Pain and Disability Clinical, Behavioral, and Public Policy Perspectives (1987) / Chapter Skim
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11. Measuring Pain and Dysfunction
11. Measuring Pain and Dysfunction
Pages 211-231
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From page 211... ...
. Topics reviewed with the panelists included physiological measures of pain, subjective and behavioral observation techniques, assessment of the meaning of pain, physical function measures and vocational assessment in chronic pain patients, and the assessment of psychosocial and psychiatric factors in the 211
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From page 212... ...
In general, medical models are best suited for explaining acute pain problems in which pain is a direct fimction of nociception, whereas nonmedical models can best account for chronic pain problems in which the relation between tissue damage and pain complaint is weak or lacking. In practice, medical and nonmedical models can be, and often are, combined.
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From page 213... ...
The lack of consensus on the role of affect in chronic pain is a major impediment in the progress of pain measurement technology. MEASUREMENT TOOLS Most pain measurement involves either structured self-report of pain, observation of patient behavior, or some combination of the two approaches.
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From page 214... ...
Carisson (1983) critically reviewed the VAS as a method for scaling pain states or pain relief in chronic pain patients, and she compared different forms of the scale.
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From page 215... ...
An adjunct test device, the Dartmouth Pain Questionnaire, has been offered to supplement the MPQ through the assessment of four additional factors, including impaired functioning (Corson and Schneider, 1984~. Many studies support the factor structure of the MPQ, its reliability, and its concurrent validity (see Shale and Chapman, 1984; Chapman et al., 1985~.
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From page 216... ...
Analogous methods are used for clinical pain scaring. The typical procedure involves matching words describing pain to line length or handgrip force, matching both to experimental pain, and then deriving scaling standards for the relationship of words describing pain to actual pain.
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From page 217... ...
devised a four-category classification scheme for patients in which Class ~ consisted of those with high behavioral determinants and low organic determinants of pain, and Class lI patients were Tow both on behavioral and organic determinants. Class ITI patients had high scores both on organic pathology and pain behaviors, and Class IV patients had high organic pathology and Tow pain behavior scores.
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From page 218... ...
Patients walked more slowly than normals, took smaller steps, failed to show normal symmetrical gait patterns, and exhibited more pain behaviors. This approach appears promising for assessing and objectively quantifying back pain behaviors.
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From page 219... ...
Thus, behavioral indicators appear well suited as highly specific and precise ways to quantify certain outward pain behaviors, but they may not serve well as global indicators of subjective pain intensity. Further work is needed before the behavioral approach can quantify a wide range of chronic pain problems.
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From page 220... ...
found that chronic pain patients, when asked to report medication use, gave information that was 50~0 percent below their actual drug intake. Kremer, Block, and Gaylor (1980)
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Sickness Impact Persisting pain typically has a significant sickness impact on the patient. For the low back pain patient (the most-studied type of patient in the chronic pain population)
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Despite the successful rehabilitation of patients in this study, and with a significant decrease of self-reported pain, these patients maintained a mean VAS pain report score of 77 out of a possible 150. This suggests that rehabilitation may be achieved without major pain relief.
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From page 223... ...
to perform normal daily functions because they believe, or they have been told by well-intentioned health care providers, that activity will exacerbate the pain and worsen their health. But for many chronic pain conditions the opposite is true: excessive rest and reclining contributes to the persistence of pain, and activity is beneficial rather than harmful to health.
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From page 224... ...
Although not designed specifically for chronic pain patients, instruments that measure the personal meaning of life events in terms of purposefulness, personal control, and self-esteem may be useful to adapt for pain patients. The theoretical concept of coherence as defined by Antonovsky (1980)
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From page 225... ...
regarding perceived vulnerability to pain, it could give assessors a quick way of taking the patient's perspective into account. Coping Chronic illness, including chronic pain, may be viewed as a stressor with which patients must cope (Lipowski, 1971; Lazarus and DeLongis, 19831.
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From page 226... ...
This influence of current pain on memory of past pain in persistent or chronic pain situations suggests that measures derived from the patient's recollection are probably invalid and at best likely to be biased. Attributional Factors Patients, like people in general, tend to behave in accordance with their beliefs about the world and themselves.
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From page 227... ...
Research on placebo effects has helped to emphasize the importance of the context of interventions and of the doctorpatient relationship as determinants of pain report and pain behavior. Medication Toxicity Measurement error may also occur when the patient is toxic from excessive medication.
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From page 228... ...
that there is no direct, objective way to measure the experience of pain. Because adequate technology for the objective assessment of chronic pain is not available, the committee believes that attempts to draw inferences about the ability of a patient to engage in gainful employment on the basis of pain measurement are futile.
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From page 229... ...
Follick, M.J., Ahern, D.K., and Laser-Wolston, N Evaluation of a daily activity diary for chronic pain patients.
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A prospective short-term study of chronic pain patients utilizing objective functional measurement.
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From page 231... ...
Self-reported vs. actual use of medications in chronic pain patients.
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