Karoly (1985) - we should focus on all of the factors that contribute to pain

Karoly (1985) - we should focus on all of the factors that contribute to pain

• 1. Sensory - intensity, duration, threshold, tolerance, location, etc

• 2. Neurophysiological - brainwave activity, heart rate, etc • 3. Emotional and motivational - anxiety, anger,

depression, resentment, etc

• 4. Behavioural - avoidance of exercise, pain complaints, etc

• 5. Impact on lifestyle - marital distress, changes in sexual behaviour

Techniques used to collect

data.

• 1. interviews - advantage - it can cover Karoly's 6 points

• 2. behavioural observations • 3. psychometric measures • 4. medical records

Physiological measures of pain

Physiological measures of pain

• Another approach has been to relate pain to

autonomic arousal. By taking measures of pulse rate, skin conductance and skin temperature, it

may be possible to measure the physiological arousal caused by experiencing pain. Finally, since pain is perceived within the brain, it may he possible to measure brain activity, using an

Physiological measures of pain

Evaluation

• The advantage of the physiological measures of pain described above is that they are objective (that is, not subject to bias by the person whose pain is being

measured, or by the person measuring the pain). On the other hand, they involve the use of expensive machinery and trained personnel. Their main disadvantage,

however, is that they are not valid (that is, they do not measure what they say they are measuring). For

Evaluation

• If someone is very anxious about the process of having his or her pain assessed, or else is worried about the meaning of the pain, this will cause

physiological changes not necessarily related to the intensity of the pain being experienced.

Autonomic responses can be affected by many

Observations of pain

behaviours

Observations of pain

behaviours

• Turk, Wack and Kerns (1985) have provided a classification of observable pain behaviours.

•

• • Facial /audible expression of distress:

Observations of pain

behaviours

• _{• Negative affect: feeling irritable;} asking for help in walking, or to be excused from activities; asking questions like ‘Why did this happen to me?’

Clinical setting

Clinical setting

Clinical setting

• • A method for sampling pain behaviour

techniques for sampling and recording behaviour include continuous observation, measuring duration (how long the patient takes to complete a task), frequency counts (the number of times a target behaviour occurs) and time sampling (for example, observing the patient for five minutes every hour). • • Definitions of the behaviour: observers need

Clinical setting

Clinical setting

UAB Pain Behaviour Scale

UAB Pain Behaviour Scale

Turk et al (1983)

Commentary

Commentary

Carroll (1993a)

• Carroll (1993a) lists the different dimensions of pain that sufferers can be questioned about:

•

• • Site of pain: where is the pain?

• • Type of pain: what does the pain feel like?

• • Frequency of pain: how often does the pain occur? • • Aggravating or relieving factors: what makes the

pain better or worse?

Carroll (1993a)

• _{Duration of pain: how long has the pain} been present?

• _{Response to current and previous}

Visual analogue scale

• Patients mark a continuum of severity from "No Pain" to "Very Severe Pain"

• Simple and Quick to use and can be filled out repeatedly

• Can track the pain experience as it changes - this could reveal patterns such as

Visual analogue scale

• This method has adequate reliability, however limits pain to a single dimension.

• Downie and colleaguesevaluated the degree of agreement between various scales in patients with rheumatic diseases and found a high correlation among the different types of scales.

• The scales are simple to understand and do not

demand a high degree of literacy or sophistication on the part of the patient, unlike other pain measurement tools, such as the semantic differential scales

Visual analogue scale

• The Visual Analogue Scale is simple and quick to administer, and may be used before, during, and following treatment to evaluate changes in the patient's perception of pain relative to

treatment.

McGill Pain Questionnaire

(MPQ)

• The McGill Pain Questionnaire, developed by Melzack (1975), was the first proper

McGill Pain Questionnaire

(MPQ)

McGill Pain Questionnaire

emotionally —whether it is frightening, worrying and so on

McGill Pain Questionnaire

(MPQ)

• Each of the three main classes was divided into a number of sub-classes (sixteen in

total). For example, the affective class was sub-divided into tension (including the

adjectives ‘tiring’, ‘exhausting’), autonomic (including ‘sickening’,

McGill Pain Questionnaire

(MPQ)

McGill Pain Questionnaire

(MPQ)

• Patients are asked to tick the word in each sub class that best describes their pain.

• Based on this, a pain rating index (PRJ) is

calculated: each sub-class is effectively a verbal rating scale and is scored accordingly (that is, 1 for the adjective describing least intensity, 2 for the next one and so on).

McGill Pain Questionnaire

(MPQ)

• In addition, patients are asked to indicate the location of the pain on a body chart (using the codes E for pain on the surface of the body, I for internal pain and El for both external and

internal), and to indicate present pain intensity (PPJ) on a 6-point verbal rating scale.

Criticisms

• Criticism of this questionnaire centres on the need to have extensive

Criticisms

• Semantic differential scales, such as the McGill, are difficult and time consuming to complete and demand a sophisticated

literacy level, a sufficient attention span, and a normal cognitive state. They therefore are less convenient to use in the clinical

Criticisms

• The issue of reliability has been addressed in numerous reports,

Criticisms

• Reliability therefore becomes an issue of "reliable in whose hands?" Reliability of many of the pain measurement

Criticisms

• A difficult aspect of reliability is that the patient may have developed a different understanding of the pain problem and may give a different response from one examination to the next. It is equally important for the examiner to ask

himself or herself whether the interpretation of the patient's responses differs from one

examination to the next. Both factors affect the reliability of the information being

Criticisms

• Perhaps it is worthwhile to re-examine the concepts of subjective and

objective measurements. It could be argued that pain is a subjective

phenomenon, but if it is measured