Psychological and Disability
Testing in Chronic Pain
Patients
Psychological testing will not supplant the need for professional
evaluation of the chronic pain patient, therefore the physician
referring patients for psychological testing
Testing in Chronic Pain
Patients
Psychological testing will not supplant the need for professional
evaluation of the chronic pain patient, therefore the physician
referring patients for psychological testing
should not be willing to accept a psychological test as ultimately diagnostic without a
psychologist/psychiatrist evaluation. The vast majority of chronic pain patients will have some
psychological disorder, often of a major caliber, but the nuances of certain disorders, such as
personality disorders, may be missed on psychological testing.
Anxiety disorders predominate in acute pain while depression predominates in chronic pain,
however one study found every scale of the SCL-90 in chronic pain patients vs controls,
demonstrated very significant differences. ( http://www.ams.ac.ir/AIM/0362/0362091.htm).
Psychological testing in pain patients are useful for 1. initial evaluation as to baseline status
2. estimate propensity for substance abuse 3. trending of psychological variables during
treatment and
4. pre neuromodulation implant evaluation. Unfortunately, most useful psychological
evaluations are laborious and require a test which needs interpretation at least by computer.
Therefore the most useful tests are the most comprehensive and include the MMPI or MMPI-2,
BHI-2, SCL-90-R. Although the most validated, the MMPI tests are very time consuming and
require up to 4 hours for pain patients to complete. Therefore it may be more appropriate to
limit the MMPI and MMPI-2 to cases involving pre-evaluation of neuromodulation implanted
devices in conjunction with a psychologist's evaluation. They are not practical to administer
in a chronic pain physicians office setting.
The SCL-90-R is a widely used test with validation for pain and non-pain patients alike. It
can be used to differentiate those who are fabricating symptoms from those with real
symptoms. Each of the items is rated on a five-point scale of distress (0-4) ranging from "not
at all" to "extremely." The nine primary symptom dimensions are labeled as: somatization
(SOM); obsessive-compulsive (O-C); interpersonal sensitivity (I-S); depression (DEP); anxiety
(ANX); hostility (HOS); phobic anxiety (PHOB); paranoid ideation (PAR); and psychoticism
(PSY). There are three global indices as well: global severity index (GSI); positive symptom
distress index (PSDI); and positive symptom total (PST). High test-retest and internal
consistency have been demonstrated, and there do not appear to be any problems with the
practice effect.
The SCL-90 has questions involving sexual activity and "pain killers" while the revised version
(SCL-90-R) substitutes questions relating to physical activity and effect of pain on activity. Chronic
pain patients should probably have the SCL-90-R version of the test. The SCL-90-R requires
approximately 15 minutes to complete. The test may be mailed in or scored with in-office computer
software available for a yearly license fee. The tests themselves cost about $11-14 for scoring plus
test sheets. Info on the SCL-90-R test and fees may be found here.
The McGill Pain Inventory is a validated test useful to evaluate chronic pain patients levels of pain,
sensory and affective components of pain. It is best used as an evaluation of interventional
treatment and for trending. The McGill short form and interpretation is available on this website as a
downloadable pdf file.
SF-36 and its ever expanding variants, the Rand 36 (identical questions to the SF-36 but with
different scoring algorithm), SF-12, etc basically measure a set of scales of physical health and of
mental health. There are several subscales in each. Because of the complexity of the scoring
calculations, it is only feasible to use computer calculations with the test. The SF-36 test information
and contact information regarding obtaining the tests and costs is located here.
An example test for the SF-36 without scoring calculations is located here. The SF-36 is well
validated for chronic pain patients, although the newer version have multiple answers rather than only
2 answers, and require more time to complete, yet yield more information theoretically.
The BHI 2 (Battery for Health Improvement) is the second version of an already good test that
represents a comprehensive alternative to the MMPI for office adminstration. The time to take the
test is usually about 30-45 min for the 217 questions. There are multiple useful physical and
psychological scales with norms for chronic pain patients standardized (rare in psych testing). The
test also is useful in ruling out somatization disorders. There is a fax in service available or for
those with computer skills, a Q scoring on site program. The test cost is about $27-30 for an
individual test. One may find ordering and pricing information here.
Disability and functional deficit testing may be accomplished via the Oswestry or Roland Morris
tests included as a downloadable test on this site. There is also a Neck Disability evaluation which
is basically scored like the oswestry. The Oswestry and Roland Morris are standard tests used in
pain management, may be useful in tracking treatment outcomes, and are widely accepted in the
pain management community.
