Chapter 5 Pain Assessment

Question 1

Three most commonly used methods to quantify the pain experience

Answer 1

verbal rating scales, numerical rating scales, and visual analog scales

Question 2

VERBAL RATING SCALES (VRS)

Answer 2

A VRS generally consists of a series of adjectives (or phrases), ordered from least intense (or unpleasant) to most intense (or unpleasant). An adequate VRS should span a maximum possible range of the pain experience (e.g., from “no pain” to “extremely intense pain”)

Question 3

Verbal Rating Scale (VRS) for Pain Intensity

Answer 3

None 0
Mild 1 
Moderate 2 
Severe 3 
Very Severe 4

Question 4

VRS weaknesses

Answer 4

First, the scoring method for VRS assumes equal intervals
between adjectives. That is, the change in pain from
“none” to “mild” is quantified identically with the change
in pain from “moderate” to “severe.
Second, in order to
properly use a VRS, a patient must both be familiar with
all of the words used on the scale, and must be able
to find one that accurately describes his or her pain.

Question 5

NUMERICAL RATING SCALES (NRS)

Answer 5

An NRS typically consists of a series of numbers with verbal
anchors representing the entire possible range of pain intensity. Generally, patients rate their pain from 0 to 10, from 0 to 20, or from 0 to 100. Zero represents “no pain” whereas the 10, 20, or 100 represents the opposite end of the pain continuum (e.g., “the most intense pain imaginable,,”
“pain as intense as it could be,,” “maximum pain”)

Question 6

Weakness of the NRS

Answer 6

The principal weakness of the NRS is that, statistically, it does not have ratio qualities. That is, numerically equal intervals on the scale (e.g., the difference between 1 and 3 and the difference between 7 and 9) may not represent equivalent intervals in terms of scaling the
intensity of pain. One other limitation of most NRS measures of pain is that individuals’ ratings of a given pain experience can be altered in idiosyncratic ways by the
choice of anchors on the upper end of the scale

Question 7

VISUAL ANALOG SCALES (VAS)

Answer 7

A VAS consists of a line, often 10 cm long, with verbal anchors at either end, similar to an NRS (e.g., “no pain” on the far left and “the most intense pain imaginable” on the far right). The patient places a mark at a point on the line corresponding to the patient’s rating of pain intensity

Question 8

VAS limitations

Answer 8

1. It can be difficult to administer to patients with perceptual motor problems
2. VAS is generally scored using a ruler (the score is the number of centimeters or millimeters from the end of the line), making
   scoring more time consuming and adding additional possible sources of bias or error.
3. relative to other rating scales, use of a VAS produces higher non-completion rates among certain populations, primarily among those with cognitive limitations and among elderly samples

Question 9

What is the MCGILL PAIN QUESTIONNAIRE (MPQ)

Answer 9

three dimensions of the experience of pain:
sensory-discriminative, affectivemotivational,
and cognitive-evaluative. The MPQ was created to assess these multiple aspects of pain

Question 10

What does the MCGILL PAIN QUESTIONNAIRE (MPQ) comprise of?

Answer 10

It consists of 20 sets of verbal descriptors, ordered in intensity
from lowest to highest. These sets of descriptors are divided
into those assessing the sensory (10 sets), affective (5 sets), evaluative (1 set), and miscellaneous (4 sets) dimensions of pain.

Question 11

How is the MPQ performed?

Answer 11

Patients select the words that describe their pain, and their word selections are converted into a pain rating index, based on the sum of all of the words
after they are assigned a rank value, as well as the total
number of words chosen. In addition, the MPQ contains
a present pain intensity VRS (i.e., the PPI), ordered from “mild” to “excruciatinG

Question 12

How is Pain relief measured?

Answer 12

using a VAS, a VRS with gradations of relief (e.g., “none,” “slight,”“moderate,” “complete”), or an NRS assessing the percentage of relief

Question 13

PainDETECT assessment system

Answer 13

The PainDETECT assessment system, which relies on a set of self-report questions about symptoms, was designed to detect neuropathic pain in patients with low back pain

Question 14

What is the purpose of Daily Diaries?

Answer 14

becoming the standard for assessing pain related
symptoms in order to minimize memory biases that threaten the validity of global retrospective ratings of pain.
Participants are generally asked to complete measures of pain and related symptoms one or more times per day, often for 1-2 weeks. Because pain reports
can have substantial day-to-day variability, aggregated (averaged) ratings have been demonstrated to be more
reliable and sensitive to treatment effects than retrospective measures of pain

Question 15

What are the benefits of Assessment of pain behaviors?

Answer 15

Assessment of pain
behaviors can be valuable in establishing a patient’s level of
physical functioning (e.g., the amount of activity engaged
in), in analyzing the factors that may reinforce displays of
pain (e.g., solicitous responses from others), or in assessing
pain in nonverbal individuals

Question 16

Noxious Stimulation

Answer 16

Several modalities of noxious stimulation are commonly used to induce pain (e.g., thermal, mechanical, electrical, chemical, ischemic);
typical parameters that are measured include pain threshold, pain tolerance, and ratings of suprathreshold noxious stimuli using an NRS, VAS, or VRS.

Question 17

Psychophysiologic data serve a number of important functions

in the assessment of acute and chronic pain

Answer 17

1. they are a prerequisite for performing biofeedback or related procedures in which patients are taught to bring
   physiological processes under some degree of voluntary
   control.
2. psychophysiologic measures can help to elucidate some of the concomitants of pain not easily measured by self-report (i.e., arousal, central processing of information related to noxious stimulation).

Question 18

Surface electromyography (EMG) use

Answer 18

is often used to record
levels of local muscle tension in the context of musculoskeletal
pain syndromes such as low back pain or tension headache,
in which heightened muscle tension is thought to contribute
to the experience of pain

Question 19

Electroencephalography

(EEG) use

Answer 19

has been used in a number of studies to assess brain

responses to noxious stimulation

Question 20

Functional neuroimaging methods

Answer 20

functional magnetic resonance imaging (fMRI) and positron
emission tomography (PET) allow noninvasive assessment 
of the neurophysiology of pain processing in the brain (and, recently, the spinal cord as well)

Question 21

What is the role of functional neuroimaging methods in several key areas of pain assessment?

Answer 21

refining the mechanism-based classification of pain
syndromes, evaluating abnormalities of pain processing in individuals with communication or cognitive deficits, studying the pharmacokinetic and pharmacodynamic properties
of analgesic drugs, identifying dysfunctional areas of processing in the nervous system that can serve as analgesic drug targets, and revolutionizing pre-clinical drug development

Question 22

Neonatal Infant Pain Scale

NIPS

Answer 22

codes the presence and intensity of six painrelated
behaviors: facial expressions, crying, breathing, arm
movement, leg movement, and arousal state
For slightly older children, a pictorial scale such as the FACES Scale or Oucher Scale may be used, whereas in children who are 6 or older, a standard VAS may be the optimal choice.

Question 23

Cognitive Test preferred among the elderly

Answer 23

VAS is rated as one of the least preferred measures among the elderly while a VRS often receives the
highest preference scores. It has been suggested
that the MPQ (long form) is inappropriate for use in elderly samples due to its complexity and time requirements
In elderly or cognitively
compromised subjects, use of a VRS or NRS is strongly preferable to use of a VAS.