Friday, September 01, 2006

Measuring Pain

Perhaps the most obvious approach to measuring people's pain is to ask them to describe their discomfort, either in their own words or by filling out a rating scale or questionnaire. In treating a patient's pain, health care workers ask where the pain is, what it feels like, how strong it is, and when it tends to occur. With chronic pain patients, medical and psychological professionals often incorporate this kind of questioning within the structure of a clinical interview.

Point 3: Interviews

To measure chronic pain effectively, professionals need more information than just a description of the pain. Interviews with the patient and key others, such as family members and co-workers, provide a rich source of background information in the early phases of treatment. These discussions ordinarily focus on such issues as:

  • History of the pain problem, including when it started, how it progressed, and what approaches have been used for controlling it.
  • The patient's emotional adjustment, currently and before the pain syndrome began.
  • The patient's lifestyle—recreational interests, exercise patterns, diet, and so on—before the pain condition began.
  • The pain syndrome's impact on the patient's current lifestyle, interpersonal relations, and work.
  • The social context of pain episodes, such as happenings in the family before an attack and how family members respond when the pain occurs.
  • Factors that seem to trigger attacks or make them worse.
  • How the patient typically tries to cope with the pain.

(Sarafino, 1994)

Point 4: Rating Scales

One of the most direct, simple, and commonly used ways to assess pain is to have individuals rate some aspect of their discomfort on a scale (Chapman et al., 1985; Jensen et al., 1989; Karoly, 1985). One type is the visual analog scale, which has people rate their pain by marking a point on a line that has labels only at each end. This type of scale is very easy for people to use and can be used with children as young as 5 years of age (Karoly, 1985).

No pain ----------------------------------------------------------- Worst pain possible

The box scale has individuals choose one number from a series of numbers that represent levels of pain within a specified range. The verbal rating scale has people describe their pain by choosing a word or phrase from several that are given.

No Pain 1 2 3 4 5 6 7 8 9 10 Worst pain possible

Because rating scales are so easy and quick to use, people can rate their pain frequently. Repeated ratings would reveal how their pain changed over time, such as during everyday activities or during the ourse of an experiment. As an example, Dennis Turk and his colleagues have described how this approach can be used with chronic pain patients (Turk, Meichenbaum, & Genest, 1983). Each hour of a day the patients rate their pain on index cards, which have separate scales for each hour. They do this for, say, 2 weeks, also indicating whenever they take pain medication. Before starting this procedure, they leam what to say if someone sees them filling out the card and asks what they are doing, ways to remind themselves to do each hourly rating, and what to do if they forget. One use of repeated ratings is in showing the ebbs and flows of pain intensity that patients often experience.

Point 5: Behavioural Assessment

Because people tend to exhibit pain behaviors when they are in discomfort, it should be possible to assess their pain by observing their behavior.

Procedures are available whereby health care workers can assess the pain behavior of patients in structured clinical sessions. These sessions are usually conducted in hospital settings and are structured by the specific pain behaviors to be assessed and the tasks the patient is asked to perform. One approach of this kind has been developed into a pain assessment instrument—the UAB Pain Behavior Scale—for use by nurses during their standard routines, such as in early morning rounds (Richards, Nepomuceno, Riles, & Suer, 1982). The nurse has the patient perform several activities and rates each of 10 behaviors, such as ie patient's mobility and use of medication, on a three-point scale: "none," "occasional," and "frequent." These ratings are converted into numerical values and summed for a total score.

Assessing Pain Behavior in Everyday Activities: Family members or key others in the patient's life are usually the best people to make these everyday assessments of pain behavior. These people must,ph of course, be willing to help and be trained to make careful observations and keep accurate records. Pain researcher Wilbert Fordyce (1976) has recommended a procedure whereby the assessor—say, the client's spouse—compiles a list of five to ten behaviors that generally signal when the patient is in pain. Then the spouse receives training in watching for these behaviors and keeping track of the amount of time the patient exhibits them. Finally, the spouse is trained to monitor how people, including the assessor, react to the client's pain behavior. This procedure is useful not only in assessing the patient's pain experiences but in determining their impact on his or her life and the social context that may maintain pain behaviors.

The above material on assessing pain is sourced from Sarafino (1994).

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