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Information on the current condition;

  • mechanism of injury
  • location of injury
  • location, quality and level of pain
  • duration of condition
  • severity of condition
  • aggravating/easing factors
  • 24hour pattern

Any relevant past medical history; allow the patient to disclose as much as they want and have some guiding questions if you require further information.

Information on drug use currently or in the past; is the patient currently on any medication for other conditions or have they in the past i.e steroid use

Information on the social factors surrounding the patient; work, family, home life, living situation, religious beliefs, hobbies ect.

A chart for the patients or clinician to mark the areas of the body where the condition/pain is currently located.

  • Unhelpful beliefs about pain: injury is uncontrollable or likely to worsen.
  • Expectations of poor treatment outcome, delayed return to work.
  • Distress not meeting criteria for diagnosis of mental disorder.
  • Worry, fears, anxiety.
  • Avoidance of activities due to expectations of pain and possible reinjury.
  • Over-reliance on passive treatments.

Signs of serious pathology : Cauda equina syndrome, fracture, tumour, unremitting night pain, sudden weight loss of 10pounds over 3 months, bladder & bowel incontinence, previous history of cancer, saddle anaesthesia,

What are the patients beliefs about pain, injury, tissue damage, role of treatment ect.

What the patients are expecting from the meeting/consultation/treatment; duration, contents, results.