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Measurement of pain
Abstract
Pain is a personal, subjective experience influenced by cultural learning, the meaning of the situation, attention, and other psychological variables.77 Pain processes do not begin with the stimulation of receptors. Rather, injury or disease produces neural signals that enter an active nervous system that (in adults) is the substrate of past experience, culture, anxiety, and depression. These brain processes actively participate in the selection, abstraction, and synthesis of information from the total sensory input. Pain, then, is not simply the end product of a linear sensory transmission system; rather, it is a dynamic process that involves continuous interactions among complex ascending and descending systems.
... The VAS and NRS are frequently used in clinical practice [6] but have certain limitations. These measures are subjective and may be affected by factors other than pain, such as mood [11][12][13]. This can lead to an inaccurate assessment of treatments' effectiveness in clinical studies and daily practice. ...
Chronic pain affects over 50 million people in the United States, particularly older adults, making effective assessment and treatment essential in primary care. Actigraphy, which monitors and records limb movement to estimate wakefulness and sleep, has emerged as a valuable tool for assessing pain by providing insights into activity patterns. This review highlights the non-invasive, cost-effective nature of actigraphy in pain monitoring, along with its ability to offer continuous, detailed data on patient movement. However, actigraphy’s reliance on physical activity as a proxy for pain, and its inability to directly measure pain intensity, limit its applicability to certain pain types, such as neuropathic pain. Further research is needed to overcome these limitations and to improve the effectiveness of actigraphy in diverse clinical settings.
This chapter introduces key concepts of nociception and pain. Therefore, it delves into current research on automatic pain assessment (APA), exploring a variety of techniques that aim to objectively measure pain through behavioral-based approaches such as speech analysis, and facial expression recognition, and neurophysiology-based pain detection methods such as electrodermal activity, electroencephalography, electrocardiography, photoplethysmography, functional magnetic resonance imaging, and other approaches. For each technique, it reviews the latest advancements in machine learning models used for pain detection and the challenges associated with assessing pain. Additionally, this chapter also discusses the limitations of current APA technologies, such as variability in individual pain responses and the influence of external factors. On these bases, this chapter offers perspectives and proposes multimodal frameworks for continuous and non-invasive pain monitoring, such as the “Pain Holter” concept. It concludes by emphasizing the need for rigorous validation studies and the future potential of these tools to support more personalized and accurate pain management.
It remains unclear whether exercises leading to different outcomes of delayed onset muscle soreness (DOMS) may also elicit different skin temperature responses. The aim of this study was to determine whether different intensities and volumes of a single-joint exercise influence the DOMS and skin temperature measurements differently in healthy adults. Thirty-nine men and women were randomly assigned to three groups performing different exercise of different intensities and volumes (Exhaustion, Fatigue, Submaximal) to induce DOMS in the biceps brachii. DOMS (numeric pain rate scale, NPRS), pressure pain threshold (PPT) and skin temperature (infrared thermography, IRT) were measured on exercise day and 48 h later. The different exercises resulted in lower PPT responses 48 h after exercise and different DOMS reported across the different groups. Skin temperature outcomes did not differ following the different protocols. We found an increased minimum skin temperature 48 h after exercise in groups performing more intense exercises, but such differences were found in both exercised and non-exercised arms. Differently of PPT outcomes, pain reported depended on exercise intensity, and skin temperature 48 h after exercise could not show acute exercise adaptations. Skin temperature responses are contingent upon the characteristics of the participants rather than exercise intensity.
Introduction:
Low back pain (LBP) is a prevalent and multifaceted health condition affecting over 619 million people globally. Today, pain evaluation heavily relies on subjective measures, so more advanced diagnosis and treatment methods are required. Electrodermal activity (EDA) could represent a potential objective tool to assess LBP. Despite its promise, EDA has been less studied in this context, and the methodologies vary across studies. The systematic review described thus aims to determine the relationship between EDA and LBP as well as the potential utility of EDA as a tool for evaluating LBP. The various EDA measurement methodologies employed to detect LBP will also be analysed to ultimately identify the most reliable and effective approaches.
Methods and analysis:
The primary databases include PubMed, Web of Science (all databases) and Scopus. The search strategy will be tailored to identify articles written in English or Spanish without imposing any time restrictions. The snowballing technique will also be used to identify additional studies by reviewing the reference lists of relevant articles or citing articles.
Eligible studies will encompass adults with both acute and chronic LBP. A diverse range of research designs will be considered, focusing on the relationship between EDA and LBP. PEDro scale and Cochrane Risk of Bias tool 2.0 (RoB2) will be used to assess the methodological quality and risk of bias in the studies, respectively. Data synthesis will be based on a structured presentation of participant characteristics, methodological details and EDA-related variables.
