Experimentally induced pain: measurement of pain threshold and pain tolerance using a new apparatus for electrical stimulation of the skin.
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Adult↗
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Results for “Pain Measurement”
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Predicting disability time using formal low back pain measurement: the Low Back Pain Simulation Scale.
Objective evaluation of simulation in low back pain is currently not possible. A new simulation scale based on subject response to 103 pain words has shown promise in discriminating patients with low back pain from those simulating low back pain. Administration of this scale to 1679 individuals who were injured at work produced a 10.4% sample with scores in the simulation range. This subsample projected more intense pain and were disabled longer. These findings were replicated in a second study in which treating physicians rated the degree of physical pathology and symptom exaggeration blind to patient classification by the Low Back Pain Simulation Scale. Medical assessment indicated less organic pathology and greater symptom exaggeration among patients classified as simulators providing a measure of support for the validity of the simulation scale.
Adolescent↗
New methods of pain measurement and their application to pain control.
Recent pain research advances show promise in their application to the relief of acute and chronic clinical dental pain. Regional electroanalgesia, or transcutaneous electrical stimulation, has been used successfully in the treatment of pain associated with peripheral nerve injuries. Electrical stimulation of teeth also may prove useful as a pain control technique during operative dentistry procedures. Another exciting research finding is the discovery of endogenous or natural pain-suppressing pathways in the brain. There are recent demonstrations that natural-occurring opiate-like compounds and receptors exist in the brain. The elucidation of stimuli and behavioral responses which will activate these specific descending pain control pathways may lead to exciting new methods of pain relief. Thus, both regional electroanalgesia and the discovery of endogenous pain-suppressing pathways offer the possibility of the future expanded use of non-pharmacological pain control techniques. The proper evaluation of new pain control techniques requires the development of better methods of measuring and assessing the multidimensional aspects of the pain experience. Category scales which scale the suprathreshold range of pain from threshold to tolerance levels can be used with both experimental and clinical pain. Sensory Decision Theory has been applied to the analysis of categorical pain responses. This method distinguishes between sensitivity to stimulus intensity and response bias, or the patient's willingness to report a given intensity as painful. Another promising method for scaling pain is the use of ratio-scaling methods with verbal pain descriptors. Verbal descriptors of pain may provide the best method of scaling different dimensions of the pain experience. Reliable and objective descriptor scales have been developed which separate pain along two dimensions: sensory intensity and affect, or unpleasantness. By using cross-modality matching procedures, specific numerical values can be calculated for each verbal descriptor. These scales have been used to measure the intensity and unpleasantness associated with tooth pulp evoked experimental and clinical pain, and should be extremely useful in the evaluation of acute and chronic dental pain. They will be important experimental and clinical adjuncts in determining the efficacy of non-pharmacological pain control methods such as regional electroanalgesia, biofeedback, relaxation-suggestion and hypnosis.
Dental Pulp↗
Pain measurement from the neurosurgical standpoint.
A selective review of the current methods of pain measurement and validation (psychophysical methods, verbal and analogical scales, psychological tests) is presented with emphasis on patient selection for surgical pain relief, and analysis of outcome. The identification of homogeneous groups of patients with clinical and research objectives is prevented by the lack of a reliable pain scale, based on the assessment of objective and comprehensive parameters. This obstacle seems to be inherent to the complex nature of human pain experience. Psychiatric examination has proved important to elucidate the operative indications, particularly in cases of non-malignant obscure neuralgias. The importance of separate validation of the pain compliant and the psychiatric assessment is stressed. A critical comment is made on Hitchcock's pain scale and Lindqvist's psychiatric classification of candidates for surgery.
Humans↗
An experimental study of visual averaged evoked responses (V. AER) and pain measures (PM) in patients with depressive disorders.
