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HP: 3.3 Pain > 3.3.2 Measuring pain > Flashcards

3.3.2 Measuring pain Flashcards

1
Q

Measuring pain

Congenital analgesia

A

Cannot feel pain.

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2
Q

Measuring pain

Organic pain

A

Physical basis for pain felt.

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3
Q

Measuring pain

Psychogenic pain

A

No physical basis for pain felt.

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4
Q

Measuring pain

Common descriptions of nerve pain:

A
  • Burning
  • Stabbing
  • Electric shock-like
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5
Q

Measuring pain

Common descriptions of muscle pain:

A
  • Tenderness
  • Achiness
  • Stiffness
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6
Q

Measuring pain

Qualities of pain

A
  • Organic/psychogenic
  • Acute/chronic
  • Malignant/benign
  • Continuous/episodic
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7
Q

Measuring pain

What techniques can be used to measure pain?

A
  • Self-report measures (clinical interview).
  • Psychometric measures and visual rating scales (McGill pain questionnaire, visual analogue scale).
  • Behavioural/observational measures (UAB pain behaviour scale).
  • Pain measures for children (pediatric pain questionnaire, Wong-Baker scale).
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8
Q

Subjective methods - clinical interviews

What type of pain are clinical interviews commonly used to assess?

A

Chronic pain.

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9
Q

Subjective methods - clinical interviews

What tools may be used during clinical interviews to help assess a patient’s pain?

A

Psychometric tests.

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10
Q

Subjective methods - clinical interviews

Strengths of clinical interviews

A
  • Effective = practitioner can ask questions, allowing them to create a tailored treatment plan than can improve adherence and likelihood of the treatment being a success.
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11
Q

Subjective methods - clinical interviews

Criticisms of clinical interviews

A
  • Effective only sometimes = depends of trust and communication between patient/physician.
  • Subjective = self-reports aren’t an objective measure.
  • May not be useful to prescribe exact doses of medicine to control pain.
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12
Q

Physiological methods

What method can be used to measure brain activity?

A

An EEG (electroencephalogram).

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13
Q

Physiological methods

How can muscle tension be measured?

A

Using an EMG (electromyograph).

This measures electrical activity in muscles, signalling how tense they are.

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14
Q

Physiological methods

How can autonomic arousal be measured?

A

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

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15
Q

Physiological methods

Strengths of physiological methods

A
  • Objective = EEG, EMG are both scientific measures and cannot be biased.
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16
Q

Physiological methods

Criticisms of physiological methods

A
  • Expensive = machinery costs a lot and practitioners must be trained to use it.
  • Low internal validity = equipment does not necessarily measure what they claim- autonomic arousal is not just a sign of pain, it can also show stress. Similarly, physiological changes can occur is someone is under the influence of alcohol or has an infection.
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17
Q

Self-report measures

What are some types of self-report scales?

A
  • Likert scales
  • Box scales
  • Visual analogue scales
  • Verbal rating scales
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18
Q

Self-report measures - Visual Analogue Scale (VAS)

What does a VAS typically consist of?

A

A line with stages indication “no pain” on the left, and “worst pain possible” on the right.

Patients can mark their pain severity.

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19
Q

Self-report measures - Visual Analogue Scale (VAS)

Strengths of VAS

A
  • Quick and easy to use.
  • Designed to show pain on a continuum, so no ‘gaps’ in pain intensity.
  • Valid measure, since patients should feel the pain is represented somewhere on the scale.
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20
Q

Self-report measures - Visual Analogue Scale (VAS)

Criticisms of VAS

A
  • Patients cannot elaborate on painful experience or its impact (no qualitative data is collected).
  • Basic measurement of pain.
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21
Q

Psychometric measures - McGill Pain Questionnaire (MPQ)

Who was the MPQ developed by?

A

Melzack (1975).

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22
Q

Psychometric measures - McGill Pain Questionnaire (MPQ)

What is the MPQ designed to assess?

A

The quality and intensity of subjective pain.

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23
Q

Psychometric measures - McGill Pain Questionnaire (MPQ)

How many categories of pain were identified?

How many questions were they divided into?

A

4 categories of pain, subdivided into 20 questions.

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24
Q

Psychometric measures - McGill Pain Questionnaire (MPQ)

What were the 4 categories identified?

