Studies on pain: measurements of aching pain threshold and discrimination of differences in intensity of aching pain.
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Humans↗
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The visual analogue scale: its use in pain measurement.
Use of pain rating scales, especially the visual analogue scale (VAS), has increased dramatically in the last decade. Consideration of the VAS in terms of its physical structure and the patient's behaviour when confronted with the scale, casts doubt on its validity. It is non-linear and prone to bias which limits its use as a serial measure of pain severity. Measuring pain intensity alone imposes further limitations. The McGill Pain Questionnaire measuring several dimensions of pain appears to be a better alternative.
Arthritis↗
American pain society pain questionnaire and other pain measures in the assessment of osteoarthritis pain: a pooled analysis of three celecoxib pivotal studies.
The aim of this study was to evaluate the utility of the American Pain Society (APS) questionnaire in the assessment of osteoarthritis (OA) pain and to determine the onset of action of celecoxib in the treatment of acute flare pain in patients with OA of the knee or hip. Pooled data from three pivotal, randomized, double-blind, placebo-controlled, 12-week trials of patients with OA who exhibited a flare of disease activity after withdrawal of nonsteroidal anti-inflammatory drug or analgesic therapy were evaluated. Patients completed the APS Pain Measure Questionnaire, which evaluates pain intensity and quality of life, at baseline and daily for the first 7 days of therapy. In addition, patients underwent a range of standard OA assessments to evaluate the analgesic efficacy of celecoxib up to 12 weeks. Three thousand two hundred fifty-eight patients were enrolled in the three studies, of whom 2041 completed the APS questionnaire (1010 received celecoxib, 513 received naproxen, and 518 received placebo). Within the first 24 hours, celecoxib at a dose of 200 or 400 mg/d significantly reduced the amount of acute pain experienced compared with placebo for four of the five measures, and statistical significance for the remaining parameter, "pain in the last 24 hours," was achieved on day 2. Celecoxib at a dose of 200 to 400 mg/d provided similar efficacy to naproxen at a dose of 1000 mg/d. The pain relief observed with celecoxib was maintained for the APS evaluation period. Long-term efficacy assessments showed the efficacy of 200 mg/d of celecoxib to be continuous and maintained for at least the 12 weeks of the study and that it was equivalent to 400 mg/d of celecoxib and 1000 mg/d of naproxen. This study demonstrates that the APS questionnaire is a useful measure of pain and therapeutic response in OA. Celecoxib furthermore seems to be an effective acute and chronic analgesic in OA.
Aged↗
Visual analogue thermometer: a valid and useful instrument for measuring pain in burned patients.
This study assessed the psychometric qualities of a new pain rating instrument--the visual analogue thermometer (VAT)--which was developed to measure pain in burned patients. The validity and utility of the VAT was assessed and compared with a conventional numeric (NUM) and adjective pain scale (ADJ) with a group of 103 burned patients and 51 nurses. Analyses of the results support the concurrent and construct validity of the VAT as a pain measure. Furthermore, the VAT gave more sensitive and precise pain measures than the ADJ and/or NUM scales. No major difference between the three scales emerged in the patients' preference. The same was true for the nurses' evaluation except for those who had more clinical experience with the VAT and who tended to prefer this scale for its accuracy and ease of utilization. The VAT appears to be a valid, sensitive and clinically useful tool to measure pain in burned patients. A systematic pain assessment procedure which can be easily implemented in burn care facilities is presented.
Adult↗
[Pain diagnosis and pain measurement. II. Clinical aspects].
Experimental methods differ from clinical methods for the measurement of pain. Some developments in both areas, clinical and experimental pain investigation, are presented. The measurement of pain, i.e. its quantification, should not be confused with pain diagnosis. Some advantages of visual analogue scales in the measurement of clinical pain, especially for intraindividual short-time issues, are presented. Nevertheless, we are still far away from "ideal" methods. If subjective phenomena such as pain are studied, especially in the field of pain therapy, then nonspecific factors like suggestion, intentional or not, must be taken into consideration: Placebo effect and Nocebo effect.
Humans↗
A visual analogue thermometer for measuring pain intensity.
