Clinical Decision Support for Chronic Pain Management and Shared Decision-Making IG
0.1.0 - CI Build
Clinical Decision Support for Chronic Pain Management and Shared Decision-Making IG
0.1.0 - CI Build
Clinical Decision Support for Chronic Pain Management and Shared Decision-Making IG, published by CQF. This guide is not an authorized publication; it is the continuous build for version 0.1.0 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/cqframework/cds4cpm/ and changes regularly. See the Directory of published versions
| Official URL: http://fhir.org/guides/cqf/cds4cpm/Questionnaire/mypain-questionnaire-ufl | Version: 0.1.0 | |||
| Active as of 2024-03-22 | Computable Name: mypainquestionnaireufl | |||
A questionnaire to use with the MyPAIN application for a patient to assess their pain levels, locations, and treatments for use in consultation with a clinician to determine further treatments. Created for UFL pilot.
| LinkId | Text | Cardinality | Type | Description & Constraints |
|---|---|---|---|---|
  mypainquestionnaireufl | A questionnaire to use with the MyPAIN application for a patient to assess their pain levels, locations, and treatments for use in consultation with a clinician to determine further treatments. Created for UFL pilot. | Questionnaire | http://fhir.org/guides/cqf/cds4cpm/Questionnaire/mypain-questionnaire-ufl#0.1.0 | |
  1 | My Pain Location. <strong>Where</strong> is the pain you would like to discuss? | 0..1 | group | |
  1.1 | Head. What does it feel like? | 0..1 | choice | Options: 6 options |
| 1.2 | Neck. What does it feel like? | 0..1 | choice | Options: 6 options |
| 1.3 | Shoulders. What does it feel like? | 0..1 | choice | Options: 6 options |
| 1.4 | Arms. What does it feel like? | 0..1 | choice | Options: 6 options |
| 1.6 | Back. What does it feel like? | 0..1 | choice | Options: 6 options |
| 1.5 | Hands/Wrist. What does it feel like? | 0..1 | choice | Options: 6 options |
| 1.7 | Abdomen/Pelvis. What does it feel like? | 0..1 | choice | Options: 6 options |
| 1.8 | Hips. What does it feel like? | 0..1 | choice | Options: 6 options |
| 1.9 | Knees. What does it feel like? | 0..1 | choice | Options: 6 options |
| 1.10 | Feet/Ankles. What does it feel like? | 0..1 | choice | Options: 6 options |
| 1.11 | Everywhere. What does it feel like? | 0..1 | choice | Options: 6 options |
  1.12 | Other, please describe. Other, please describe | 0..1 | text | |
| 2 | My Pain Intensity. Over the past 7 days... | 0..1 | group | |
| 2.1 | How intense was your <strong>pain at its worst</strong>? | 0..1 | choice | Options: 5 options |
| 2.2 | How intense was your <strong>average pain</strong>? | 0..1 | choice | Options: 5 options |
| 2.3 | What is your level of <strong>pain right now</strong>? | 0..1 | choice | Options: 5 options |
| 3 | My Pain Interference. Over the past 7 days... | 0..1 | group | |
| 3.1 | How much did pain interfere with your <strong>day to day activities</strong>? | 0..1 | choice | Options: 5 options |
| 3.2 | How much did pain interfere with your <strong>work around the home</strong>? | 0..1 | choice | Options: 5 options |
| 3.3 | How much did pain interfere with your <strong>ability to participate in social activities</strong>? | 0..1 | choice | Options: 5 options |
| 3.4 | How much did pain interfere with your <strong>household chores</strong>? | 0..1 | choice | Options: 5 options |
| 4 | My Pain Interference. Over the past 7 days... | 0..1 | group | |
| 4.1 | How much did pain <em>interfere</em> with <strong>things you usually do for fun</strong>? | 0..1 | choice | Options: 5 options |
| 4.2 | How much did pain <em>interfere</em> with your <strong>enjoyment of social activities</strong>? | 0..1 | choice | Options: 5 options |
| 4.3 | How much did pain <em>interfere</em> with your <strong>enjoyment of life</strong>? | 0..1 | choice | Options: 5 options |
| 4.4 | How much did pain <em>interfere</em> with your <strong>family life</strong>? | 0..1 | choice | Options: 5 options |
| 5 | About My Treatments. What <strong>medications</strong> have you tried for pain? | 0..1 | group | |
