Since pelvic pain is such a complex condition, a multidimensional approach is essential to diagnose and treat it. However, traditional objective measures have their limitations when it comes to understanding the patient’s experience and the impact of their symptoms on daily life.
This is where using the SAD CLLIFSS acronym coined by Carolyn Vandyken and Antony Lo comes in 2019 comes into play and it is widely used in Carolyn’s courses at REFRAME REHAB.
The acronym stands for Stress, Anxiety/Depression, Castrophization, Low Self Efficacy, Low Positive Effect, Injustice, Fear, Shame/Self Compassion and Sensory-Motor Dysregulation. It represents a comprehensive set of self-reported measures designed specifically for psychosocial constructs that are part of a phenotypic understanding of nocioplastic pain.
We took a deep dive into the Central Sensitivity Index (CSI), one of the 8 questionnaires part of the SAD CLLIFSS framework, in our last article. This month we’ll take a closer look at the DASS Questionnaire, Insomnia Severity Index (ISI), and Fremantle Back Awareness Questionnaire (FreBAQ).
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DASS Questionnaire:
The Depression, Anxiety, and Stress Scale (DASS) is a 42-item self-report questionnaire designed to measure the negative emotional states of depression, anxiety, and tension/stress.
The DASS is divided into three subscales that each contain 14 items. Each item is scored from 0 (did not apply to me at all over the last week) to 3 (applied to me very much or most of the time over the past week).
The DASS is a useful tool for clinicians and researchers to assess the emotional states of individuals in a variety of settings.
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Insomnia Severity Index (ISI):
The Insomnia Severity Index is a brief instrument measuring a patient’s perception of his/her insomnia. It consists of 7 items assessing the severity of:
- sleep onset
- sleep maintenance
- early morning awakening problems
- sleep dissatisfaction
- interference of sleep difficulties with daytime functioning
- noticeability of sleep problems by others, and distress caused by sleep difficulties.
Each item is rated on a 0 (not at all) to 4 (very much) scale. Scores range from 0 to 28, with higher scores indicating more severe insomnia.
The ISI is used to quantify the patient’s perception of insomnia and to assess the efficacy of treatments for insomnia, both in research and in clinical practice.
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Fremantle Back Awareness Questionnaire (FreBAQ):
While the original version of the questionnaire (FreBAQ) was designed for people with back pain, the tool has been adapted for other areas of the body, including the pelvis.
The Fremantle Back Awareness Questionnaire is a 9-item self-report measure designed to assess body perception disturbance in people with chronic pain. Each item is rated on a 0 (never) to 5 (always) scale and higher scores indicate greater body perception disturbance.
It’s used in clinical settings to identify those with a disturbed body image due to chronic pain. In the context of pelvic health, therapists might use this questionnaire to better understand how pain is affecting a patient’s perception of their pelvic area.
As a healthcare professional treating patients in chronic pain, these questionnaires can provide valuable insights into a patient’s emotional state, sleep quality, and perception of their own body – all of which can play significant roles in the management and treatment of chronic pain conditions.
Here are two examples of how these questionnaires can help broaden the assessment of your clients.
Example 1: A 30-year-old female patient comes in complaining of chronic pelvic pain that’s been persistent for the past six months. The pain is significantly affecting her daily life and causing her distress.
As part of the initial assessment:
- The DASS questionnaire is administered to screen for symptoms of depression, anxiety, and stress that might be related to her chronic pain condition. The results show elevated scores in the anxiety and stress subscales. This indicates that her chronic pelvic pain might be causing significant emotional distress and these factors could be exacerbating her pain perception.
In this questionnaire, notice how often the subtasks ask about specific pelvic health issues including symptoms of urgency/frequency/IBS etc.
- The Insomnia Severity Index (ISI) is used to evaluate her sleep quality. The patient’s score suggests moderate insomnia, which may or may not be a symptom of her chronic pain but could also be contributing to her overall pain experience and affecting her recovery.
- The Fremantle Back Awareness Questionnaire is administered (in its adapted form for pelvic pain), which reveals that she has a high level of disturbance in body perception. This suggests she may benefit from treatments targeting body perception, such as pain neuroscience education and sensorimotor retraining.
With the information from these questionnaires, an integrated treatment plan can be developed that addresses not only the physical aspects of her pain but also the psychological and perceptual aspects.
Example 2: A 45-year-old male patient with a history of chronic prostatitis comes in with complaints of unrelenting pelvic pain. Despite numerous treatments, the pain persists and it’s affecting his work and personal life.
During his evaluation:
- The DASS questionnaire reveals high levels of depression and stress. This indicates the need to address these emotional states as part of a holistic pain management approach. A referral to a psychologist may be considered.
- The Insomnia Severity Index (ISI) reveals that the patient is experiencing severe insomnia. This could be contributing to the persistence of his pain and affecting his ability to cope. The patient might benefit from interventions aimed at improving sleep hygiene or perhaps even a referral to a sleep specialist.
- The Fremantle Back Awareness Questionnaire, in its adapted form for pelvic pain, shows a disturbed body perception. This suggests that therapies focusing on improving body awareness, such as mindfulness-based stress reduction or yoga, might be beneficial in his case.
In both cases, these assessments help create a more complete picture of the patient’s experience and guide the development of a tailored approach to the specific needs of the individual.