In a group of 100 patients admitted to the Department of Psychiatry in Umeå between January 1973 and July 1974 with depressive syndromes, pain measures - PM - and visual averaged evoked responses - V.AER - have been investigated and the patients have been rated by the doctor by means of the Cronholm-Ottosson depression rating scale. According to the results of V. AER patients have been grouped as augmenters or reducers, depending upon the tendency to augment or to reduce the intensity of incoming signals with increasing stimulus intensity. V. AER are found to vary with age but not with sex. Differences are found between patients with and those without a psychotic dimension of their depressive syndromes. Patients with depressive syndromes of psychotic dimension tend more often to be reducers. When patients are divided according to diagnostic groups no differences are found. PM are found to vary with sex and detection threshold - DT - are found to vary with age while pain threshold - PT - tolerance level - TL - and pain endurance - PE - do not vary with age. Patients with depressive syndromes of a psychotic dimension are found to have higher PM while there is no consistent picture when patients are divided according to diagnostic groups. Possible explanations for contradictory results found by other authors are discussed.
Bipolar Disorder↗
Signal detection theory pain measures: empirical validation studies and adaptation-level effects.
Proponents of the use of signal detection theory (SDT) in the assessment of pain modulation have generally looked for changes in d' to indicate a reduction of sensory function, and a change in criterion to indicate a modification of the subject's response bias or attitudinal predisposition. In the first experiment, both assumptions failed to receive empirical verification. Discrimination d' was eqivalent before and after two strong levels of electrical current was reduced. The criterion parameter appeared to shift in a more conservative direction after the stimulus diminution. These results are used to question the validity of both detection and discrimination indices in the measurement of pain. An alternative means for describing the experimental results revealed a striking adaptation-level effect with implications for the assessment of both experimentally induced and endogenous pain. The outcome of a second experiment reinforced the adaptation-level theory interpretation of the results and provided additional evidence concerning the difficultuies in evaluating SDT parameters in studies of potential analgesics.
Discrimination, Psychological↗
[Elaboration of a pain measurement scale].
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Forms and Records Control↗
Algometry. Measuring pain threshold, method and characteristics in healthy subjects.
A pressure algometer was tested using a specially designed protocol in 28 healthy adult males and females. Two observers examined the pressure threshold (PT) of local tenderness at the joints of the wrists, elbows, knees, ankles, and at the paravertebral tissues. Several characteristics of the instrument were found. There were no significant differences in PT's between the same points on either side of the body (r = 0.738-0.934). A large source of variance was the measurement of one area within short time intervals. No significant differences in means were found between the two observers for the paravertebral points, while significant differences were found at the peripheral joints. Male subjects had significantly higher PT's than females. The PT's of the paravertebral tissues decreased in a cranial direction, while PT's of the peripheral joints showed similar levels. There was no significant influence on observing PT's on different dates or in a different order.
Adult↗
A modification of the jump-flinch technique for measuring pain sensitivity in rats.
The jump-flinch procedure provides a sensivite alternative to the hot-plate and tail-flick procedures. Analysis of the components of motor responses to increasing intensity of foot shock presentation has allowed the observational discrimination of five reliably elicited categories of unlearned responses to inescapable foot shock. Morphine sulfate differentially altered response category thresholds in rats. Response category thresholds also differed between Wistar and Fisher strain rats in analgesic effects of morphine sulfate.
Animals↗
From the NIH: Studies to measure pain response show narcotics can reduce intensity notably.
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Humans↗
Pain assessment in children: theoretical and empirical validity.
Valid assessment of pain in children is foundational for both the nursing practice and research domains, yet few validated methods of pain measurement are currently available for young children. This article describes an innovative research approach used in the development of photographic instruments to measure pain intensity in young African-American and Hispanic children. The instruments were designed to enable children to participate actively in their own care and to do so in ways that are congruent with their developmental and cultural heritage. Conceptualization of the instruments, methodological development, and validation processes grounded in Orem's Self-Care Deficit Theory of Nursing are described. The authors discuss the ways in which the gaps between nursing theory, research, and practice are narrowed when development of instruments to measure clinical nursing phenomena are grounded in nursing theory, validated through research and utilized in practice settings.
Black or African American↗
Pain intensity measurement in chronic low back pain.
This study investigated the psychometric properties of eight pain intensity measures used with chronic low back pain patients. All measures were similar in terms of scale distribution and rates of incorrect responses, with all scales apart from the Pain Rating Index significantly correlated. Principal axis factoring of data from 92 patients indicated the presence of one general factor on which all pain intensity measures except the Pain Rating Index loaded. The 101-point Numeric Rating Scale and the Box Scale had the strongest relationship, with loadings of 0.90. The Numeric Rating Scale and the Box Scale appear to be the scales of choice for the measurement of pain intensity in the low back pain patient.
