Pain Measurement Pain Outlines Topics Nociception: Transduction Nociception: Transmission Nociception: Modulation The ANS Pain measurement Epidemiology of mental illness Deafferentiation pain Peripheral neuropathies and neuralgias Sympathetic dystrophies Central pain syndromes Post-herpetic neuralgia Extremity pain Low back pain Headache Pediatric pain Antidepressants Anticonvulsants Neurolytic blocks Celiac plexus block Neurosurgical procedures Epidural steroids Local anesthetics Psychological techniques Spinal stimulation TENS

1. General Comments
   1. Pain has multiple components
      1. nociception
      2. sensation
      3. suffering
      4. Behavior

   2. Disability refers to lack of mobility, inability to work, difficulty in interpersonal relationships

   3. Multiple components of pain assessment
      1. physical location of pain, description tools: Wisconsin brief pain questionnaire
         
      2. functional tools: sickness/impact profile, health assessment questionnaire, pain disability index
         
      3. behavioral/cognitive drug use, physician visits tools: illness behal depression and anxiety tools: MMPI, Beck depression scale
         
      4. economic
         
      5. sociocultural litigation, patient independence, quality of life, family dynamics, patient goals.

      
      

   4. Test Characteristics
      1. simple to administer
      2. easy to understand
      3. validity Extent to which a test measures what it is supposed to measure:
         1. Content validity
            
         2. Construct validity
            
      4. Sensitivity
         
      5. Reliability
         1. Internal consistency. Requires wide range of questions of single scale items
            
         2. Test-re-test reliability
            
         3. Interrater reliability

   
   

2. Specific Tests
   1. Self-reported information:
      1. Patients retain fairly accurate recall of specific pain experiences
      2. Cancer pain: individuals who lived with patient reported pain levels which matched patient.
      3. Patients under report opioid use (women> men)

   Single Dimension scales

   1. Visual Analog Scale
      1. single dimension scale
         
      2. in adults, horizontal = vertical
         
      3. valid in ages > 7 years
         
      4. failure rate = 7%
         

      
      

   2. Verbal Numerical Scale
      1. More useful than VAS for early post-op pain

      
      

   3. Verbal rating Scale
      1. use of word descriptors (none, mile, discomforting, distressing, horrible, excruciating)
         
      2. limited by choice of words
         
      3. Sensitive to gender and ethnic differences
         
      4. May be superior to VAS in assessing effects of analgesics on acute pain

   
   Multidimensional descriptive Reports

   1. Pain Diary
      1. useful for research
      2. Obtain detailed information

   2. Pain Drawings
      1. Useful to asses site/distribution of pain
         
      2. Do not measure intensity
         
      3. Not useful to asses descrete pain (I.E. headache)

   3. Wisconsin Brief Pain Questionnaire
      1. 17 questions
         
      2. Adequate reliability
         
      3. Does not asses emotional aspect of pain

   4. McGill Pain Questionnaire
      1. sensitive
      2. Words in group may not be equidistant
      3. May be imbalance between sensory, affective, evaluative components of pain.
      4. Does provide information on qualitative and quantitative aspects of pain. (multidimensional).
      5. Used for cancer, acute, chronic non-malignant pain.

   5. Short McGill pain questionnaire
      1. 15 pain descriptor words, (11 sensory, 4 affective), plus VAS and PPIS (Present pain intensity scale)
         
      2. Useful in acute, post-op and OB pain

   6. Memorial Pain Assessment Card
      1. Quick
      2. Appears to be valid

   
   Pediatric Pain Assessment

   1. Oucher
      1. photos of children
      2. valid in ages 3-6 years

   2. Faces Drawing Scales
      1. may be valid ages 2-6 years

   3. poker chip scale
      1. limited sensitivity
      2. valid, reproducible

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