REHABILITATION PROFESSIONALS’ KNOWLEDGE AND ATTITUDES SURVEY REGARDING PAIN

 

Boston School of Occupational Therapy

Boston, Massachusetts

 

Developed by:

Deborah Rochman, MS, OTR/L and

Penny Herbert, MS, PT

 

 

Distributed by the CITY OF HOPE PAIN & PALLIATIVE CARE RESOURCE CENTER                                                                                                                          1999

 


REHABILITATION PROFESSIONALS’ KNOWLEDGE

AND ATTITUDES SURVEY REGARDING PAIN

 

True/False - Circle the Correct Answer Created by D. Rochman MS,OTR/L

P. Herbert MS, PT

1.

T F Observable changes in vital signs must be relied upon to verify a person’s statement that he has severe pain.

2.

T F Because of an underdeveloped neurological system, children under 2 years of age, have decreased pain sensitivity and limited memory of painful experiences.

3.

T F If the person can be distracted from his pain, this usually means that he does NOT have high pain intensity.

4.

T F People may sleep in spite of severe pain.

5.

T F Comparable stimuli in different people produce the same intensity of pain.

6.

T F Aspirin and other nonsteroidal anti-inflammatory agents are NOT effective analgesics for bone pain such as fractures and post operative orthopedic pain.

7.

T F Non-drug interventions (e.g., heat, ice massage, relaxation methods) are very effective for mild-moderate pain control but are rarely effective for more severe pain.

8.

T F A spouse/parents or other family member’s presence may re-inforce a person’s non-coping behaviors, such as limping or grimacing.

9.

T F The person with pain should be encouraged to endure as much pain as possible before resorting to a pain relief measure.

10.

T F Children less than 11 years cannot report pain with reliability and therefore, the therapist should rely on the parent’s assessment of the child’s pain intensity.

11.

T F Based on one’s religious beliefs a person may think that pain and suffering is necessary.

12.

T F The person with pain should be advised to use non-drug techniques alone rather than concurrently with pain medications.

13.

T F In order to be effective, heat and cold should only be applied to the painful location.

14.

T F Being engaged in a purposeful activity may reduce a person’s perception of pain, for example cooking.

15.

T F Changing a person’s beliefs regarding pain may improve his/her coping skills.

True/False - Circle the Correct Answer

16. T F Malingering is uncommon among people suffering from chronic pain.
17. T F Relief following a placebo means the pain is "all in the person’s head".
18. T F A health care provider’s personal values/intuition are useful tools in determining whether a person is lying about his/her pain.
19. T F All "real" pain has an identifiable physical cause.
20. T F Depression is commonly associated with chronic pain.
21. T F The cause of chronic non-malignant pain is primarily psychological.
22. T F Acute and chronic pain require similar interventions.
23. T F Pain intensity can be reliably measured on a variety of numerical scales.
24. T F Under treated acute pain contributes to the onset of chronic pain.
25. T F Elderly people often suffer unnecessarily, presuming their pain is part of the aging process.
26. T F Elderly people are not good candidates for self-management programs for their pain.

Multiple Choice - Place a Check by the Correct Answer

27.   The most likely explanation for why a person with pain would request increased doses of pain medication is:

____ a. The person is  experiencing increased pain.

____ b. The person is experiencing increased anxiety or depression.

____ c. The person is requesting more staff attention.

____ d. The person’s requests are related to addiction.

28   The most accurate judge of the intensity of the person’s pain is:

____ a. The treating physician.

____ b. The person’s primary nurse.

____ c. The person experiencing pain.

____ d. The physical therapist.

____ e. The occupational therapist.

Multiple Choice - Place a Check by the Correct Answer

29.   Which of the following describes the best approach for cultural considerations in caring for people in pain:

____ a. Because of diverse and mixed cultures in the United States, there are no longer cultural influences on the pain experience.

____ b. Therapists should use knowledge that has defined clearly the influence of pain on culture (e.g., Asian patients are generally stoic, Italians are expressive and exaggerate their pain.