A
  1. Sensory (1-10): patients choose word describing their pain.
  2. Affective (11-15): looking at the emotions the pain makes the patient feel, with choices from numbered words such as tiring, sickening or fearful.
  3. Evaluative (16): subjective intensity of pain, measured on a 5-point scale.
  4. Miscellaneous (17-20): various aspects of pain on 3-5-point rating scales.
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25
Q

Psychometric measures - McGill Pain Questionnaire (MPQ)

How does the MPQ work?

What is the highest score possible?

A

Composed of 78 words, which the patient chooses the ones that best describe their pain.

The words are assigned a value based on their severity and the patient is then given a total score from 0 (no pain) to 78 (severe pain).

26
Q

Psychometric measures - McGill Pain Questionnaire (MPQ)

What other factors does the MPQ list which patients can choose if they affect their pain?

A
  • Eating
  • Heat
  • Cold
  • Weather changes
  • Movement
  • Rest
  • Mild exercise
27
Q

Psychometric measures - McGill Pain Questionnaire (MPQ)

What words does the MPQ list in order to get patients to choose to describe their pain severity?

A
  • Mild
  • Discomforting
  • Distressing
  • Horrible
  • Excruciating
28
Q

Psychometric measures - McGill Pain Questionnaire (MPQ)

Strengths of MPQ

A
  • Reliable = good test-retest relibaility in arthritic patients (Ferras et al., 1990).
  • Ecologically valid = used worldwide with practitioners and patients.
29
Q

Psychometric measures - McGill Pain Questionnaire (MPQ)

Criticisms of MPQ

A
  • Low validity/generalisable = patients need a high level of literacy to understand all the words, making it unsuitable for children.
  • Unethical = can cause distress to people with low literacy (discrimination).
  • Quantitative data = lack of open questions means mostly quantitative data is collected, lacking personal experience details.
30
Q

Behavioural/observational methods - UAB pain behavioural scale

What does the UAB measure?

A

Observable pain behaviour and verbal/non-verbal signs of pain.

31
Q

Behavioural/observational methods - UAB pain behavioural scale

How does the UAB work?

A

Using a 3-point scale, an observer judges how frequently each behaviour occurs across a 3-week period.

32
Q

Behavioural/observational methods - UAB pain behavioural scale

How does the scoring work?

A

Each item is scored on a 3-point scale (0 = none, 0.5 = occasional, 1 = frequent).

Maximum score of 10, minimum of 0.

The higher the score, the more marked the pain associated-behaviour and the greater the level of impairment.

33
Q

Behavioural/observational methods - UAB pain behavioural scale

Example of UAB being used in a medical setting

A

Patient is asked to perform activities, whilst the practitioner rates them from 0-1 depending on how much the pain appears to be affecting them.

Scores and then added up and a final score is given.

34
Q

Behavioural/observational methods - UAB pain behavioural scale

Strengths of UAB

A
  • Quick and easy to use, don’t need high medical qualifications in order to observe.
  • Can be used with a large no. of patients, even those who cannot complete a self-report (generalisable).
35
Q

Behavioural/observational methods - UAB pain behavioural scale

Criticisms of UAB

A
  • Subjective = observer must correctly recognise and rate all behaviours, which can be hard.
  • Social desirability bias = patients may not want to seem as ill/in pain as they really are.
  • Low correlation between observer scores on UAB and self-reports on the MPQ.
36
Q

Pain measures for children

Why can it be more difficult to measure pain in children?

A

Children’s literacy and understanding of the body is often quite low.

Pain is an abstract concept and may be meaningless to children in the pre-abstract stage of cognitive development.

37
Q

BRUDVIK ET AL. (2016)

Clinical assessment

A

Refers to collecting info and drawing conclusions through the use of observation, psychological tests, neurological tests and interviews, to determine what the person’s problem is and what symptoms they are presenting with.

38
Q

BRUDVIK ET AL. (2016)

Emergency department management

A

A hospital facility that is staffed 24 hours per day, 7 days a week and provides unscheduled outpatient services to patients whose condition requires immediate care.

39
Q

BRUDVIK ET AL. (2016)

Fractures vs dislocations

A

Dislocation = a bone is displaced from its normal position at a joint.

Fracture = bone has been broken.

40
Q

BRUDVIK ET AL. (2016)

Paediatrics

A

Branch of medicine than involves the medical care of infants, children, adolescents and young adults (1-18 years-old).

These injuries have many different causes, severities and effects.

41
Q

BRUDVIK ET AL. (2016)

FPS-R: Faces pain rating scale- revised

A

A pain rating scale suitable for children aged 3-8 years-old, showing 6 faces indication increasing levels of pain.