Ethics and dissemination:
This protocol of systematic review, registered in the International Prospective Register of Systematic Reviews, adheres to the PRISMA checklist. The study findings will be disseminated through publication in peer-reviewed journals. The search process is forecast to end on 30 November 2024. Adhering to Spanish guidelines, ethical approval is deemed unnecessary for our secondary analyses, given the de-identification and anonymous analysis of all data.
PROSPERO registration number
CRD42023464812.
Background
The Central Sensitization Inventory (CSI) is a patient-reported screening instrument that can be used to identify and assess central sensitization (CS)/Central Sensitization Syndrome (CSS)-related symptoms.
Objective
The aim was to translate the CSI into Arabic (CSI-Ar) and to subsequently validate its psychometric properties.
Design
Cross-sectional.
Methods
The CSI was translated and cross-culturally adapted into Arabic, and validated following international standardized guidelines. This study included patients with chronic musculoskeletal pain ( n = 264) and healthy control participants ( n = 56). Patients completed the CSI-Ar, Pain Catastrophizing Scale (PCS), Depression, Anxiety, and Stress scale (DASS-21), Tampa Scale of Kinesiophobia (TSK), and 5-level EuroQol-5D (EQ-5D). Patients completed the CSI-Ar twice to assess test–retest reliability. To evaluate discriminative validity, healthy controls participants completed the CSI-Ar. Statistical analyses were conducted to test the internal consistency, reliability, and structural, construct and discriminant validity of CSI-Ar.
Results
The CSI-Ar showed acceptable internal consistency (Cronbach’s alpha = 0.919) and excellent test–retest reliability (intraclass correlation coefficient = 0.874). The CSI-Ar scale had significant correlations ( P < 0.001) with all PCS subscales and total score (Spearman’s rho = 0.459–0.563, P < 0.001), all DASS-21 subscales and total score (Spearman’s rho = 0.599–0.685, P < 0.001), the TSK (Spearman’s rho = 0.395, P < 0.001), and the EQ-5D (Spearman’s rho = −0.396, P < 0.001). The Mann-Whitney U-test showed a statistically significant difference between the patient group and the healthy control group ( P < 0.001), with the healthy controls displaying a lower average CSI-Ar score (12.27 ± 11.50) when compared to the patient group (27.97 ± 16.08). Factor analysis indicated that the CSI-Ar is a unidimensional tool.
Conclusion
The CSI-Ar is a reliable and valid screening tool that can be used to assess CS/CSS-related symptoms in Arabic-speaking people with chronic musculoskeletal pain.
Purpose
To assess patients’ perceptions of their abdominal wall following extensile anterolateral approaches to the thoracolumbar spine for adult spinal deformity (ASD) using validated questionnaires.
Methods
Adults who underwent anterior–posterior thoracolumbar spinal operations to the pelvis for ASD in which the anterior fusion was performed through an extensile anterolateral approach were reviewed. Three questionnaires were administered at least 1 year following surgery and included The Abdominal Core Health Quality Collaborative Survey (AHS-QC), The Patient Scar Assessment Scale (PSAS), and The Anterior Abdominal Incision Questionnaire (AAIQ).
Results
Fifty-one patients (80.4% female, median age 65 years) were included. Average follow-up was 2.8 ± 1.7 years. Average number of anterior fusion levels was 3.5 ± 1.4. Patients achieved high satisfaction rates from surgery (74.5%). AAIQ responses included postoperative pain (33.3%), bulging (41.7%), and limitations in daily activities (18.8%) with only 15.7% experienced moderate–severe pain related to their incisions and only 6.3% seeking treatment for their scars. Post-operatively, 63.2% had a neutral or improved self-image of their torso and trunk, while only 10.2% stating it was much worse. Patients’ overall opinion of their scar compared to their normal skin was very positive [average 2.75 ± 2.93 (10 = worst possible scar)]. Favorable scores were also reported for color difference, stiffness, change in thickness, and irregularity in their abdominal scar compared to normal skin.
Conclusions
Following extensile anterolateral approaches to the thoracolumbar spine for ASD, the majority of patients reported mild pain, mild functional limitations, good cosmesis, and high satisfaction rates with their anterior incisions based on validated questionnaires.
Purpose
To validate and assess the cross‐sectional adaptation of the modified Cincinnati knee rating system (MCRKS) Persian translation.
Methods
To assess test‐pretest reliability, 102 participants were asked to fill out the MCRKS (Per) scale after anterior cruciate ligament (ACL) reconstruction surgery. Internal consistency (Cronbach's α), reliability (intraclass correlation coefficients), construct validity (Pearson's r) and sensitivity (floor/ceiling effect) were determined. In addition, patients completed other relevant measures as the ACL return to sports after injury (ACL‐RSI) survey, hospital for special surgery ACL satisfaction survey (HSS ACL‐SS), visual analogue scale (VAS) of pain and patient's satisfaction, Tegner activity score (TAS), single assessment numeric evaluation, and Lysholm score.
