Questionnaires on pain syndromes and mental health status

Musculoskeletal practitioners, such as physiotherapists, osteopaths, and chiropractors, often use specific questionnaires to assess both fibromyalgia and mental health conditions that can impact patients’ overall health and recovery. These tools help identify the extent of a patient’s physical and psychological symptoms, which is crucial for formulating comprehensive treatment plans.

1. Fibromyalgia Impact Questionnaire (FIQ)

The FIQ is the most commonly used tool for assessing the overall impact of fibromyalgia on a patient’s physical and psychological functioning.

• Use: It evaluates key areas such as pain, fatigue, sleep disturbance, depression, anxiety, and physical function.
• Scoring: Patients score on various items, and higher scores indicate greater disease burden and lower quality of life.
• Implications: The FIQ is essential for tracking the severity of fibromyalgia symptoms and guiding treatment (Bennett et al., 2009).

2. Hospital Anxiety and Depression Scale (HADS)

The HADS is used to screen for anxiety and depression in patients with chronic pain conditions, including fibromyalgia.

• Use: It assesses symptoms of anxiety and depression without confounding effects from physical illness.
• Scoring: The questionnaire includes 14 items—7 each for anxiety and depression—with scores ranging from 0 to 21 for each.
• Implications: Identifying anxiety and depression is crucial, as these mental health conditions can exacerbate pain and affect rehabilitation outcomes (Zigmond & Snaith, 1983).

3. Patient Health Questionnaire-9 (PHQ-9)

The PHQ-9 is a widely used screening tool for diagnosing and monitoring depression, which is common among patients with fibromyalgia and chronic pain.

• Use: Assesses the severity of depressive symptoms over the past two weeks.
• Scoring: Scores range from 0 (no depression) to 27 (severe depression), helping guide treatment options.
• Implications: Depression can worsen pain perception and treatment adherence in patients with chronic musculoskeletal conditions (Kroenke et al., 2001).

4. Generalized Anxiety Disorder-7 (GAD-7)

The GAD-7 is a brief tool used to assess anxiety in patients, often utilized in cases of fibromyalgia where anxiety frequently co-exists with chronic pain.

• Use: Measures anxiety levels, including worrying and nervousness.
• Scoring: Scores range from 0 to 21, with higher scores indicating more severe anxiety symptoms.
• Implications: Anxiety can affect pain perception and physical function, making it a critical factor to address in treatment (Spitzer et al., 2006).

5. Pain Catastrophizing Scale (PCS)

The PCS assesses exaggerated negative responses to pain, which is a common problem in patients with fibromyalgia and other chronic pain conditions.

• Use: Measures thoughts and feelings related to the experience of pain, such as rumination and helplessness.
• Scoring: Higher scores reflect greater catastrophizing, which is associated with worse pain outcomes.
• Implications: Patients with high levels of pain catastrophizing are at risk for more severe pain and disability, and they may require cognitive-behavioral interventions (Sullivan et al., 1995).

6. Beck Depression Inventory-II (BDI-II)

The BDI-II is a widely used tool to measure the severity of depression. Chronic pain patients, including those with fibromyalgia, frequently report mood disturbances, which can exacerbate their pain symptoms.

• Use: It evaluates symptoms such as sadness, hopelessness, and irritability.
• Scoring: Scores range from 0 to 63, with higher scores indicating more severe depressive symptoms.
• Implications: Effective management of depression is critical for improving the overall outcomes in musculoskeletal pain patients (Beck et al., 1996).

7. Chronic Pain Acceptance Questionnaire (CPAQ)

The CPAQ evaluates how well a patient accepts their chronic pain condition, which can be an essential factor in long-term recovery.

• Use: Measures pain acceptance and the ability to engage in life activities despite pain.
• Scoring: The score reflects the degree of pain acceptance, with higher scores indicating better acceptance and adaptation.
• Implications: Acceptance of chronic pain is associated with lower levels of pain-related distress and disability (McCracken et al., 2004).

Conclusion

Fibromyalgia and other mental health conditions, such as anxiety and depression, are common comorbidities in patients with musculoskeletal pain. Questionnaires such as the FIQ, PHQ-9, GAD-7, and PCS provide musculoskeletal practitioners with crucial information on both physical and psychological symptoms. This holistic approach is essential for delivering effective treatment and improving patient outcomes.

References:

• Bennett, R., Friend, R., Jones, K., Ward, R., Han, B. K., & Ross, R. L. (2009). The revised fibromyalgia impact questionnaire (FIQR): Validation and psychometric properties. Arthritis Research & Therapy, 11(4), R120.
• Beck, A. T., Steer, R. A., & Brown, G. K. (1996). Beck Depression Inventory-II. Psychological Corporation.
• Kroenke, K., Spitzer, R. L., & Williams, J. B. (2001). The PHQ-9: Validity of a brief depression severity measure. Journal of General Internal Medicine, 16(9), 606-613.
• McCracken, L. M., Vowles, K. E., & Eccleston, C. (2004). Acceptance of chronic pain: Component analysis and a revised assessment method. Pain, 107(1-2), 159-166.
• Spitzer, R. L., Kroenke, K., Williams, J. B., & Löwe, B. (2006). A brief measure for assessing generalized anxiety disorder: The GAD-7. Archives of Internal Medicine, 166(10), 1092-1097.
• Sullivan, M. J. L., Bishop, S. R., & Pivik, J. (1995). The Pain Catastrophizing Scale: Development and validation. Psychological Assessment, 7(4), 524-532.
• Zigmond, A. S., & Snaith, R. P. (1983). The hospital anxiety and depression scale. Acta Psychiatrica Scandinavica, 67(6), 361-370.