Home / Sample PainApp Summary Report

Summary for your provider     10/5/2018
Age: 71    Gender: Female

Overview: Chronic pain for 20 years // No opioid use // SUD// Moderate depression // PTSD/Family history of suicide///
Preferred decision-making role:

Goals for treatment
#1: Having a better quality of life
#2: Managing pain
#3: Physical abilities
Very important goals: have more energy and stamina, build more strength and flexibility, manage my pain so it does not control me, travel with more comfort, live independently, socialize with family and friends.
 Important goals: be more active, accept my limitations, help others or volunteer

Pain is nearly constant and not sure if it’s getting better or worse
Pain worsened by: sitting, motion, standing, fatigue
Pain improved by: ice, heat, rest, changing positions

Pain Severity: (0=none, 10=worst)
Current pain:8
Average pain:6
Worst pain:9
Least pain:4
Pain interferes with: (0 = not at all, 10= extremely)
General activity: 8
Mood: 8
Work: 7
Relations with others: 4
Sleep: 5
Enjoyment of life: 8

Sometimes needs help with: driving, household chores

OPIOID USE: No past opioid use
No current opioid use
Opioid risk: Moderate risk
Past treatment in drug or alcohol rehab facility

Interest in changing treatment? Yes.
Treatments that helped: Very helpful: Talk therapy, Physical therapy, Occupational therapy
Somewhat helpful: Acupuncture, Injections (for pain), Surgery (for pain)
Treatment failures: Not helpful: Dry needling
Harmful: None
Willing to try: Group counseling, Yoga, Tai chi, or Pilates
Not willing to try:

Not sure about trying:

MEDICAL HISTORY: Bowel problems,  Weakness-lower back, down my hips and legs Numbness or tingling-hands and feet
Prior surgery: None reported

PSYCHOLOGICAL HISTORY: Moderate depression (self-rated based on PHQ-9). Anxiety disorder likely (self-rated based on PHQ-2). Previously evaluated or treated for:  depression, PTSD (post traumatic stress disorder) Family history of suicide
Childhood abuse: yes
Health behaviors: No tobacco use / nondrinker / Exercise: 0 times per week
Perceived weight: Very overweight
Interested in changing now: exercise more, lose weight

Medication adherence: Always or nearly always takes prescription medications as prescribed

SOCIAL HISTORY: divorced, lives alone in single-floor house or apartment. disabled–unable to work

Corrections: I have in the past been prescribed opioids, morphine and fentanyl. I was on both these medications at the same time for about 2-3 years while living in xxx. I was very lucky in that I did not get addicted to the meds but I did go through a prescription med. withdrawal program in a rehabilitation setting. I was there for three weeks and had Prolonged Abstinence Syndrome for about 9 months. I had physical dependency but not emotional dependency or addiction to the opioids and regard myself profoundly lucky that this was the case.