Measuring pain: not a trivial task (2017)
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A brief look at the complexity of measuring pain and its impact on function, with a particular focus on the use of actigraphy to objectively measure pain interference with daily activities. The presentation was delivered at the 2017 Johannesburg Pain Academy, a PainSA (www.painsa.org.za) organised pain-education event.
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Measuring pain: not a trivial task (2017)
- 1. Measuring pain: not a trivial task Peter Kamerman UNIVERSITY OF THE WITWATERSRAND www.painblogr.org @painblogR Johannesburg Pain Academy, 25 February 2017
- 2. www.painsa.org.za @painsouthafrica #JHBPainAcademy2017 • Information gathering • Decision making Why do we measure pain?
- 3. www.painsa.org.za @painsouthafrica #JHBPainAcademy2017 Domains of pain Pain Sensory AffectiveCognitive
- 4. www.painsa.org.za @painsouthafrica #JHBPainAcademy2017 What do you want to know: Unidimensional What do you want to know? Intensity RiskQuality Interference Visual analogue scale (VAS) Numeric rating scales (NRS) Faces Pain Scales (FPS) Actigraphy Verbal rating scales (VRS) Tampa Scale of Kinesiophobia (TSK) Brief Pain Inventory: Interference Scale (BPI-I) McGill Pain Questionnaire (MPQ) Neuropathic Pain Symptom Inventory (NPS) Tampa Scale of Kinesiophobia (TSK) Pain Catastrophizing Scale (PCS) Coping Strategies Questionnaire (CSQ)
- 5. www.painsa.org.za @painsouthafrica #JHBPainAcademy2017 What do you want to know: Multidimensional What do you want to know? Intensity Risk Quality Interfer- ence Brief Pain Inventory (BPI) Universal Pain Scale Multidimensional Pain Inventory (MPI) McGill Pain Questionnaire (MPQ) Neuropathic Pain Symptom Inventory (NPS)
- 6. www.painsa.org.za @painsouthafrica #JHBPainAcademy2017 Whatever you use, know your instrument Pain Scale Validity Reliability Utility Scale
- 7. www.painsa.org.za @painsouthafrica #JHBPainAcademy2017 Validity Validity cannot be assumed • Face validity, construct validity • Pain type • Age • Educational level / mental status • Culture
- 8. www.painsa.org.za @painsouthafrica #JHBPainAcademy2017 Validity Yasbek M, Stewart A, Becker P Conclusion: From the statistical analysis of the results, it became apparent that the subjects tested did not have an understanding of any of the three pain scales.
- 9. www.painsa.org.za @painsouthafrica #JHBPainAcademy2017 Validity In conclusion, we show significant similarity in the terms used to describe neuropathic pain in isiZulu compared to non-African languages, thus indicating that translation of existing neuropathic pain screening tools into this, and possibly other Bantu languages, is a viable option. However, the usefulness of English-language screening tools in this non-native English speaking population may be limited.
- 10. www.painsa.org.za @painsouthafrica #JHBPainAcademy2017 Validity “…men are not allowed to show their pain (physical or emotional). Expressing pain in any manner is strictly taboo as it is indicative of being weak. [Women] on the other hand, should express her level of discomfort in any way possible as it will ensure she receives help”. “…when you have pain there is high possibility that you are being bewitched…”
- 11. www.painsa.org.za @painsouthafrica #JHBPainAcademy2017 Utility Clinical vs Research Focussed vs General
- 12. www.painsa.org.za @painsouthafrica #JHBPainAcademy2017 Linearity and ratio-scaling • Are the distances between points on the scale equal? • Does the scale have a true zero?
- 13. www.painsa.org.za @painsouthafrica #JHBPainAcademy2017 He said, she said… Subjective vs Objective measures
- 14. www.painsa.org.za @painsouthafrica #JHBPainAcademy2017 Physical activity: an objective measurement?
