Assessing psychosocial distress: a pain audit at IRCH-AIIMS

Recent work in palliative care has recognized that pain is a complex social, psychological, spiritual and psychological experience. In order to assess if each of these components is equally well addressed in clinical practice, we undertook a retrospective audit of psychosocial assessment procedures at the pain clinic at IRCH-AIIMS, New Delhi.

686 pain assessment forms collected over 2011 were examined and analysed through SPPS.

(I) While physical aspects of pain are recorded at almost 100% levels in the pain forms, psychosocial components of patient distress are found to be less adequately recorded; (II) The layout the assessment is slanted towards functional factors (such interference with daily activities and mobility), while non-functional symptoms are being recorded at relatively low levels (anxiety-1.2%, depression-4.4%). Prior studies in the same clinic as well as in the Indian psycho-oncology literature has shown that non-functional distress (such as anxiety and depression) are usually found at much higher rates of incidence (33-80%); (III) Analysis of the existing data revealed severe demographic vulnerabilities in our patient sample, an aspect that is recorded but not currently addressed as part of a psychosocial assessment.

In light of these findings we surveyed 14 existing pain assessment tools, and chose two for incorporation into our existing pain practice. These tools were the Distress Inventory for Cancer-2 and the American Pain Society Patient Outcome Questionnaire. They were chosen for their balance between functional and non-functional symptoms, sensitivity to socioeconomic distress and ease of completion in the high volume public health scenario.