Measuring & Treating Pain

Pain is what the patient says it is, but treating pain effectively, requires a number of key aspects to be taken into account. Feedback from pain sufferers is essential to help healthcare professionals configure the best treatment.

Because pain is relative to the individual it does not lend itself to easy or accurate measurement. This may lead to a misinterpretation of the pain an individual is experiencing, particularly when others cannot relate the experience to themselves. During a typical medical consultation, the patient is asked to describe their own symptoms, which in turn acts as the most accurate measure for the physician to work with. The judgement as to the nature and type of pain relief to be used is guided by the adjectives the patient uses to describe its intensity (stabbing, dull, crushing, etc). The patient may also be questioned regarding its duration, location and what, if anything, they are doing to relieve the symptoms and its effectiveness. Of course if pain is then associated with a clinical condition then treatment of the condition will help to reduce or stop pain.

Once treatment is administered, the healthcare worker relies on feedback from the patient. This feedback comes directly (nurse I’m still in pain), and indirectly, e.g. from relatives or from an observation of body language. Developing a full appreciation of pain experience can be a time consuming issue. For example, Karoly (1985) states that six key elements contribute to how we perceive pain. These are:

1. Sensory (intensity, duration, location, etc)
2. Neurophysiological (heart-rate, blood pressure, EEG, etc)
3. Emotional / Motivational (anxiety, depression, anger, etc)
4. Lifestyle (relationships, sexual behaviour, marriage etc)
5. Behavioural (exercise, work, previous history)
6. Information Processing (coping style, health beliefs and knowledge, etc)

More commonly, questionnaires or scales are used. One of the simplest measures is the use of the Visual Analogue Scale (VAS) The VAS is a small plastic ruler about 12 cm long, along which the patient can slide a marker. At each end of the ruler a statement is printed. The patient is asked to slide the marker to a point that represents their level of pain. Once done, the healthcare worker simply turns the ruler over and can obtain a rough numerical guide as to how the patient feels. VAS scales, despite their simplicity, are quite accurate forms of self-reporting. Over time, the healthcare worker can establish whether or not pain is diminishing, remaining stable, or getting worse.

Pain relief then, can come from a variety of sources. Drugs, such as opiates in the form of morphine, or salicylates like aspirin or ibuprofen, are standard and effective methods. Surgery is reluctantly used as pain often re-occurs after neural pathways have been severed. Physical methods such as massage, heat or cold packs, ultra-sound or TENS machines, serve to disrupt the pain in a manner similar to changing the wavelength on a radio. Psychologists encourage new ways of thinking, particularly with chronic pain, where dwelling on pain serves to make it feel worse. Relaxation and more focused ways of thinking are acknowledged to increase effective coping skills.