____ c. People should be individually assessed to determine cultural influences on pain.

Circle the Correct Answer

30 Research has shown that the percentage of people who over report the amount of pain they experience are:

less than 10% 10-20% 20-40% 40-60% 60-80% 80-100%

31 Narcotic/opioid addiction is defined as psychological dependence accompanied by overwhelming concern with obtaining and using narcotics for psychic effect, not for medical reasons. It may occur with or without the physiological changes of tolerance to analgesia and physical dependence (withdrawal).

Using this definition, how likely is it that opioid addiction will occur as a result if treating pain with opioid analgesics? Circle the number closest to what you consider the correct answer.

1-5% 10-25% 25-50% 50-75% 75-100%

Four case studies are presented. For each, you are asked to make decisions about the pain and the person’s motivation.

Directions: Please select one answer.

32. Case 1:  Stewart, a 12 year old boy with cerebral palsy, cries and complains about pain during his range of motion exercises in therapy. About 3 months ago, the clinic’s psychologist assessed Stewart as being depressed. You decide:

1. that Stewart’s pain is due to his depression and his pain complaints do not require any further intervention.

2. Ignoring Stewart’s pain complaint is the most appropriate strategy.

3. Stewart is complaining about pain in order to get sympathy and avoid doing the exercises.

4. to assess Stewart’s pain using a visual analgue scale and to teach Stewart pain coping strategies.

33. Case 2:

Frank is 60 years old and this is his first day following total hip arthroplasty. As you enter his room, he smiles at you and continues talking and joking with his visitors. When asked to rate his pain on a scale of 0-10 (0 = no pain, 10 = worst pain) he rates his pain as 8.

A. Circle the number that represents your assessment of Frank’s pain.

0 1 2 3 4 5 6 7 8 9 10

No pain/discomfort                                                                     Worst pain/discomfort

B. What other interpretations are most likely true about Frank’s behaviors on the first day following his surgery?

___ 1) He has much less pain than he reports and he is medication seeking.

___ 2) He is distracted by his visitors and misrepresents his pain.

___ 3) He is using distraction effectively to deal with his pain.

___ 4) He is in denial about his illness.

 Directions: Please select one answer.

34. Case 3:

Lisa is a 22 year old college athlete who had a car accident 8 months ago in which she sustained fractures to right tib/fib, clavicle and multiple facial lacerations. Her physician reports her fractures are healed and she is cleared for full weightbearing on both upper and lower extremity. Lisa is currently completing her college degree, but reports that because of the pain she is constantly tired and unable to be involved in any social campus life. She appears anxious as she ambulates into your office with a single crutch and an extremely guarded gait. She reports her pain as 9 on a 0-10 visual analogue scale. To begin your intervention you:

___ 1) Complete the subjective part of the evaluation and request further consultation with the physician prior to completing the objective testing.

___ 2) Ignore her pain complaints, complete your assessment and set up a stress loading program for increasing weight bearing.

___ 3) Decide to focus on treating her pain before you can completely assess her or address her functional deficits.

___ 4) Offer Lisa a thermal modality and complete your assessment, beginning to instruct her in self management of pain.

35. Case 4:

Scott is a 49 year old former truck driver with a 15 year history of low back pain. He has had multiple laminectomies with subsequent rehabilitation in the past, and has completed vocational retraining. He last worked 4 months ago as a VCR repairman which was a job he held for less than a year. He is currently on workman’s compensation for a lifting injury sustained on that job. You observe Scott sitting comfortably in the waiting room reading but when you call him he grimaces, struggles to his feet and limps into the treatment area. Based on your observations, you surmise Scott:

___ 1) is in severe pain from sitting too long in the waiting room.

___ 2) is a symptom magnifier and is likely his pain will be out of proportion to his physical findings.

___ 3) is a malingerer and is faking his pain to get higher benefits.

___ 4) will need a thorough evaluation given his complex history of multiple injuries and treatments.

This tool was adapted from Nurses’ knowledge and attitudes survey regarding pain (1987). California: City of Hope National Medical Center, Betty Ferrell Phd FAAN and Margo McCaffery, RN, MS, PAAN.