Finally, the standard Beck Depression Scale is included as a downloadable patient form on this
site. Although the more general psych testing will pick up significant depression, in lieu of those
tests one may grade the depression level through the Beck Depression test.
psychologist/psychiatrist evaluation. The vast majority of chronic pain patients will have some
psychological disorder, often of a major caliber, but the nuances of certain disorders, such as
personality disorders, may be missed on psychological testing.
Anxiety disorders predominate in acute pain while depression predominates in chronic pain,
however one study found every scale of the SCL-90 in chronic pain patients vs controls,
demonstrated very significant differences. ( http://www.ams.ac.ir/AIM/0362/0362091.htm).
Psychological testing in pain patients are useful for 1. initial evaluation as to baseline status
2. estimate propensity for substance abuse 3. trending of psychological variables during
treatment and
4. pre neuromodulation implant evaluation. Unfortunately, most useful psychological
evaluations are laborious and require a test which needs interpretation at least by computer.
Therefore the most useful tests are the most comprehensive and include the MMPI or MMPI-2,
BHI-2, SCL-90-R. Although the most validated, the MMPI tests are very time consuming and
require up to 4 hours for pain patients to complete. Therefore it may be more appropriate to
limit the MMPI and MMPI-2 to cases involving pre-evaluation of neuromodulation implanted
devices in conjunction with a psychologist's evaluation. They are not practical to administer
in a chronic pain physicians office setting.
The SCL-90-R is a widely used test with validation for pain and non-pain patients alike. It
can be used to differentiate those who are fabricating symptoms from those with real
symptoms. Each of the items is rated on a five-point scale of distress (0-4) ranging from "not
at all" to "extremely." The nine primary symptom dimensions are labeled as: somatization
(SOM); obsessive-compulsive (O-C); interpersonal sensitivity (I-S); depression (DEP); anxiety
(ANX); hostility (HOS); phobic anxiety (PHOB); paranoid ideation (PAR); and psychoticism
(PSY). There are three global indices as well: global severity index (GSI); positive symptom
distress index (PSDI); and positive symptom total (PST). High test-retest and internal
consistency have been demonstrated, and there do not appear to be any problems with the
practice effect.
The SCL-90 has questions involving sexual activity and "pain killers" while the revised version
(SCL-90-R) substitutes questions relating to physical activity and effect of pain on activity. Chronic
pain patients should probably have the SCL-90-R version of the test. The SCL-90-R requires
approximately 15 minutes to complete. The test may be mailed in or scored with in-office computer
software available for a yearly license fee. The tests themselves cost about $11-14 for scoring plus
test sheets. Info on the SCL-90-R test and fees may be found here.
The McGill Pain Inventory is a validated test useful to evaluate chronic pain patients levels of pain,
sensory and affective components of pain. It is best used as an evaluation of interventional
treatment and for trending. The McGill short form and interpretation is available on this website as a
downloadable pdf file.
SF-36 and its ever expanding variants, the Rand 36 (identical questions to the SF-36 but with
different scoring algorithm), SF-12, etc basically measure a set of scales of physical health and of
mental health. There are several subscales in each. Because of the complexity of the scoring
calculations, it is only feasible to use computer calculations with the test. The SF-36 test information
and contact information regarding obtaining the tests and costs is located here.
An example test for the SF-36 without scoring calculations is located here. The SF-36 is well
validated for chronic pain patients, although the newer version have multiple answers rather than only
2 answers, and require more time to complete, yet yield more information theoretically.
The BHI 2 (Battery for Health Improvement) is the second version of an already good test that
represents a comprehensive alternative to the MMPI for office adminstration. The time to take the
test is usually about 30-45 min for the 217 questions. There are multiple useful physical and
psychological scales with norms for chronic pain patients standardized (rare in psych testing). The
test also is useful in ruling out somatization disorders. There is a fax in service available or for
those with computer skills, a Q scoring on site program. The test cost is about $27-30 for an
individual test. One may find ordering and pricing information here.
Disability and functional deficit testing may be accomplished via the Oswestry or Roland Morris
tests included as a downloadable test on this site. There is also a Neck Disability evaluation which
is basically scored like the oswestry. The Oswestry and Roland Morris are standard tests used in
pain management, may be useful in tracking treatment outcomes, and are widely accepted in the
pain management community.
Finally, the standard Beck Depression Scale is included as a downloadable patient form on this
site. Although the more general psych testing will pick up significant depression, in lieu of those
tests one may grade the depression level through the Beck Depression test.