- 15. www.painsa.org.za @painsouthafrica #JHBPainAcademy2017 Physical activity: an objective measurement? Dysmenorrhoea No dysmenorrhoea Menstruation Least pain Intermediate pain Worst painLate follicular Physicalactivity(%) 5 10 25 15 20 0 Chantler et al. J Pain 10: 38-46, 2009a
- 16. www.painsa.org.za @painsouthafrica #JHBPainAcademy2017 Physical activity: an objective measurement? Menstruation Placebo DiclofenacLate follicular Timetocompletetask(s) 70 60 50 80 Chantler et al. J Pain 10: 191-200, 2009b
- 17. www.painsa.org.za @painsouthafrica #JHBPainAcademy2017 Physical activity: an objective measurement? Chantler et al. J Pain 10: 191-200, 2009b Menstruation Placebo DiclofenacLate follicular Heartrate (beats/min) 180 160 200 140 Durationof Exercise(min) 8 6 10 4 12
- 18. www.painsa.org.za @painsouthafrica #JHBPainAcademy2017 Physical activity: an objective measurement? Wadley et al., PeerJ 4: e2464, DOI 10.7717/peerj.2464, 2016 Employed Unemployed No chronic pain Chronic pain No chronic pain Chronic pain 0 100 200 300 Timespentactiveperday(minutes)
- 19. www.painsa.org.za @painsouthafrica #JHBPainAcademy2017 • Choose your assessment method according to your requirements. • Be aware of the limitations of your assessment method. Summary
- 20. TL;DR “Science that jumps to measurement too soon is as unsound as science that ignore measurement too long.” John Rodgers (US Naval Officer)
Editor's Notes
- Validity refers to how well a test measures what it is purported to measure. Reliability is the degree to which an assessment tool produces stable and consistent results. Utility is the state of being useful, profitable, or beneficial Measurement scales are used to categorize and/or quantify variables. Four scales of measurement that are commonly used in statistical analysis: nominal, ordinal, interval, and ratio scales.
- Face Validity ascertains that the measure appears to be assessing the intended construct under study Construct Validity is used to ensure that the measure is actually measure what it is intended to measure (i.e. the construct), and not other variables
- Yasbek et al assessd: VRS, VAS, Wong-Baker
- Knowledge and understanding of English neuropathic pain descriptors by non-native English speakers was highly variable. For example, knowledge of English terms ranged from 98% (‘‘hot’’, ‘‘cold/freezing’’, ‘‘cramping’’) to 25% (‘‘pricking’’, ‘‘radiating’’, ‘‘throbbing’’). Only 42% of those who spontaneously identified numbness as a symptom in isiZulu, selected the word ‘numb’ from an English list of words.
- E.g., 60-90m QST vs 10s NRS E.g., PainDETECT for back pain (radicular vs non-radicular) or BPI / MPQ
- Is a change in pain from 5 to 3 (-40%) on an NRS the same as a change from 8 to 6 (-25%)? Is a pain of 8 twice as painful as a pain of 4? (generally VAS has linear scaling in the mild to moderate range)
- N: 12 women with and without primary dysmenorrhoea 24-hour physical activity expressed as a percentage of maximum recorded activity for each woman (mean SD)
- N: 12 women with primary dysmenorrhoea Diclofenac dose: 100mg Protocol: The test required the women to flex at the waist, lift up 1-kg weights, and carry each weight for 3.5 meters from the ground to a ledge positioned 120 mm above their heads. They carried 8 of the 1-kg weights, 1 at a time. Once all 8 of the weights were on the raised ledge, the women carried each weight back to the ground position. The women were encouraged to complete the task as quickly as possible, and their time to do so was recorded.
- N: 12 women with primary dysmenorrhoea Diclofenac dose: 100mg Protocol: A modified version of the Bruce Protocol was used. The protocol assessed the women’s ability to walk up a steep incline on a motorized treadmill. For the first 3 minutes of the test, the women walked at a speed of 2.7km/h on a 3% gradient and then at 4km/h (12% gradient) for the next 3 minutes. The women walked at 5 km/h for the remainder of the test, but the gradient was increased by 1% every 3 minutes until they were unable to continue.
- N: 31 no chronic pain, 37 with chronic pain (pain on most days for at least three months