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 | Version: 0.1.0 | |||
| Active as of 2024-03-22 | Computable Name: mypainquestionnaire | |||
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.
| LinkId | Text | Cardinality | Type | Description & Constraints |
|---|---|---|---|---|
  mypainquestionnaire | 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. | Questionnaire | http://fhir.org/guides/cqf/cds4cpm/Questionnaire/mypain-questionnaire#0.1.0 | |
  1 | My Pain Location. We’d like to ask you a few questions about your pain and how it is affecting your life. Please describe the location(s) of any pain you have had in the past 7 days. Please select only one pain type per location. | 0..1 | group | |
  1.1 | Head. What type of HEAD pain? | 0..1 | choice | Options: 6 options |
| 1.2 | Neck. What type of NECK pain? | 0..1 | choice | Options: 6 options |
| 1.3 | Shoulders. What type of SHOULDERS pain? | 0..1 | choice | Options: 6 options |
| 1.4 | Arms. What type of ARMS pain? | 0..1 | choice | Options: 6 options |
| 1.5 | Upper Back. What type of UPPER BACK pain? | 0..1 | choice | Options: 6 options |
| 1.6 | Lower Back. What type of LOWER BACK pain? | 0..1 | choice | Options: 6 options |
| 1.7 | Hands. What type of HANDS pain? | 0..1 | choice | Options: 6 options |
| 1.8 | Abdomen. What type of ABDOMEN pain? | 0..1 | choice | Options: 6 options |
| 1.9 | Pelvis. What type of PELVIS pain? | 0..1 | choice | Options: 6 options |
| 1.10 | Hips. What type of HIPS pain? | 0..1 | choice | Options: 6 options |
| 1.11 | Upper Legs. What type of UPPER LEGS pain? | 0..1 | choice | Options: 6 options |
| 1.12 | Knees. What type of KNEES pain? | 0..1 | choice | Options: 6 options |
| 1.13 | Lower Legs. What type of LOWER LEGS pain? | 0..1 | choice | Options: 6 options |
| 1.14 | Feet. What type of FEET pain? | 0..1 | choice | Options: 6 options |
| 1.15 | Everywhere. What type of EVERYWHERE pain? | 0..1 | choice | Options: 6 options |
  1.16 | Other, please describe. Other, please describe | 0..1 | text | |
| 2 | My Pain Intensity. Thinking about your overall pain, in the past 7 days, please respond to the questions below: | 0..1 | group | |
| 2.1 | How intense was your pain at its worst? | 0..1 | choice | Options: 5 options |
| 2.2 | How intense was your average pain? | 0..1 | choice | Options: 5 options |
| 2.3 | What is your level of pain right now? | 0..1 | choice | Options: 5 options |
| 3 | My Pain Interference. Thinking about your overall pain, in the past 7 days, please respond to the questions below: | 0..1 | group | |
| 3.1 | How much did pain interfere with your day to day activities? | 0..1 | choice | Options: 5 options |
| 3.2 | How much did pain interfere with your work around the home? | 0..1 | choice | Options: 5 options |
| 3.3 | How much did pain interfere with your ability to participate in social activities? | 0..1 | choice | Options: 5 options |
| 3.4 | How much did pain interfere with your household chores? | 0..1 | choice | Options: 5 options |
| 4 | My Pain Interference. Thinking about your overall pain, in the past 7 days, please respond to the questions below: | 0..1 | group | |
| 4.1 | How much did pain interfere with the things you usually do for fun? | 0..1 | choice | Options: 5 options |
| 4.2 | How much did pain interfere with your enjoyment of social activities? | 0..1 | choice | Options: 5 options |
| 4.3 | How much did pain interfere with your enjoyment of life? | 0..1 | choice | Options: 5 options |
| 4.4 | How much did pain interfere with your family life? | 0..1 | choice | Options: 5 options |
 5 | About My Treatments. We’d like to know more about how you manage your pain and what has worked for you. When answering these questions, please <strong>focus on pain</strong> related to what brings you in for your upcoming medical visit. <br/><br/> These treatments are organized into sections by type: <br/> Basic therapies <br/>Mind-body therapies<br/>New therapies<br/>Non-prescription medicines <br/>Prescription medicines | 0..1 | display | |
| 6 | About My Treatments. What have you tried in the <strong>past 6 months</strong> to help you with your pain? Select all answers that apply. We also want to know if it worked for you. | 0..1 | group | |
| 6.1 | Exercises at home (such as those assigned by a therapist) or outside (such as walking, jogging, swimming). Did it work? | 0..1 | choice | Options: 3 options |
| 6.2 | Sleep positioners or devices (such as additional pillows, padding, etc.). Did it work? | 0..1 | choice | Options: 3 options |
| 6.3 | Stretching. Did it work? | 0..1 | choice | Options: 3 options |
| 6.4 | Weight loss or changes in your diet. Did it work? | 0..1 | choice | Options: 3 options |
| 6.5 | Setting and reaching activity goals. Did it work? | 0..1 | choice | Options: 3 options |
| 6.6 | Ice or Heat Therapy. Did it work? | 0..1 | choice | Options: 3 options |
| 6.7 | Physical Therapy. Did it work? | 0..1 | choice | Options: 3 options |
| 6.8 | Acupuncture. Did it work? | 0..1 | choice | Options: 3 options |
| 6.9 | Chiropractic treatment. Did it work? | 0..1 | choice | Options: 3 options |
| 6.10 | Other, please describe. Other, please describe | 0..1 | text | |
| 7 | About My Treatments. Have you used any of the following <strong>items you can buy without a prescription from your doctor</strong> to help with your pain in the <strong>last 6 months</strong> (select all that apply)? | 0..1 | group | |
| 7.1 | Pain relievers (such as Advil, Aleve, Aspirin, Ibuprofen, Motrin, Tylenol). Did it work? | 0..1 | choice | Options: 3 options |
