Physiological and Psychological Measures of Pain

Physiological measures of pain: Muscle tension is associated with painful conditions such as headaches and lower backache, and it can be measured using an electromyograph (EMG). This apparatus measures electrical activity in the muscles, which is a sign of how tense they are. Some link has been established between headaches and EMG patterns, but EMG recordings do not generally correlate with pain perception (Chapman et al 1985) and EMG measurements have not been shown to be a useful way of measuring pain. Another approach has been to relate pain to autonomic arousal. By taking measures of pulse rate, skin conductance and skin temperature, it may be possible to measure the physiological arousal caused by experiencing pain. Finally, since pain is perceived within the brain, it may he possible to measure brain activity, using an electroencephalograph (EEG), in order to determine the extent to which an individual is experiencing pain. It has been shown that subjective reports of pain do correlate with electrical changes that show up as peaks in EEG recordings. Moreover, when analgesics are given, both pain report and waveform amplitude on the EEG are decreased (Chapman et al, 1985). Observations of pain behaviours: People tend to behave in certain ways when they are in pain; observing such behaviour could provide a means of assessing pain. Turk, Wack and Kerns (1985) have provided a classification of observable pain behaviours. Facial /audible expression of distress: grimacing and teeth clenching; moaning and sighing. Distorted ambulation or posture: limping or walking with a stoop; moving slowly or carefully to protect an injury; supporting, rubbing or holding a painful spot; frequently shifting position. Negative affect: feeling irritable; asking for help in walking, or to be excused from activities; asking questions like Why did this happen to me?

 Avoidance of activity: lying down frequently; avoiding physical activity; using a prosthetic device. UAB Pain Behaviour Scale: A commonly used example of an observation tool for, assessing pain behaviour is the UAB Pain Behaviour Scale designed by Richards et al (1982). This scale consists of ten target behaviours and observers have to rate how frequently each occurs. The UAB is easy to use and quick to score; it has scored well on inter-rater and test-retest reliability.

Turk et al (1983)
Turk et al (1983) describe techniques that someone living with the patient (the observer) can use to provide a record of their pain behaviour. These include asking the observer to keep a pain diary, which includes a record of when the patient is in pain and for how long, how the observer recognized the pain, what the observer thought and felt at the time, and how the observer attempted to help the patient alleviate the pain.

Criticisms
Criticism of this questionnaire centres on the need to have extensive understanding of the English language e.g. discriminate between words such as "Smarting" and "Stinging The issue of reliability has been addressed in numerous reports, particularly as it concerns the VAS and the McGill Pain Questionnaire. These reports do not lead to a consensus on reliability of these measurements. They suggest that reliability varies based on the patient groups that were examined for pain. A difficult aspect of reliability is that the patient may have developed a different understanding of the pain problem and may give a different response from one examination to the next. It is equally important for the examiner to ask himself or herself whether the interpretation of the patient's responses differs from one examination to the next. Both factors affect the reliability of the information being gathered.

 Perhaps it is worthwhile to re-examine the concepts of subjective and objective measurements. It could be argued that pain is a subjective phenomenon, but if it is measured reliably, the quality of the measurement would be objective.