Other sources used for development of the survey include:

McCaffery, M. & Beebe, A. (1989). Pain clinical manual for nursing practice. St. Louis: Mosby

Unruh, A. (1995). Teaching student occupational therapists about pain: A course evaluation. Canadian Journal of Occupational Therapy, 62, 30-36.


 ANSWER KEY

REHABILITATION PROFESSIONALS’ KNOWLEDGE

AND ATTITUDES SURVEY REGARDING PAIN

True/False - Circle the Correct Answer

1.

T (F) Observable changes in vital signs must be relied upon to verify a person’s statement that he has severe pain.

2.

T (F) Because of an underdeveloped neurological system, children under 2 years of age, have decreased pain sensitivity and limited memory of painful experiences.

3.

T (F) If the person can be distracted from his pain, this usually means that he does NOT have high pain intensity.

4.

(T) F People may sleep in spite of severe pain.

5.

T (F) Comparable stimuli in different people produce the same intensity of pain.

6.

T (F) Aspirin and other nonsteroidal anti-inflammatory agents are NOT effective analgesics for bone pain such as fractures and post operative orthopedic pain.

7.

T (F) Non-drug interventions (e.g., heat, ice massage, relaxation methods) are very effective for mild-moderate pain control but are rarely effective for more severe pain.

8.

(T)F A spouse/parents or other family member’s presence may re-inforce a person’s non-coping behaviors, such as limping or grimacing.

9.

T (F) The person with pain should be encouraged to endure as much pain as possible before resorting to a pain relief measure.

10.

T (F) Children less than 11 years cannot report pain with reliability and therefore, the therapist should rely on the parent’s assessment of the child’s pain intensity.

11.

(T) F Based on one’s religious beliefs a person may think that pain and suffering is necessary.

12.

T (F) The person with pain should be advised to use non-drug techniques alone rather than concurrently with pain medications.

13.

T (F) In order to be effective, heat and cold should only be applied to the painful location.

14.

(T) F Being engaged in a purposeful activity may reduce a person’s perception of pain, for example cooking.

15.

(T) F Changing a person’s beliefs regarding pain may improve his/her coping skills.

True/False - Circle the Correct Answer

16. (T) F Malingering is uncommon among people suffering from chronic pain.
17. T (F) Relief following a placebo means the pain is "all in the person’s head".
18. T (F) A health care provider’s personal values/intuition are useful tools in determining whether a person is lying about his/her pain.
19. T (F) All "real" pain has an identifiable physical cause.
20. (T) F Depression is commonly associated with chronic pain.
21. T (F) The cause of chronic non-malignant pain is primarily psychological.
22. T (F) Acute and chronic pain require similar interventions.
23. (T) F Pain intensity can be reliably measured on a variety of numerical scales.
24. (T) F Under treated acute pain contributes to the onset of chronic pain.
25. (T) F Elderly people often suffer unnecessarily, presuming their pain is part of the aging process.
26. T (F) Elderly people are not good candidates for self-management programs for their pain.

Multiple Choice - Place a Check by the Correct Answer

27. The most likely explanation for why a person with pain would request increased doses of pain medication is:

__X__a. The person is experiencing increased pain.

____b. The person is experiencing increased anxiety or depression.

____ c. The person is requesting more staff attention.

____d. The person’s requests are related to addiction.

28. The most accurate judge of the intensity of the person’s pain is:

____a. The treating physician.

____b. The person’s primary nurse.

__X__ c. The person experiencing pain.

____d. The physical therapist.

____e. The occupational therapist.

 Multiple Choice - Place a Check by the Correct Answer

29. Which of the following describes the best approach for cultural considerations in caring for people in pain:

____ a. Because of diverse and mixed cultures in the United States, there are no longer cultural influences on the pain experience.

____ b. Therapists should use knowledge that has defined clearly the influence of pain on culture (e.g., Asian patients are generally stoic, Italians are expressive and exaggerate their pain.