Adult↗
Clinical measurement of pain.
The problems of clinical measurement of pain are considered. Various adjuncts to the standard clinical interview are proposed. These are: written reports, visual analogue scales, McGill's Pain Assessment Questionnaire, and a weekly pain chart. The advantages and disadvantages of each are discussed. Correlations between various pain measures are shown. The use of the weekly pain chart by doctors is recommended in cases of chronic pain.
Chronic Disease↗
Cervicogenic headache, migraine, and tension-type headache. Pressure-pain threshold measurements.
Pressure-pain threshold (PPT) measurements were performed with a pressure algometer, at 22 specified points in the head in patients with cervicogenic headache (n = 32), migraine (with and without aura) (n = 26) and tension-type headache (n = 17). Comparisons were made with a group of healthy controls (n = 20). The average PPT differed significantly between the groups (ANOVA, F = 9.5, P < 0.0005), largely caused by the low threshold in cervicogenic headache patients. There were no significant differences between controls and the 2 other headache groups. In the cervicogenic headache group, the lowest PPT was found in the occipital part of the head on the side with pain predominance. The ratio between the dominant and non-dominant sides (all 11 points on each side) was 0.85 in cervicogenic headache, whereas it was 0.99 in migraine patients with side preponderance of the pain. The present results support the view that the pathogenesis of cervicogenic headache differs from that of migraine and tension-type headache. The results may further support the theory that fibres from the C2 level (innervating the occipital part of the head) may be included in the pathogenetic mechanism in cervicogenic headache.
Adult↗
The Toddler-Preschooler Postoperative Pain Scale: an observational scale for measuring postoperative pain in children aged 1-5. Preliminary report.
This study evaluates the reliability and validity of the Toddler-Preschooler Postoperative Pain Scale (TPPPS), an observational scale developed to be a clinically useful measure of postoperative pain in children aged 1-5 years. The TPPPS consists of 7 items divided among 3 pain behavior categories: (1) Vocal pain expression; (2) Facial pain expression; and (3) Bodily pain expression. These items were derived from preliminary studies by the authors and from other observational studies of children's pain behavior. Seventy-four children between the ages of 12 and 64 months seen for inguinal hernia or hydrocele repair were the subjects of the study. Subjects were observed postoperatively for six 5-min intervals, commencing with their awakening from anesthesia, using the TPPPS. Two raters independently observed 28 of the children to assess inter-rater reliability. Validity was assessed by relating TPPPS scores to the timing and type of analgesics used, visual analog and numerical scale pain ratings made by parents and nurses, and perioperative vital signs. The TPPPS was found to possess satisfactory internal reliability (Cronbach's alpha = 0.88). Inter-rater reliability was good, with kappas for the pain behavior items ranging from 0.53 to 0.78. Preliminary evidence of the scale's validity is provided by the sensitivity of the scale to analgesic regimen, the convergence between TPPPS scores and nurse and parent ratings of postoperative pain, and the associations found between TPPPS scores and perioperative vital signs.
Analgesia↗
Measurement of pain in postoperative abdominal surgery patients.
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Abdomen↗
Comprehensive and multidimensional assessment and measurement of pain.
Current theories of pain and clinical experience support a multidimensional framework for the experience of pain that has implications for assessment and management in any setting. Six major dimensions have been identified: physiologic, sensory, affective, cognitive, behavioral, and sociocultural. Any clinical assessment process must address relevant dimensions of pain in the given setting. In acute care settings, for example, clinicians may focus on physiologic and sensory dimensions, whereas in chronic care settings, the affective, cognitive, and behavioral dimensions might assume priority. Various tools are available for multidimensional assessment of pain, spanning the dimensions of the experience from physiologic to sociocultural. The clinician in any setting must use appropriate tools that provide useful information. Guidelines helpful in a selection process include identification of relevant dimensions of pain, type of pain, patient population and setting, psychometric properties of the tool, and issues of time, clinical relevance, and feasibility. When a careful selection process occurs, the resulting data should simultaneously meet clinicians' needs for information as well as provide the foundation for initiation of multidisciplinary interventions.
Humans↗