comprehensive examination of systems such as the chest, abdomen, and vascular system should be conducted to rule out other potential sources of non-acute pain.
Neurologic Evaluation
- This involves assessing cranial nerves, muscle tone and strength, sensory examination, motor evaluation, spinal cord and peripheral nervous system, reflexes, cerebellar function, and provocative neurological maneuvers.
Sensory Evaluation
- Routine quantitative sensory testing like Semmes-Weinstein monofilaments may aid in identifying sensory abnormalities.
Musculoskeletal Evaluation
- This includes assessing range-of-motion, segmental mobility, musculoskeletal provocative maneuvers, palpation, observation, and functional activities to examine joints, muscles, ligaments, and tendons for abnormalities.
Electrodiagnostic Studies (EDX)
- These studies, like EMG/NCV, are separate diagnostic procedures addressed in specific sections of relevant medical treatment guidelines.
Evaluation of non-physiologic findings
- Examination for non-physiologic findings includes assessing for Waddell Signs, variability on formal exams, and inconsistencies between formal exams and observed abilities.
Red Flags
- Assessment should involve evaluating for red flags such as fractures, dislocation, infection, tumor, and progressive deficit through history and physical examination.
