Net Guide: Measurement of Pain

Pain Management, December 2010, Volume 3, Issue 8

A collection of links and resources from across the web focus on one specific condition. These resource range from useful websites to clinical trials.

//Medical Websites

Pain Measurement in Humans

Featured on the International Association for Studying Pain website, this section of the document titled “Core Curriculum for Professional Education in Pain” outlines what medical professionals should know about effectively measuring pain, including the psychological and physiological components of pain expression in humans. The document highlights six key points, among them that pain is subjective, physicians should be aware of the challenges and limitations in measuring pain, and physicians should be familiar with observational methods of indirectly measuring pain.

Pain Measurement in Children

Yes, this resource is from 1995, but many of the scales highlighted in the document are still relevant to the current practice of pain measurement in children. Take a look at this clinical update, provided by the IASP, if you’re looking to refresh your memory on pain measurement, or if you’d like to share this with a patient. The piece reviews “self-report” methods, face scales, word-graphic scales, biological measures, and more.

//Online CME

Module 1 Pain Management: Pathophysiology of Pain Assessment

Credits: 1.00

Fee: None

Expires: March 2012

Multimedia: None

This activity is designed to help physicians describe the pathophysiology and underlying mechanisms of pain, as well as the tools used to assess pain and guide pain management.


Facial Expression and Pain in the Critically Ill Non-communicative Patient: State of Science Review

Journal: Intensive and Critical Care Nursing (November 2, 2010)

Authors: Arif-Rahu M, Grap M

Purpose: The review is designed to “analyse the evidence related to the relationship between facial expression and pain assessment tools in the critically ill non-communicative patients.”

Results: The authors write that while the “use of facial expression is an important behavioural measure of pain intensity, there are inconsistencies in defining descriptors of facial behaviour.” They focus on understanding “facial expression in non-communicative critically ill patients experiencing pain to assist in the development of concise descriptors to enhance pain evaluation and management.”

Correlates of Perceived Pain-related Restrictions Among Women with Fibromyalgia

Journal: Pain Medicine (November 11, 2010)

Authors: Przekop P, Haviland M, Morton K, et al

Purpose: “To identify correlates of perceived pain-related restrictions in a community sample of women with fibromyalgia.”

Results: The team studied a group of women “with a self-reported, physician-diagnosed” case of fibromyalgia. The women took part in the Biopsychosocial Religion and Health Study (BRHS) and participated in the Adventist Health Study-2. The researches also identified “associations with pain-related restrictions.” They concluded that, “Experience of a traumatic event with physical pain was the strongest predictor in the fibromyalgia group. These findings may be useful in constructing novel treatments and prevention strategies for pain-related morbidity in fibromyalgia patients.”

Validity of Weekly Recall Ratings of Average Pain Intensity in Neck Pain Patients

Journal: Journal of Manipulative Physiological Therapeutics (October 22)

Authors: Bolton J, Humphreys B, van Hedel H

Purpose: To investigate “the validity of weekly recall pain ratings and biasing effects of pain levels on these ratings.”

Results: The study included 78 patients “presenting to a chiropractic outpatient clinic with nonspecific neck pain.” The patients completed a “7-day diary rating their pain 4 times each day on a 11-point numerical rating scale.” The patients were “asked to rate their current pain, as well as recall their pain” beginning on the 8th day. Based on the results, the researchers concluded that “recall ratings of pain intensity may be valid for use in clinical research and practice on patients with nonspecific neck pain.”

Newborn Infant Pain Assessment Using Heart Rate Variability Analysis

Journal: The Clinical Journal of Pain (November/December 2010)

Authors: Faye P, De Jonckheere J, Logier R, et al

Purpose: The researchers sought to prove the hypothesis that “pain may alter HRV in the newborn infant and that HRV analysis could be used as an indicator of prolonged pain in the newborn infant.”

Results: The team measured “the magnitude of the heart rate high-frequency variations using an innovative High Frequency Variability Index (HFVI) in newborn infants at risk of postoperative pain.” They studied 28 newborn infants admitted after a “major surgical procedure.” Post-operative pain was measured using EDIN scale from 2 to 72 hours. Based on the results of the study, the researchers concluded that “postoperative pain is associated with a decreased high-frequency HRV in full-term newborn infants.” They suggest that “HRV could be used as an indicator to assess prolonged pain in the newborn infants.”