| 5.1 | <strong>Over-the-counter</strong> pain reliever (such as Advil, Aleve, Aspirin, Ibuprofen, Motrin, or Tylenol). Did it work? | 0..1 | open-choice | Options: 4 options |
| 5.2 | <strong>Prescription nonsteroidal anti-inflammatory</strong> (such as Celebrex). Did it work? | 0..1 | open-choice | Options: 4 options |
| 5.3 | <strong>Prescription nerve pain</strong> medication (such as Lyrica, Neurontin, or Cymbalta). Did it work? | 0..1 | open-choice | Options: 4 options |
| 5.4 | <strong>Prescription muscle relaxant</strong> (such as Soma or Baclofen). Did it work? | 0..1 | open-choice | Options: 4 options |
| 5.5 | <strong>Prescription opioid</strong> medication (such as Vicodin, hydrocodone, oxycodone, codeine, morphine, or tramadol). Did it work? | 0..1 | open-choice | Options: 4 options |
| 5.6 | <strong>Other</strong>: describe other medications you've tried for pain. Other: describe other medications you've tried for pain | 0..1 | text | |
 5.7 | I haven't tried any medications for pain.. <strong>I haven't tried any medications for pain.</strong> | 0..1 | boolean | |
| 6 | About My Treatments. What <strong>specialists</strong> have you seen for pain? | 0..1 | group | |
| 6.1 | <strong>Chiropractor</strong>. Did it work? | 0..1 | open-choice | Options: 4 options |
| 6.2 | <strong>Physical therapist</strong>. Did it work? | 0..1 | open-choice | Options: 4 options |
| 6.3 | <strong>Pain management specialist</strong>. Did it work? | 0..1 | open-choice | Options: 4 options |
| 6.4 | <strong>Orthopedist</strong>. Did it work? | 0..1 | open-choice | Options: 4 options |
| 6.5 | <strong>Psychologist</strong> or <strong>counselor</strong> (such as for group or individual therapy, acceptance & commitment therapy, cognitive behavior therapy). Did it work? | 0..1 | open-choice | Options: 4 options |
| 6.6 | <strong>Integrative medicine specialist</strong>. Did it work? | 0..1 | open-choice | Options: 4 options |
| 6.7 | <strong>Other</strong>: describe other specialists you have seen for pain (such as neurologist, spine doctor rheumatologist, or physiatrist). <strong>Other</strong>: describe other specialists you have seen for pain (such as neurologist, spine doctor rheumatologist, or physiatrist) | 0..1 | text | |
| 6.8 | I haven't seen any specialists for pain. <strong>I haven't seen any specialists for pain.</strong> | 0..1 | boolean | |
| 7 | About My Treatments. What <strong>procedures</strong> or <strong>physical treatments</strong> have you tried for pain? | 0..1 | group | |
| 7.1 | <strong>Surgery</strong>. Did it work? | 0..1 | open-choice | Options: 4 options |
| 7.2 | <strong>Injection</strong> (such as a shot to relieve inflammation). Did it work? | 0..1 | open-choice | Options: 4 options |
| 7.3 | <strong>Massage</strong>. Did it work? | 0..1 | open-choice | Options: 4 options |
| 7.4 | <strong>Dry needling</strong> or <strong>cupping</strong>. Did it work? | 0..1 | open-choice | Options: 4 options |
| 7.5 | <strong>Acupuncture</strong>. Did it work? | 0..1 | open-choice | Options: 4 options |
| 7.6 | <strong>Other</strong>: describe other procedures or physical treatments you've tried for pain. Other, please describe | 0..1 | text | |
| 7.7 | I haven't tried any procedures or physical treatments for pain.. <strong>I haven't tried any procedures or physical treatments for pain.</strong> | 0..1 | boolean | |
| 8 | About My Treatments. What <strong>topical treatments</strong> or <strong>devices</strong> have you tried for pain? | 0..1 | group | |
| 8.1 | <strong>Heat</strong> and/or <strong>ice</strong>. Did it work? | 0..1 | open-choice | Options: 4 options |
| 8.2 | <strong>Topical medications</strong> (such as creams, lotions, gel, patches, Bengay, Tiger Balm, Salonpas, Biofreeze, or Lidoderm). Did it work? | 0..1 | open-choice | Options: 4 options |
| 8.3 | <strong>TENs unit</strong> device. Did it work? | 0..1 | open-choice | Options: 4 options |
| 8.4 | <strong>Bracing</strong>. Did it work? | 0..1 | open-choice | Options: 4 options |
| 8.5 | <strong>Other</strong>: describe other topical treatments or devices you've tried for pain. <strong>Other</strong>: describe other topical treatments or devices you've tried for pain | 0..1 | text | |
