TANNER BAILEY PAIN MANAGEMENT SHADOW
HEALTH FOCUSED EXAM- TRANSCRIPT
Introduction
This simulation replicates the structure and depth of the Shadow Health “Pain
Management” Focused Exam featuring digital standardized patient Tanner Bailey.
Domains evaluated include evidence-based pain assessment, therapeutic
communication, physical-exam technique, clinical reasoning for nociceptive vs.
neuropathic vs. nociplastic pain, medication reconciliation, patient education, and inter-
professional planning. All dialogue and clinical data are original and aligned with 2024
best-practice guidelines (APS, IASP, CDC).
SECTION 1 – Pre-Interaction & Pain History
Scenario Element:
Tanner Bailey, 28 y/o software engineer, presents to outpatient clinic with 3-week
history of “constant burning pain” across left scapula and lateral arm after a cycling fall.
Optimal Clinical Response:
“Good morning, Mr. Bailey. I’m [Name], the RN who’ll be working with you today. I’d like
to sit and talk about the pain you’ve been experiencing since your fall so we can create a
plan together. Is now a good time?”
Clinical Rationale:
• Opens with respectful introduction and obtains permission → builds therapeutic
alliance
• Immediately states purpose (pain history) to reduce anxiety and set agenda
Therapeutic Communication Principles:
• Person-centered language (“Mr. Bailey”)
• Collaborative wording (“together”)
• Clear, jargon-free speech
SECTION 2 – OLDCARTS + Pain Quality
Scenario Element:
Patient states, “It burns and shoots into my upper arm. Sometimes it feels like ants
crawling.”
pg. 1
, Optimal Clinical Response:
“I hear you describing burning, shooting, and crawling sensations. Using your own
words, can you rate the average pain 0–10, with 0 being no pain and 10 the worst you
could imagine?”
Clinical Rationale:
• Accepts patient’s descriptors without paraphrasing → validates experience
• Uses numeric rating scale (NRS) → valid, reliable metric for initial pain intensity
(APS, 2022)
Therapeutic Communication Principles:
• Active listening (repeats descriptors)
• Uses open-ended question
• Avoids leading (“Is it 8 out of 10?”)
SECTION 3 – Pain Mechanism Screen
Scenario Element:
Patient rates pain 7/10 average, 9/10 worst. Aggravating factors: typing >30 min, cold
air. Relieving factors: warm compress, gabapentin 300 mg at night.
Optimal Clinical Response:
“Thank you. To help us understand the type of pain, I’ll ask a few yes/no questions: Does
brushing light fabric across the skin cause pain? Do you notice swelling or color changes
in that shoulder?”
Clinical Rationale:
• Light-touch allodynia screen → suggests peripheral/central sensitization
(neuropathic component)
• Asks about autonomic signs → rules out complex regional pain syndrome (CRPS)
Therapeutic Communication Principles:
• Explains rationale before questioning → increases cooperation
• Yes/no format accommodates cognitive load when pain is high
SECTION 4 – Functional Impact & Mood
Scenario Element:
Patient volunteers, “I can’t code for long stretches. I’m worried this will affect my job.”
pg. 2
HEALTH FOCUSED EXAM- TRANSCRIPT
Introduction
This simulation replicates the structure and depth of the Shadow Health “Pain
Management” Focused Exam featuring digital standardized patient Tanner Bailey.
Domains evaluated include evidence-based pain assessment, therapeutic
communication, physical-exam technique, clinical reasoning for nociceptive vs.
neuropathic vs. nociplastic pain, medication reconciliation, patient education, and inter-
professional planning. All dialogue and clinical data are original and aligned with 2024
best-practice guidelines (APS, IASP, CDC).
SECTION 1 – Pre-Interaction & Pain History
Scenario Element:
Tanner Bailey, 28 y/o software engineer, presents to outpatient clinic with 3-week
history of “constant burning pain” across left scapula and lateral arm after a cycling fall.
Optimal Clinical Response:
“Good morning, Mr. Bailey. I’m [Name], the RN who’ll be working with you today. I’d like
to sit and talk about the pain you’ve been experiencing since your fall so we can create a
plan together. Is now a good time?”
Clinical Rationale:
• Opens with respectful introduction and obtains permission → builds therapeutic
alliance
• Immediately states purpose (pain history) to reduce anxiety and set agenda
Therapeutic Communication Principles:
• Person-centered language (“Mr. Bailey”)
• Collaborative wording (“together”)
• Clear, jargon-free speech
SECTION 2 – OLDCARTS + Pain Quality
Scenario Element:
Patient states, “It burns and shoots into my upper arm. Sometimes it feels like ants
crawling.”
pg. 1
, Optimal Clinical Response:
“I hear you describing burning, shooting, and crawling sensations. Using your own
words, can you rate the average pain 0–10, with 0 being no pain and 10 the worst you
could imagine?”
Clinical Rationale:
• Accepts patient’s descriptors without paraphrasing → validates experience
• Uses numeric rating scale (NRS) → valid, reliable metric for initial pain intensity
(APS, 2022)
Therapeutic Communication Principles:
• Active listening (repeats descriptors)
• Uses open-ended question
• Avoids leading (“Is it 8 out of 10?”)
SECTION 3 – Pain Mechanism Screen
Scenario Element:
Patient rates pain 7/10 average, 9/10 worst. Aggravating factors: typing >30 min, cold
air. Relieving factors: warm compress, gabapentin 300 mg at night.
Optimal Clinical Response:
“Thank you. To help us understand the type of pain, I’ll ask a few yes/no questions: Does
brushing light fabric across the skin cause pain? Do you notice swelling or color changes
in that shoulder?”
Clinical Rationale:
• Light-touch allodynia screen → suggests peripheral/central sensitization
(neuropathic component)
• Asks about autonomic signs → rules out complex regional pain syndrome (CRPS)
Therapeutic Communication Principles:
• Explains rationale before questioning → increases cooperation
• Yes/no format accommodates cognitive load when pain is high
SECTION 4 – Functional Impact & Mood
Scenario Element:
Patient volunteers, “I can’t code for long stretches. I’m worried this will affect my job.”
pg. 2
