Review Article

Tramadol/Paracetamol Fixed-Dose Combination for Chronic Pain Management in Family Practice: A Clinical Review

Table 1

Instruments for the assessment of pain and pain-related quality of life.

QuestionnaireAssessmentsScoring

Pain scales, for example,
(i) numerical scales (NRS) [16]
(ii) visual analogue scales (VAS)
(iii) verbal rating scales (VRS)
(iv) Wong-Baker FACES scales [17]
Assessment of pain intensitySelf-assessment and physician assessment
11-point or 100 mm scales
0 = no pain to 10 = worst imaginable pain

CHANGE PAIN scale [33]
(i) 11-point NRS on the front
(ii) 6 key parameters affecting quality
  of life on the back
Assessment of pain intensity
Setting individual treatment goals for the patients
11-point scale with 0 = no pain to 10 = worst imaginable pain
Need for improvement: not at all, a little, very much

SF-36-Health Survey [28]Measures general health status including physical functioning, role-physical, bodily pain, general health, vitality, social functioning, role-emotional, and mental health
An additional question determines the health status compared to the previous year
8 items are rated on a scale ranging from 0 to 100;
higher values indicate a better outcome
A frequently used shorter version is the SF-12 [34]

Short Form McGill Pain Questionnaire (SF-MPQ) [35]Pain assessment with a short form of the McGill Pain Questionnaire
It includes the Present Pain Intensity (PPI) index of the standard MPQ and a visual analogue scale (VAS).
15 items with sensory and affective subscores
Pain over the last 7 days is rated on a 4-point categorical scale

Brief Pain Inventory (BPI) [36]Measures pain (including presence of pain, localization, pain intensity, pain medication, and pain reduction during defined time frame) and impairments of daily life Self-assessment
Short version contains 9 questions scored on an 11-point scale ranging from
0 = no pain/no impairment to 10 = as bad as you can imagine

EuroQol (EQ-5D) [37]Assessment of pain, quality of life, and daily functioning Part 1 includes five dimensions: mobility, self-care, usual activities, pain/discomfort, and anxiety/depression
For each dimension, three statements that best describe the patient’s health status are selected
Part 2: VAS health status rating scale from 0 (worst status) to 100 (best status).

Depression, Anxiety, and Stress Scale (DASS) [29]Assessment of depression, anxiety, and stressSelf-assessment
Three subscales with 14 items, rated on a four-point Likert scale (total scores from 0 to 42 on each subscale)
Depression: scores above 20 indicate severe depression
Anxiety: scores above 14 indicate severe anxiety
Stress: scores above 25 indicate severe stress

Beck Depression Inventory (BDI) [30]Sensory pain description and assessment of affective pain experience Self-assessment
8 adjectives for the description of sensory components
4 adjectives for the description of affective components
Scores from 0 to 63: 14–19 mild depression, 20–28 moderate depression, and 29–63 severe depression

Western Ontario and McMaster Universities (WOMAC) Osteoarthritis Index [31, 32]Condition-specific
Assessment of pain, stiffness, and difficulty in function
Patient self-assessment
24 questions in three domains: pain, disability, and joint stiffness
Answers are scored on a 5-point Likert scale or 100 mm visual analogue scale with higher scores indicating greater difficulty