A new instrument for measuring pain intensity--the visual analogue thermometer (VAT)--was developed to overcome limitations and disadvantages of the conventional visual analogue scale (VAS). Two studies were performed to assess the validity and utility of the VAT as compared to conventional pain instruments whose psychometric qualities are scientifically recognized. The first study was carried out with a group of 65 chronic pain patients who provided pain intensity ratings using the VAT, a standard VAS, and the McGill Pain Questionnaire. A second set of measures was obtained from a group of 243 adult healthy volunteers who quantified the intensity of a set of descriptive pain terms with the VAT, a numerical scale (NUM), and a VAS. The results of both studies support the concurrent validity of the VAT as a pain measure. When assessing changes in pain levels, the VAT was able to distinguish between different pain intensities, confirming the construct validity of the instrument. No major difference emerged in the relative sensitivity of the VAT compared to the standard VAS, both scales yielding comparable pain estimates. In contrast, the NUM scale tended to produce higher pain ratings. Regardless of the pain scale used, the results showed unequal differences between descriptive pain terms that are commonly considered equidistant on an ordinal scale. No major problem was noticed in subjects' understanding or using either the VAT, VAS, or NUM scales. When questioned about pain scale preference, a substantial number of participants preferred the VAT to the standard VAS as a means of rating pain intensity. In view of the results obtained in the present studies, it is concluded that the VAT is a valid accurate, and clinically useful tool for measuring pain. Its design makes it suitable and effective for clinical use and as an outcome measure in clinical trials.
Adolescent↗
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↗
The Geriatric Pain Measure: validity, reliability and factor analysis.
BACKGROUND: Pain is a multidimensional experience that should be evaluated beyond an estimate of intensity. A multidimensional pain measure has not been developed for older persons undergoing comprehensive geriatric assessment. OBJECTIVE: To develop and evaluate validity and reliability of a multidimensional pain assessment instrument for older persons. RESEARCH DESIGN: A series of steps in instrument development and evaluation. SUBJECTS: A total of 176 subjects (mean age 84 +/- 6.0 years) in ambulatory geriatric clinics; 64% were women, and 73% had a history of chronic pain. MEASUREMENTS: Measurements included the Geriatric Pain Measure (GPM), the McGill Pain Questionnaire, Yesavage GDS, Katz ADLs, Lawton IADLs, Tinetti Gait and Balance, Folstein MMSE, and other demographic and clinical characteristics from interview and chart review. RESULTS: The GPM demonstrated a standardized alpha = 0.9445, homogeneity ratio =0.457, and average inter-item correlation =0.415. A subgroup of 50 subjects demonstrated concurrent validity of the GPM in comparison with the McGill Pain Questionnaire (Pearson's r correlation 0.6269 (P < .0000). Test-retest reliability was demonstrated in another subgroup of 50 subjects who repeated the GPM within 48 to 72 hours (Pearson's r = 0.9018; P < .0000). Factor analysis revealed five clusters of components: Pain Intensity, Disengagement, Pain with Ambulation, Pain with Strenuous Activities, and Pain with Other Activities. CONCLUSIONS: The GPM is a 24-item questionnaire that is easy to administer and has significant validity and reliability in older persons with multiple medical problems. The GPM may be a useful addition to the multidimensional geriatric assessment process.
Activities of Daily Living↗
An evaluation of clinical tools to measure pain in older people with cognitive impairment.
Pain in older people with cognitive impairment is often untreated or under-treated despite the fact that the likelihood of having pain increases with advanced age. One reason that pain is poorly managed in older people is that it is not detected. Assessing pain is an integral part of clinical practice and is required for effective pain management. However, systematically measuring pain intensity and location with standardized tools in older people has not been well studied. This article will summarize tools used to assess pain in older people, inducing self-report scales measuring pain intensity, the presence or absence of pain, pain location and pain behaviour scales. Identifying the advantages and disadvantages of these clinical assessment tools has implications for nursing practice, research and education.
Aged↗
Disease-specific pain measures for osteoarthritis of the knee or hip.
Many elders suffer from chronic pain resulting from osteoarthritis (OA) of the knee or hip. This review identifies useful pain measures for assessing OA. Several disease-specific pain measures are discussed: Arthritis Impact Measurement Scales pain subscale, Western Ontario and McMaster University OA Index pain subscale, pain subscales of the Index of Severity for OA of the Hip or of the Knee, and Knee Pain Scale. Generic pain measures, the verbal descriptor scale, and the 21-point box scale, also are discussed. Because knee/hip OA is characterized by pain that is activated during or aggravated by certain activities, disease-specific pain scales that measure pain associated with these various activities are more effective than a generic pain scale.