Results
Using MCRKS (Per), the internal consistency (Cronbach's α) was 0.9 (if item deleted: 0.81–0.86); the construct validity (Pearson's r) varied between –0.50 (for VAS pain scale) and 0.79 (for Lysholm score); the reliability (ICC value) varied between 0.82 and 0.97; furthermore, no ceiling or floor effect was present.
Conclusion
The MCRKS (Per) has adequate measurement properties and is considered a valid, reliable and sensitive instrument which can identify clinical outcomes after ACLR surgery.
Level of Evidence
Level IV.
Subjective experience of pain and disability was assessed for 4-5 weeks on a weekly basis in 14 consecutive out-patients complaining of low-back pain and/or leg pain that had lasted for at least 6 months. The following measures were used for assessment: a visual analogue scale (VAS) (present pain and worst pain during preceding 2 weeks), a short-form McGill Pain Questionnaire (SF-MPQ), the Pain Disability Index (PDI) and the pain drawing. In addition, psychological variables of pain experience were evaluated with the Comprehensible Psychopathological Rating Scale (CPRS). When the median of the variation coefficient for repeated measures was compared, the most stable measures were, in rank order: PDI, total number of words chosen in the SF-MPQ and worst pain during the preceding two weeks (VAS). The Spearman correlation showed statistically significant intercorrelation for present pain assessed with the VAS score, for the sensory word score of the SF-MPQ and for the PDI. Especially the PDI, which represents a global score for disability, showed very little test-retest variability and a high intercorrelation with the other methods of assessment, i.e. the pain drawing, the VAS scale for pain and the SF-MPQ
Recent studies of the relationship between age and the intensity of chronic pain report increases, decreases or no change in pain intensity as a function of age. These inconsistencies may be due in part to the pain assessment tools employed and their appropriateness with different age groups.
OBJECTIVES: To assess age differences in chronic pain by using several measures of pain intensity and a multidimensional measure of pain qualities in the same sample; to assess the consistency of pain intensity estimates obtained from different scales within age groups; to determine whether the failure rates for appropriately completing the scale (such as choosing more than one descriptor or making more than one mark on the Visual Analog Scale [VAS]) differ among age groups.
SUBJECTS: Seventy-nine adults aged 27 to 79 years with chronic arthritis pain.
MEASUREMENTS: The unidimensional pain intensity scales used were the VAS, the Verbal Descriptor Scale and the Behavioural Rating Scale. The multidimensional pain scale used was the short form McGill Pain Questionnaire (SF-MPQ). The Beck Depression Inventory was also administered.
RESULTS: Age-related decreases were found in the sensory and affective dimensions of chronic pain as measured with the SF-MPQ. No age differences in pain intensity were measured with any of the unidimensional scales. These results were maintained after controlling for the effects of concurrent depressive symptomatology. Pain intensity estimates differed within groups, with verbal descriptors yielding the most consistent estimates in the elderly group. The elderly were significantly more likely to fail on the VAS than younger subjects. There were no age differences on any other measure.
CONCLUSIONS: There may be age-related changes in the quality but not in the intensity of chronic arthritis pain. Implications for clinical pain assessment in the elderly are discussed.
The occurrence of a stroke in children and adolescents constitutes a rare, critical event that is associated with substantial morbidity and mortality. In addition to the individual suffering for the young patient and the medical burden for the affected family, a stroke is also associated with high follow-up costs for the health system because of the necessary long-term rehabilitative treatment. Establishing an early and prompt diagnosis is of great therapeutic importance. Because of the rarity of the illness and the plethora of clinical manifestations, diagnosis is often delayed. The most frequent clinical presentation is an acute focal-neurological deficit, usually in the form of hemiparesis, but headache, seizures or alteration of consciousness may also be seen. Nowadays, the prompt performance of diffusion-weighted, blood-sensitive magnetic resonance imaging (MRI) constitutes the gold standard. The most relevant risk factors for the occurrence of a stroke in this age cohort are vasculopathies, infections, pathological cardiac conditions or coagulopathies. Recurrence of stroke is dependent on the underlying risk factors. In a substantial percentage of patients, residual neurological deficits are seen.Owing to a lack of randomized controlled trials in children and adolescents with stroke, the optimal treatment approach is still under debate. In addition to anti-platelet medication and heparinization, systematic intravenous thrombolysis and endovascular thrombectomy are other potentially effective treatment options. The long-term prognosis in children is dependent on establishing a correct, early diagnosis.