| 8.6 | I haven't tried any topical treatments or devices for pain.. <strong>I haven't tried any topical treatments or devices for pain.</strong> | 0..1 | boolean | |
| 9 | About My Treatments. What <strong>lifestyle changes</strong> have you tried for pain? | 0..1 | group | |
| 9.1 | <strong>Exercises</strong> or </strong>stretching</strong> (such as walking, yoga, water aerobics). Did it work? | 0..1 | open-choice | Options: 4 options |
| 9.2 | <strong>Diet</strong> or <strong>hydration</strong> (such as an anti-inflammatory diet or drinking enough water). Did it work? | 0..1 | open-choice | Options: 4 options |
| 9.3 | <strong>Weight loss</strong>. Did it work? | 0..1 | open-choice | Options: 4 options |
| 9.4 | <strong>Stress reduction</strong> (such as relaxation, meditation, mindfulness, laughter). Did it work? | 0..1 | open-choice | Options: 4 options |
| 9.5 | <strong>Posture</strong> or <strong>ergonomics</strong>. Did it work? | 0..1 | open-choice | Options: 4 options |
| 9.6 | <strong>Other</strong>: describe other lifestyle changes you've tried for pain . <strong>Other</strong>: describe other lifestyle changes you've tried for pain | 0..1 | text | |
| 9.7 | I haven't tried any lifestyle changes for pain.. <strong>I haven't tried any lifestyle changes for pain.</strong> | 0..1 | boolean | |
| 10 | About My Treatments. What <strong>alternative treatments</strong> have you tried for pain? | 0..1 | group | |
| 10.1 | <strong>Herbal treatments or supplements</strong> (such as ginseng or kava kava). Did it work? | 0..1 | open-choice | Options: 4 options |
| 10.2 | <strong>Aromatherapy</strong>. Did it work? | 0..1 | open-choice | Options: 4 options |
| 10.3 | <strong>CBD oil</strong>. Did it work? | 0..1 | open-choice | Options: 4 options |
| 10.4 | <strong>Marijuana</strong> used for medical purposes. Did it work? | 0..1 | open-choice | Options: 4 options |
| 10.5 | <strong>Other</strong>: describe other alternative treatments you've tried for pain. <strong>Other</strong>: describe other alternative treatments you've tried for pain | 0..1 | text | |
| 10.6 | I haven't tried any alternative treatments for pain. <strong>I haven't tried any alternative treatments for pain</strong> | 0..1 | boolean | |
| 11 | About My Goals. <strong>Activity Goals</strong>: what goals do you have for your daily activities?<br/><br/>Examples: <em>I want to walk my dog daily. I want to continue to play guitar with my son.</em> | 0..1 | text | |
| 12 | About My Goals. <strong>Activity Barriers</strong>: what are the biggest barriers to achieving your daily activity goals?<br/><br/>Example: <em>I have a lot of stress from work that makes my pain worse.</em> | 0..1 | text | |
| Documentation for this format | ||||
Option Sets
Answer options for 1.1
Answer options for 1.2
Answer options for 1.3
Answer options for 1.4
Answer options for 1.6
Answer options for 1.5
Answer options for 1.7
Answer options for 1.8
Answer options for 1.9
Answer options for 1.10
Answer options for 1.11
Answer options for 2.1
Answer options for 2.2
Answer options for 2.3
Answer options for 3.1
Answer options for 3.2
Answer options for 3.3
Answer options for 3.4
Answer options for 4.1
Answer options for 4.2
Answer options for 4.3
Answer options for 4.4
Answer options for 5.1
Answer options for 5.2
Answer options for 5.3
Answer options for 5.4
Answer options for 5.5
Answer options for 6.1
Answer options for 6.2
Answer options for 6.3
Answer options for 6.4
Answer options for 6.5
Answer options for 6.6
Answer options for 7.1
Answer options for 7.2
Answer options for 7.3
Answer options for 7.4
Answer options for 7.5
Answer options for 8.1
Answer options for 8.2
Answer options for 8.3
Answer options for 8.4
Answer options for 9.1
Answer options for 9.2
Answer options for 9.3
Answer options for 9.4
Answer options for 9.5
Answer options for 10.1
Answer options for 10.2
Answer options for 10.3
Answer options for 10.4
IG © 2019+ CQF. Package cqf.fhir.cds4cpm#0.1.0 based on FHIR 4.0.1. Generated 2024-03-22
Links: Table of Contents |
QA Report
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