Aged↗
Incisional sensitivity and pain measurements: dissecting mechanisms for postoperative pain.
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Animals↗
Multiple session experimental pain measurement.
Experimental heat pain transients were administered to 30 normal volunteers over four weekly sessions, measuring both heat pain (HP) threshold and suprathreshold magnitude estimation through VAS. Repeatability and bias for these two factors were evaluated. Heat pain thresholds measured through the method of limits were previously shown to have inter-session bias, presumably due to a practice effect. Existence of such a bias between first and second measurement sessions casts doubt on the usefulness of this parameter for pain assessment of individuals over time. In the present study, measurements of normal HP thresholds over four sessions showed that bias exists between the first and successive sessions, but not among sessions other than the first. It is concluded that (i) HP thresholds obtained from a single session are of limited value, and should be carefully interpreted. (ii) Long-term studies that use the HP threshold should take results from the second (or later) session as their baseline. The Visual Analog Scale (VAS) is considered the 'gold standard' for assessment of clinical and suprathreshold experimental pain, and changes in VAS score are regarded as significant evidence of individual response to treatment, placebo, or experimental manipulation. Although its overall group accuracy and precision have been examined for both clinical and experimental pain, and found adequate (Price 1988), the VAS has not been rigorously assessed for repeatability. Stimuli at three pain levels, 1.5, 3 and 4.5 degrees C above each individual's heat pain threshold as determined at each session, were given. Several models of analysis of the VAS were tested and repeatabilities (r) obtained from these analyses demonstrate poor precision for each of the tested analysis models. For example, inter-session repeatabilities for the three individual pain levels ranged from r = 3.8-4.7, effectively providing a confidence interval of 7.6-9.4 for any VAS reading on a 0- to 10-point scale. An examination of intra-session VAS provided somewhat better results. Thus, use of the VAS in similar experimental settings is called into question. The use of the VAS in clinical settings, where individual assessments are necessary, is also called into question, but remains to be specifically tested.
Adolescent↗
Comparison of clinical and evoked pain measures in fibromyalgia.
UNLABELLED: Evoked pain measures such as tender point count and dolorimetry are often used to determine tenderness in studies of fibromyalgia (FM). However, these measures frequently do not improve in clinical trials and are known to be influenced by factors other than pain such as distress and expectancy. The purpose of this investigation was to determine whether evoked pain paradigms that present pressure stimuli in a random fashion (eg, Multiple Random Staircase [MRS]) would track with clinical pain improvement in patients with FM better than traditional measures. Sixty-five subjects enrolled in a randomized clinical trial of acupuncture were observed longitudinally. Clinical pain was measured on a 101-point numerical rating scale (NRS) and the Short Form McGill Pain Questionnaire (SF-MPQ), whereas evoked pressure sensitivity was assessed via manual tender point count, dolorimetry, and MRS methods. Improvements in clinical pain and evoked pain were assessed irrespective of group assignment. Improvement was seen in clinical pain during the course of the trial as measured by both NRS (P = .032) and SF-MPQ (P = .001). The MRS was the only evoked pain measure to improve correspondingly with treatment (MRS, P = .001; tender point count and dolorimeter, P > .05). MRS change scores were correlated with changes in NRS pain ratings (P = .003); however, this association was not stronger than tender point or dolorimetry correlations with clinical pain improvement (P > .05). Pain sensitivity as assessed by random paradigms was associated with improvements in clinical FM pain. Sophisticated pain testing paradigms might be responsive to change in clinical trials. PERSPECTIVE: Trials in fibromyalgia often use both clinical and experimental methods of pain assessment; however, these two outcomes are often poorly correlated. We explore the relationship between changes in clinical and experimental pain within FM patients. Pressure pain testing that applies stimuli in a random order is associated with improvements in clinical pain, but this association was not stronger than other experimental techniques.
Acupuncture Analgesia↗
Pain measurement: the affective dimensional measure of the McGill pain questionnaire with a cancer pain population.
Two experiments used the McGill Pain Questionnaire (MPQ) to examine the affective dimension of pain in patients whose pain was secondary to malignancy. In experiment I, segregating groups of cancer patients on the basis of extreme scores (high versus low) on the MPQ failed to produce segregation on independent measures of affect and infirmity. This outcome contrasts with earlier work with chronic benign pain patients. Experiment II compared cancer pain patients matched with benign pain patients on intensity of pain report on the affective dimension of the MPQ. Cancer pain patients reported a reliably higher affective loading to their pain. These data suggest that cancer pain patients employ different criteria than benign pain patients in selecting affective pain descriptors. Possible explanations for this difference are discussed.
