PSY 352 Topic 4 Discussion Question 2:
Physiological measures of pain are objective ways of measuring the effects of a painful stimulus. They include methods based on the heartbeat and brainwave responses, muscle tension and changes in blood flow and hormone levels in the body. Physiological measures have some advantages over self-report; they are not subject to the idiosyncrasies of individual perception or memory. However, physiological measures have a number of disadvantages, including cost and complexity, as well as limited availability and difficulty in standardising different equipment. Behavioural assessment has long been used to measure the degree to which an individual feels pain; this is subjective but its scale can be measured easily and it is highly reliable for people with dementia. It is advantageous that behavioural assessment is non-invasive and does not require sophisticated equipment. However, behavioural assessment does not measure the physiological changes underlying a person’s pain level, which makes it difficult to confirm that pain exists if there is no objective physical abnormality present. Self-support measures or personal analgesia allow patients to self-manage their own pain by providing them with a drug or other solution that can assist them without medical intervention. It has clear advantages over medical intervention: it saves healthcare resources, allows greater freedom of movement and is simple to administer. However
Pain is one of the most common reasons for people to seek professional medical care, and pain is also a symptom that is often assessed by health professionals. Therefore, health professionals should learn to assess pain. This study provides an overview of the assessment of pain, presenting information on the main approaches that can be used to assess pain, including physiological measures (such as heart rate), behavioural measures (such as facial expressions), and self-report measures (such as questionnaires). Potential advantages and disadvantages associated with each measure are also summarised.
Physical pain is a common problem that can lead to major pain-related disability. Many people want to choose their own treatment. A physical, behavioural or self-management plan can be recommended by a provider who understands your situation and knows how to avoid any problems that may result from the painful condition or the therapy. Physiological measures are powerful ways of learning how pain affects the body at its most basic level. Behavioural assessment involves documenting a patient’s activities and understanding the patterns of coping – or not coping – with pain. It also involves identifying whether cognitive biases, such as catastrophizing, are related to greater levels of pain. Self-management plans focus more on managing pain and helping people feel more in control of their day-to-day lives.
Physiological measures are the most reliable of all pain assessment methods (Treede and Alford, 2006). However, there are ethical issues with using physiological measures because they interfere with a person’s level of functioning. Behavioural measures can be unreliable because pain behaviours may be controlled well by patients trying to preserve their self-esteem. Most behavioural assessments require an examiner to interpret behaviours as indicating no pain, indicating pain, or not indicating pain.
The use of self-report measures of pain has been popular for decades in the research environment. These measures include both physiological and behavioural assessments, and are considered by many researchers as the best approach to assess pain, and thus treatment efficacy or effectiveness (Wiggins & Ritter, 2006). However, pain is a subjective experience that is perceived differently by each person. This subjective nature of pain makes it difficult for researchers to obtain information about other’s perception of pain through behavioural measures, especially when there are no outcomes that can be measured and compared between two individuals.
Patients with chronic pain are often assessed on the basis of self-report questionnaire ratings, but these measures may mask important clinical information. It is well known that patients can have negative emotions about their pain. But to what extent does it influence the accuracy of self-report? In this article, we analyse the difference between self-report and physiological evidence for chronic musculoskeletal pain, taking into account recent work in older adults where such differences may be more marked due to sensory and cognitive functioning. We also include findings from behavioural assessment studies, which show that there are limits to what patients with chronic pain can report on themselves. Nonspecific measures of well-being (such as the SF-36) may be useful in assessing response to treatment because they are less influenced by the level of pain or disability.
Psychological factors have consistently been found to exert strong influences on experience and expression of pain. A behavioural approach is based on the premise that pain behaviour, allowing quantification and assessment of the relationship between a patient’s behaviour, knowledge and beliefs/expectations, and the effectiveness of a treatment intervention. In particular, cognitive factors have consistently been found to be of most importance in predicting responses to different treatments for chronic low back pain. Cooper LS, Webster BS, Glaser D. The effectiveness of cognitive-behaviour therapy for chronic low back pain: a meta-analytic review
Pain is a complex experience that can be assessed by several different approaches. From a physiological standpoint, skin conductance can be used as a noninvasive measure of pain. However, pain measurement behaviours are typically what patients report. Self-report measures such as the Visual Analogue Scale (VAS) and Brief Pain Inventory (BPI) have been shown to be reliable in quantifying a patient’s pain experience, but can also have limitations. For example, self-report measures tend to be subject to ceiling and floor effects resulting in decreased sensitivity and specificity when compared to psychophysical measures such as heat and pressure stimuli.
In psychophysiology, research has shown that four factors can serve as valid measures of pain: the brain’s reaction to painful stimulation, subjective evaluation of pain, observations of changes in behaviour due to the presence or absence of pain, and reports of pain after prolonged time periods. Though these measures do not directly assess each other, they are closely related. However, there have been discrepancies found among the validity coefficients presented in literature because most studies have focused on only one type of measure, while others have also combined several measures into cohesive scales. This paper presents validity coefficients for pain measures taken from literature published over three decades. Eleven separate studies were analyzed and divided into two major categories: single factor measures and multi-factor measures. The results suggest that no single psychophysiological measurement attribute is sufficient for assessing and quantifying overall clinical pain experience. Modern applications should consider the inclusion of multiple characteristics (multi-factor approaches) when designing a test battery to assess pain intensity and its associated impact on daily living activities.
There are a variety of ways to assess pain. The way in which it is assessed depends upon the nature of study and the objective of assessing pain. However all three different measures either directly or indirectly measure aspects of the individuals’ experience of pain