UNDERSTANDING THE CHRONIC PAIN REPORT

PAIN RATING INDEX

Pain is a personal, subjective experience that is influenced by cultural learning, the meaning of the situation, the attention of the patient, and other psychological values. Because pain is subjective, the patient's "self report" provides the MOST valid measure of this experience.

There are three major psychological dimensions of pain:

1. Sensory-Discrimitive
2. Motivational-Affective
3. Cognitive-Evaluative

The Pain Questionnaire's (PQ) data obtained by the patient's own "self report" provides information on the Sensory, Affective, and overall intensity of Pain and is useful in discriminating among different pain syndromes. For instance, differing descriptions of the "burning" pain after peripheral nerve injuries versus the "stabbing - cramping" quality of visceral pain. There is remarkable consistency in the choice of words used by patients suffering the same or similar pain syndromes.

The Pain Rating Index (PRI) of the PQ is based upon ranked values of similar words to describe pain. The ranked values of the words chosen by the patient are summed to obtain a score separately for the Sensory, Affective, Evaluative, and Miscellaneous aspects of pain, in addition to providing a total score. The PRI can be obtained both before and after each therapeutic session in a pain clinic, to document pain change. It is evident that this decriptive capacity of the PQ has limits. High levels of anxiety and other psychological disturbances that may produce a high Affective score, can obscure some discriminative capacity; however the PQ still retains good discriminative function even at high levels of anxiety. It is important to note that the PRI will only be obtained if the PATIENT is answering the questions. It will not be obtained by a NON-PATIENT being asked the questions, even if the patient is also present. No attempt has been made by the Cortex System to interpret these obtained values but only to tabulate and report these values to the medical practitioner. Further information on PRI can be obtained by referring to Dr. Ron Melzack's textbook of "PAIN".

SUICIDE RISK

The CARES Suicide Risk is asked to chronic pain patients in an attempt to address the increased risk of depression and suicide in this patient population. These questions will only be asked if the PATIENT is answering the questions. Clinical judgment should be given precedence over this scale.

ACCURATE
The Cortex System™ utilizes patient-computer interaction using state-of-art touch screen or light-pen technology to obtain a detailed history through "branching tree" questions.

The FIRST part is a patient history questionnaire which leads the patient through questions with each answer triggering other questions. Critical information is requested in similar questions in an attempt to gather an accurate and consistent patient history. Each question is individualized for each patient, based on their age, sex, race, and other factors that contribute to differences in health status. It has been shown that patients interacting with a computer, answer questions more truthfully than they do when they are responding to an interviewer.

Patient history is easily obtained through interactive questions. The patient is actively involved, increasing the accuracy of the information and the efficiency of the interview.

In the future, the Cortex System will recommend pre-op lab work, calculate fluid requirements, size endotracheal tubes, and figure common drug dosages, all based upon the results of the questionaire.

EDUCATIONAL
The SECOND part of the Cortex System has five different audio/visual slide shows including a history of anesthesia, a child's steps through the process of anesthesia, and answers to common questions concerning anesthesia. Patients understand computer instructions much better than written or verbal. They also enjoy the interaction with the computer and retain the information they've been given. A better educated patient increases the safety of surgery.

EFFICIENT
You will enjoy the speed and efficiency the Cortex System offers. You can decrease the time it takes to have pre-anesthesia interviews as well as increase your patients' knowledge and information.

Every member of your group will benefit from the Cortex System. From standardizing the quality and accuracy of patient histories to decrease the time per patient obtaining the information, your practice will see a difference in patient care. See that difference in your practice's bottom line.

FLEXIBLE
The Cortex System program introduction can be personalized for you, your group, or hospital setting. Both questions and answers can be added, deleted, and/or modified based on your needs. Updates, such as other languages, voice activation, auto faxed from surgeons' offices, etc., are included with program leases.

You will be up and running in no time.