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Assessment Tools


FREE Patient Assessment Tools


Please feel free to print and use in your practice.

Below are documents and tools that are found in the 2010 and 2015 Interagency Guideline on Prescribing Opioids for Pain. While the guideline contains other useful tools, we feel these are the most valuable and efficient.

 

 

Assessing Function and Pain
Title Description
PDF Pain, Enjoyment of life, General Activity (PEG)

Include two citations by Krebs when using tool:

PDF Two Item Graded Chronic Pain Scale Clinician or patient self-report, takes about 1 minute
Risk of Transitioning to Chronic Pain
PDF StarTBack Screening Tool (for evaluating back pain disability)

STarT Back Screening Tool website and instructions: View here
Patient self-report, takes about 5 minutes

PDF Functional Recovery Questionnaire (FRQ) Copyright University of Washington, but available for public use with proper citations. View here
Clinician or patient self-report, takes less than 5 minutes
Screening for Risk of Opioid Addiction and Substance Abuse
PDF Opioid Risk Tool (ORT)

Clinician or patient self-report, takes about 1 minute.

PDF CAGE Adapted to Include Drugs (CAGE-AID) Instructions here
Clinician interview, takes less than 5 minutes
web link Screener and Opioid Assessment for Patients with Pain - Revised (SOAPP-R)

You must get this tool from the painedu.org site, requires account registration
Patient self-report, takes less than 10 minutes

web link Current Opioid Misuse Measure (COMM)

You must get this tool from the painedu.org site, requires account registration
Patient self-report, takes less than 10 minutes

PDF DIRE: Risk assessment that addresses the risks of maintaining long-term opioid treatments in chronic pain patients.

Source: University of Colorado, Denver View here
Clinician interview, takes less than 2 minutes

PDF Alcohol Use Disorders Identification Test (AUDIT)

Clinician or patient self-report, takes about 10 minutes

Screening for Mental Health Disorders
PDF Patient Health Questionnaire 9 (PHQ-9)

Instructions here
Patient self-report, takes less than 5 minutes

PDF GAD-7 Generalized Anxiety Disorder Questionnaire Patient self-report, takes less than 5 minutes
PDF PC-PTSD (Primary Care Post Traumatic Stress Disorder)

Instructions here
Clinician interview, takes less than 5 minutes

Patient Tools
PDF WA State Labor and Industries’ “Patient’s Activity Diary”

Patient self-report, 7-day diary

PDF WA State Labor and Industries’ Opioid Treatment Agreement Patient self-report, time varies
PDF WA State Department of Corrections’ Chronic Pain Management Agreement

Patient self-report, time varies

 


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