_X___ c. People should be individually assessed to determine cultural influences on pain.

Circle the Correct Answer

30. Research has shown that the percentage of people who over report the amount of pain they experience are:

(less than 10%) 10-20% 20-40% 40-60% 60-80% 80-100%

31 Narcotic/opioid addiction is defined as psychological dependence accompanied by overwhelming concern with obtaining and using narcotics for psychic effect, not for medical reasons. It may occur with or without the physiological changes of tolerance to analgesia and physical dependence (withdrawal).

Using this definition, how likely is it that opioid addiction will occur as a result if treating pain with opioid analgesics? Circle the number closest to what you consider the correct answer.

(1-5% )10-25% 25-50% 50-75% 75-100%

Four case studies are presented. For each, you are asked to make decisions about the pain and the person’s motivation.

Directions: Please select one answer.

32. Case 1:

Stewart, a 12 year old boy with cerebral palsy, cries and complains about pain during his range of motion exercises in therapy. About 3 months ago, the clinic’s psychologist assessed Stewart as being depressed. You decide:

1. that Stewart’s pain is due to his depression and his pain complaints do not require any further intervention.

2. Ignoring Stewart’s pain complaint is the most appropriate strategy.

3. Stewart is complaining about pain in order to get sympathy and avoid doing the exercises.

X4. to assess Stewart’s pain using a visual analgue scale and to teach Stewart pain coping strategies.

33. Case 2:

Frank is 60 years old and this is his first day following total hip arthroplasty. As you enter his room, he smiles at you and continues talking and joking with his visitors. When asked to rate his pain on a scale of 0-10 (0 = no pain, 10 = worst pain) he rates his pain as 8.

A. Circle the number that represents your assessment of Frank’s pain.

0 1 2 3 4 5 6 7 8 9 10

No pain/discomfort                                                                                                Worst pain/discomfort

B. What other interpretations are most likely true about Frank’s behaviors on the first day following his surgery?

___ 1) He has much less pain than he reports and he is medication seeking.

___ 2) He is distracted by his visitors and misrepresents his pain.

_X__ 3) He is using distraction effectively to deal with his pain.

___ 4) He is in denial about his illness.

Directions: Please select one answer.

34. Case 3:

Lisa is a 22 year old college athlete who had a car accident 8 months ago in which she sustained fractures to right tib/fib, clavicle and multiple facial lacerations. Her physician reports her fractures are healed and she is cleared for full weightbearing on both upper and lower extremity. Lisa is currently completing her college degree, but reports that because of the pain she is constantly tired and unable to be involved in any social campus life. She appears anxious as she ambulates into your office with a single crutch and an extremely guarded gait. She reports her pain as 9 on a 0-10 visual analogue scale. To begin your intervention you:

___ 1) Complete the subjective part of the evaluation and request further consultation with the physician prior to completing the objective testing.

___ 2) Ignore her pain complaints, complete your assessment and set up a stress loading program for increasing weight bearing.

___ 3) Decide to focus on treating her pain before you can completely assess her or address her functional deficits.

_X_ 4) Offer Lisa a thermal modality and complete your assessment, beginning to instruct her in self management of pain.

35. Case 4:

Scott is a 49 year old former truck driver with a 15 year history of low back pain. He has had multiple laminectomies with subsequent rehabilitation in the past, and has completed vocational retraining. He last worked 4 months ago as a VCR repairman which was a job he held for less than a year. He is currently on workman’s compensation for a lifting injury sustained on that job. You observe Scott sitting comfortably in the waiting room reading but when you call him he grimaces, struggles to his feet and limps into the treatment area. Based on your observations, you surmise Scott:

___ 1) is in severe pain from sitting too long in the waiting room.

___ 2) is a symptom magnifier and is likely his pain will be out of proportion to his physical findings.

___ 3) is a malingerer and is faking his pain to get higher benefits.

_X_ 4) will need a thorough evaluation given his complex history of multiple injuries and treatments.