Disclaimer: English Kinda Thing

The sole purpose of the "English Kinda Thing" is to document my attempts to correct my own mistakes in standard English usage and to share the resources I find. In no way do I attempt to teach nobody English through these blurbs--just as I intend not to teach nobody to be a neurotic and psychotic handicap in Ratology Reloaded or Down with Meds! :-)

Tuesday, May 26, 2009

The measurement of Pain and the Assessment of People Experiencing pain (Turk & Melzack, 2001)

Turk, D. C., & Melzack, R. (2001). The measurement of Pain and the Assessment of People Experiencing pain. In D. C. Turk & R. Melzack (Eds.), Handbook of Pain Assessment (pp. 3-11). New York: The Guilford Press.

"Just as 'my pain' belongs in a unique way only to me, so I am utterly alone with it. I cannot share it. I have no doubt about the reality of the pain experience, but I cannot tell anybody what I experience. I surmise that others have 'their' pain, even though I cannot perceive what they mean when they tell me about them." (Illich, 1976 cited in D.C. Turk & R. Melzack, 2001)

The associations between reported pain and physical abnormality are fairly weak. Studies have found that, while patients with significant pathology might sustain only little pain or no pain (e.g., Boden, Davis, Dina, Patronas & Wiesel, 1990; Jensen, Brant-Zawadski, Wiesel, Tsourmas, & Malkasian, Ross, 1994) there are other patients who suffered from unproportional amount of pain despite the limited amount of identified pathology (e.g., White & Gordon, 1982). In a lot of patients, physical pathology underlies their pain actually could not be identified.

Some experts suggested that results of lab tests and imaging techniques should be used as the basis of pain assessments. Again, even with techniques sophisticated like MRI scans, research studies remain to find weak associations between physical pathology and pain.

In addition, weak associations have also be reported between the degree of physical disability and functionality, of returning to work and, of treatment outcomes. It has been suggested that the observed weak correlation between "pathology, symptoms and outcome" might have something to do with the reliability of the examination procedure.

The weak correlations between pathology and pain led experts to consider whether personal factor, such as a "pain-prone personality" or "psychogenic pain" might have contributed to such a weak association. Existing research provided little evidence supporting such an argument although there might be promises associated with this area of research.

The differences among nociception, pain, pain behavior and suffering

  • Nociception: the processing of stimuli that are defined as related to the stimulation of nociceptors and capable of being interpreted as pain.
  • Pain: A perceptual process involving multiple perspectives.
  • Suffering: the interpretation and subsequent response to the perception of pain.

Interesting study by Reesor and Craig (1988): cognitive process seems to distort or amplify patients' pain experiences and suffering. Unfotunately, since I have not read this paper, I can't quite tell you yet how they came up with this conclusion about "distortion" and "amplification". One naive question I have now is... how do you come up with a baseline to make such an argument?

It is important to realize that disability is not solely a function of the extent of physical pathology or the level of pain. Disability is a complex phenomenon that multiple factors such as the physical pathology and the environmental factor. (Check the disability related articles for more information).

Like the instruments used to assess functional disability, currently, there is no single measure that has been used to assess pain and there are too many competing instruments. These instruments have often been developed for particular group of people or for particular diagnosis. In addition, even if an instrument has been validated for certain population, researchers and practitioners often select items of their interest from existing instruments to develop their own assessment. This practice, thus, would result in problems with the scale validity and reliability; in addition, it also makes it difficult to compare the results yielded by different studies.

No comments:

Post a Comment