Adult↗
Differing correlations between pain measures in syndromes with or without explicable organic pathology.
We investigated the use of pain measures in chronic pain syndromes with and without explicable organic cause by correlating scores obtained from the Visual Analog Scale and from subscales of the McGill Pain Questionnaire in patients with either inflammatory arthritis or primary fibrositis. We confirmed the finding that patients with fibrositis, despite having significantly less demonstrable pathology, report more pain on a significant number of measures. In patients with arthritis, we observed large positive correlations between scores on different pain measures, supporting the hypothesis that these scores validly measure pain secondary to tissue injury. In the fibrositis group, however, significantly lower correlations, and one even strongly negative, were found between scores on different measures. We suggest that commonly used pain measures which have been shown to be valid to study patients with demonstrable pathology may be less valid for measurement of pain in patients with syndrome such as fibrositis, whose pain may be different or more complex than that of patients with explicable organic basis.
Adult↗
Measuring pain in children with cognitive impairment: pain response to surgical procedures.
This study investigated post-surgical pain in children with profound cognitive impairment (PCI), searching for a core set of cues these children use to express their pain. Fifty-two children were observed while they were admitted to the Sophia Children's Hospital for surgery, twice before and five times after surgery. All observations were scored with the item pool consisting of 134 possible pain indicators, using a five-point scale ranging from 0 (never shown) to 4 (always shown). Second, we used the visual analogue scale (VAS) to give a general impression of the severity of the children's pain during the episodes they were observed. Several analyses provided evidence that 23 observable behaviors are sensitive to post-surgical pain in children with PCI, regardless of the pain intensity of the surgical procedures they underwent. The finding that all indicators, except for one, were scored significantly higher on episodes with VAS ratings >or=4, indicates the sensitivity of these indicators concerning absence versus presence of clinically meaningful levels of pain. This study reveals the potential clinical utility of a core set of indicators which can be used to assess post-surgical pain in children with PCI.
Adolescent↗
Psychophysical responses to a speech stressor: correlation of plasma beta-endorphin levels at rest and after psychological stress with thermally measured pain threshold in patients with coronary artery disease.
OBJECTIVES: We tested the hypothesis that psychological stress alters plasma levels of opioid peptides and that these plasma levels are related to pain perception in patients with coronary artery disease. BACKGROUND: Public speaking psychological stress has previously been shown to be associated with silent ischemia. METHODS: After instrumentation and a 30-min rest period, venous blood samples for beta-endorphin were obtained before and immediately after psychological stress in 20 patients with coronary artery disease. Pain threshold was then assessed using a thermal probe technique at baseline and immediately after stress. Patients gave three brief speeches lasting a total of 15 min about real-life hassle situations. RESULTS: Psychological stress significantly increases plasma beta-endorphin levels (4.3 +/- 0.9 pmol/liter [mean +/- SE] at rest to 8.3 +/- 2 pmol/liter after stress, p < 0.05). There was a significant positive correlation between pain threshold and beta-endorphin levels after stress (r = 0.577, p = 0.008). This significant positive correlation was still present while rest blood pressure and change in blood pressure during stress were controlled for by analysis of covariance techniques. CONCLUSIONS: In patients with coronary artery disease and exercise-induced ischemia, public speaking produces psychological stress manifested by increased cardiovascular reactivity and causes an increase in plasma beta-endorphin levels that is significantly correlated with pain thresholds. These findings may explain the predominance of silent ischemia during psychological stress in patients with coronary artery disease.
Blood Pressure↗
Measuring pain in the (knockout) mouse: big challenges in a small mammal.
The increasing popularity of the mouse as a subject in basic science studies of pain can largely be attributed to the development of transgenic "knockout" technology in this species only. To take advantage of this biological technique, many investigators are rushing to adapt to the mouse experimental protocols that were designed for the rat. However, the myriad physiological and behavioral differences between these two rodent species render such adaptations non-trivial and in many cases seriously problematic. In this article we review the basic nociceptive assays used in behavioral pain research (thermal, mechanical, electrical and chemical), and highlight how species differences affect their proper application. In addition, some of the issues specifically pertaining to the interpretation of such data in knockout studies are addressed.
Animals↗