Why this exists

The co-occurrence of chronic pain with depression, post-traumatic stress and substance use disorder is well documented, and the federal Pain Management Best Practices Inter-Agency Task Force put a biopsychosocial model and a multidisciplinary approach at the head of its recommendations for exactly that reason. Psychosocial distress contributes to pain intensity, to pain-related disability and to poor response to treatment. Untreated psychiatric conditions raise the risk of medication mismanagement and overdose.

The practical problem is that this screening is recommended far more often than it is done, because doing it properly consumes clinical time that a pain visit does not have. The result is that the behavioral half of a biopsychosocial model quietly does not happen.

The specific thing worth catching early is suicidality. It is the outcome for which delay is least recoverable, and it is the one a rushed visit is most likely to miss.

How it works

• The ordering clinician selects the instruments after an initial treatment plan exists. This is not a fixed battery applied to everyone.
• The patient is invited by email and completes the screening in their own time, which produces better answers than a clipboard in a waiting room.
• Scored against normative data and against the person’s own prior results, so that a change is visible rather than only an absolute score.
• Critical results are highlighted for immediate clinical attention rather than appearing in a monthly summary.
• Trends inform the treatment plan, and rescreening is guided by the plan and the clinical picture rather than by a fixed calendar.