| 7.2 | Herbal or nutritional pain relievers (such as ginseng or kava kava). Did it work? | 0..1 | choice | Options: 3 options |
| 7.3 | Cremes, lotions, gels or patches applied to the skin (for example BENGAY®, TIGER BALM® or BiOFREEZE®). Did it work? | 0..1 | choice | Options: 3 options |
| 7.4 | Other items you can buy without a prescription from your doctor, please describe. Other, please describe | 0..1 | text | |
| 8 | About My Treatments. Have you used any of the following <strong>prescription medications</strong> to help with your pain in the <strong>last 6 months</strong>? | 0..1 | group | |
| 8.1 | Opioid medications (such as hydrocodone, oxycodone, codeine, morphine and fentanyl). Did it work? | 0..1 | choice | Options: 3 options |
| 8.2 | Procedure or Injection (such as a shot to relieve inflammation). Did it work? | 0..1 | choice | Options: 3 options |
| 8.3 | Non-opioid medications as prescribed by a doctor (such as Celebrex or Cymbalta). Did it work? | 0..1 | choice | Options: 3 options |
| 8.4 | Medical marijuana. Did it work? | 0..1 | choice | Options: 3 options |
| 8.5 | Other, please describe. Other, please describe | 0..1 | text | |
| 9 | About My Treatments. Have you tried any of the following <strong>new therapies</strong> to help with your pain in the <strong>last 6 months</strong> (select all that apply)? | 0..1 | group | |
| 9.1 | Yoga. Did it work? | 0..1 | choice | Options: 3 options |
| 9.2 | Massage. Did it work? | 0..1 | choice | Options: 3 options |
| 9.3 | Meditation. Did it work? | 0..1 | choice | Options: 3 options |
| 9.4 | Relaxation or mindfulness-based training. Did it work? | 0..1 | choice | Options: 3 options |
| 9.5 | Group or individual therapy for pain. Did it work? | 0..1 | choice | Options: 3 options |
| 9.6 | Cognitive behavioral therapy. Did it work? | 0..1 | choice | Options: 3 options |
| 9.7 | Acceptance or commitment therapy. Did it work? | 0..1 | choice | Options: 3 options |
| 9.8 | Sleep management (such as a sleep study or CPAP). Did it work? | 0..1 | choice | Options: 3 options |
| 9.9 | Other, please describe. Other, please describe | 0..1 | text | |
| 10 | About My Treatments. Have you tried any of the following <strong>new therapies</strong> to help with your pain in the <strong>last 6 months</strong> (select all that apply)? | 0..1 | group | |
| 10.1 | Aromatherapy. Did it work? | 0..1 | choice | Options: 3 options |
| 10.2 | Crystals. Did it work? | 0..1 | choice | Options: 3 options |
| 10.3 | Essential oils. Did it work? | 0..1 | choice | Options: 3 options |
| 10.4 | CBD oil. Did it work? | 0..1 | choice | Options: 3 options |
| 10.5 | Music therapy. Did it work? | 0..1 | choice | Options: 3 options |
| 10.6 | Other, please describe. Other, please describe | 0..1 | text | |
| 11 | About My Goals. We’d like to know more about you and your goals. What are your most important activity goals? For example: I’d like to be able to walk without pain. | 0..1 | text | |
| 12 | About My Goals. What are the biggest barriers to achieving your activity goals? For example: I have a lot of stress from work which makes my pain worse. | 0..1 | text | |
| 13 | Managing Chronic Pain. Below is a link to a video produced by the American Chronic Pain Association about living with chronic pain. We’d like to suggest you watch the video to help you prepare for your upcoming visit. This video can help you prepare to ask questions that are important to you when you visit with your provider. <br/> <br/> <a id="replace" value="video"></a> | 0..1 | text | |
| 14 | Managing Chronic Pain. The website linked below provides some information from the U.S. Pain Foundation about the causes and diagnosis of pain in general, treatment options and self management and well-being when living with pain. This information can help you prepare to ask questions that are important to you when you visit with your provider.<br/> <br/> <img width="100%" src="https://uspainfoundation.org//wp-content/uploads/2017/07/Woman-holding-neck-1024x682.jpg"/> <a id="replace" value="pain-link"></a> | 0..1 | text | |
| 15 | MyPAIN Feedback. Please indicate your level of agreement with the following statement: | 0..1 | group | |
| 15.1 | Using the MyPAIN tool has helped me begin preparing for a conversation with my provider about managing my pain. | 0..1 | choice | Options: 5 options |
| 16 | MyPAIN Feedback. Do you have any other feedback or thoughts to share on your use of MyPAIN? | 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 1.5
Answer options for 1.6
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 1.12
Answer options for 1.13
Answer options for 1.14
Answer options for 1.15
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
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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 6.1
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Answer options for 6.3
Answer options for 6.4
Answer options for 6.5
Answer options for 6.6
Answer options for 6.7
Answer options for 6.8
Answer options for 6.9
Answer options for 7.1
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Answer options for 7.3
Answer options for 8.1
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Answer options for 8.3
Answer options for 8.4
Answer options for 9.1
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Answer options for 9.6
Answer options for 9.7
Answer options for 9.8
Answer options for 10.1
Answer options for 10.2
Answer options for 10.3
Answer options for 10.4
Answer options for 10.5
Answer options for 15.1
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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