42
Q

BRUDVIK ET AL. (2016)

CAS: Coloured analogue scale

A

A pain rating scale suitable for children aged 9-15 years-old, where respondents mark on a line where their pain was from ‘no pain’ (green) to ‘worst thinkable pain’ (red).

43
Q

BRUDVIK ET AL. (2016)

NRS: Numerical rating scale

A

A scale from 0-10 where respondents give the numerical value that best represents their pain, 0 being no pain etc.

44
Q

BRUDVIK ET AL. (2016)

Background

A

Research shows that doctors in hospitals often underestimate children’s pain, administering weaker pain relief less often.

Parents are better at estimating than nurses, but still underestimate their children’s pain (Rajasagaram et al., 2009).

45
Q

BRUDVIK ET AL. (2016)

Aims

A

To investigate:

  1. the relationship between children’s self reported pain and parents’ and doctors’ pain ratings.
  2. how age, medical condition and severity of pain affect pain estimates.
  3. whether pain assessment affects administration of pain relief.
46
Q

BRUDVIK ET AL. (2016)

Participants

A

243 paediatric patients aged 3-15 years-old (mean age 10.6), their parents and 51 doctors.

47
Q

BRUDVIK ET AL. (2016)

Sampling

A

Opportunity sample of patients being treated as Bergen Accident & Emergency Department (ED) in Norway, 2011.

48
Q

BRUDVIK ET AL. (2016)

Method

A

Correlational field study.

49
Q

BRUDVIK ET AL. (2016)

Dependent variables

A
  • Numeric rating of child’s pain by doctors and parents.
  • 3-8 year-olds responses on 2 visual analogue scales.
  • 9-15 year-olds responses using a visual analogue rating scale, with a coloured green-red line.
50
Q

BRUDVIK ET AL. (2016)

What did participants complete?

What about their parents?

A

Scales and questionnaires.

Their parents answered demographic questions.

51
Q

BRUDVIK ET AL. (2016)

What were doctors asked to do?

A

Give details of experience, whether they were parents, pain relief given and match between child’s rating and their own.

52
Q

BRUDVIK ET AL. (2016)

What were the childrens’ diagnoses classed as?

A
  • Infection
  • Fracture
  • Wound/soft tissue injury
  • Ligament/muscle injury
53
Q

BRUDVIK ET AL. (2016)

What else was recorded?

A

Each family’s total waiting time.

54
Q

BRUDVIK ET AL. (2016)

Was consent given? By who?

What other ethical measures were taken?

A

Written consent was provided by parents for themselves and their children.

Researchers ensured someone was always available to provide extra support/guidance.

The children’s medical condition could change rapidly, so it was important parents knew someone was avaiable if they wished to use their right to withdraw.

55
Q

BRUDVIK ET AL. (2016)

Results

A
  • Only 42% of children with severe pain (judged by doctors) were given pain relief medication.
  • Only 14.3% of children self-rating pain as severe were given pain relief medication.
56
Q

BRUDVIK ET AL. (2016)

Assessed the child’s mean pain to be…

A
  • Physicians: NRS = 3.2
  • Parents: NRS = 4.8
  • Children: NRS = 5.5
57
Q

BRUDVIK ET AL. (2016)

Conclusions

A
  • Doctors significantly underestimate pain in 3-15 year-olds.
  • Anxiety increases pain perception.
  • Doctors should place higher value on parental reports of children’s pain.
58
Q

BRUDVIK ET AL. (2016)

Strengths

A
  • Standardised procedure = increases validity and reliability since it can easily be replicated.
  • Ecologically valid = field experiment in a natural setting with real doctors, parents, patients etc. with real medical conditions.
  • Sample = large sample of children allows a range of conditions and pain to be measured, increasing validity.
  • RWA
59
Q

BRUDVIK ET AL. (2016)

Criticisms

A
  • Cultural bias = Norwegian emergency department, only with children, so low generalisability.
  • Low validity = parents and children knew each other’s answers, therefore children could have been influenced by their parent’s reactions.
60
Q

Issues and debates

How does Brudvik’s study show idiographic vs nomothetic?

A

Illustrates the nomothetic approach by measuring pain numerically and using statistical analysis to determine the significance.

Open questions and a more idiographic approach could have collected more data about how/why children experience pain differently.

61
Q

Issues and debates

How does Brudvik’s study have application to everyday life?

A

Study can be used to support changes in Norwegian paediatric care.

Training should include listening to children/parents regarding pain levels and remembering people can experience the same pain differently.

HP: 3.3 Pain (3 decks)

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