Development of a Severity Score for CRPS

Journal: Pain (December 2010)

Authors: Harden R, Bruehl S, Perez R, et al

Purpose: The researches sought to evaluate “the validity and potential utility of a continuous type score to index severity of CRPS.”

Results: The study focused on psychometric and medical evaluations conducted in 114 CRPS patients and 41 non-CRPS neuropathic pain patients. “Based on the presence/absence of 17 clinically-assessed signs and symptoms of CRPS, an overall CRPS Severity Score (CSS) was derived.” The researchers found that “CSS corresponds with and complements currently accepted dichotomous diagnostic criteria for CRPS, and support its validity as an index of CRPS severity.”

Parent Perceptions of Adolescent Pain Expression: The Adolescent Pain Behavior Questionnaire

Journal: Pain (December 2010)

Authors: Lynch-Jordan A, Kashikar-Zuck S, Goldschneider K

Purpose: The research was designed to develop and “evaluate the Adolescent Pain Behavior Questionnaire (APBQ), a parent-report measure of adolescent (11-19 years) pain expressions.”

Results: The researchers evaluated parent-adolescent “dyads seen in a multidisciplinary pain management clinic.” The participants completed the APQB and “questionnaires assessing pain characteristics, quality of life, functional disablility, depressive symptoms, and pain catastrophizing.” They found significant correlations between parent- and adolescent-reported functional disablility, pain catastrophizing, depressive symptoms, and poorer quality of life.” The authors concluded that assessing pain behaviors “provides qualitatively different information than solely recording pain intensity and disability.” This can be used in behavioral treatments to reduce disability, poor coping, and distress.

//Clinical Trials

Spinal Cord Stimulation Efficacy Measures

Study Type: Interventional

Age/Gender Requirements: 18 years (male/female)

Sponsor: New York Neurosurgery & Neuroscience Associates, PLLC

Purpose: The authors designed the study to “measure the efficacy of varying spinal cord stimulation frequencies and pulse-width settings on chronic pain management.”

Validation of the Facial and Cephalic Pain Inventory (FACE PAIN)

Study Type: Observational

Age/Gender Requirements: 18 years (male/female)

Sponsor: University of Washington

Purpose: The authors propose to “develop and validate a new instrument designed to measure facial and nasal discomfort related to chronic sinusitis. The second phase of the study will be to use this instrument to measure correlation with sinus computed tomography (CT) scans.”

An fMRI Study of Brain Response In Patients With Fibromyalgia

Study Type: Interventional

Age/Gender Requirements: 18-70 years (female)

Sponsor: Pfizer

Purpose: The researchers have two goals: “to explore how pregabalin works in patients with fibromyalgia by evaluating brain imaging signals,” and to “find out whether fMRI (functional magnetic resonance imaging) is an efficient way to show whether new pain medications are effective in treating fibromyalgia.”

From the HCPLive Network

Forget Faces and Numerical Scales; New Pain Test on the Way

A new pain tool, developed to help pain physicians better interpret the effect pain has on their patients, will be presented at the American Society of Regional Anesthesia’s 2010 Fall Conference.

Increase in Back Pain Tests and Treatments to No Avail

New research shows there has been an unnecessary increase in tests and treatments targeting back pain.

Device Focus

Rehabilicare Maxima TENS (Transcutaneous electrical nerve stimulation)

Clinical Trials

Transcutaneous Electrical Nerve Stimulation (TENS) and Fibromyalgia (FM) (TENS&FM)

Study Type: Interventional

Sponsor: University of Iowa

Age/Gender Requirements: 18-90 years (male/female)

Purpose: The study is designed to test the hypothesis that “that application of Transcutaneous Electrical Nerve Stimulation (TENS) to patients with Fibromyalgia (FM) will reduce pain, reduce central excitability by restoring diffuse noxious inhibitory controls (DNIC), and reduce temporal summation and that this decrease in pain and/or central excitability will improve function.”