Objective vs Subjective
-objective measures give us precise responses, subjective would be too broad
-an advantage of an objective measures: not as prone to bias from sufferer or interpreter,
-an advantage of a subjective measure: usually easier to gather, we are more interested in subjective concept
Thermode Test
-deliver pain to a certain radius of skin that its applied to to
-can be heat or cold, usually heat
-can start at a level, and can ramp up
-can ask person for their threshold, or their tolerance
Cold Pressor Test
-have person put their hand in for how long they can stand it
-part of the pain comes from diminished blood flow from ur hand becoming so cold it becomes ischemic
Pressure Algometry
-device where you press on a part of someones body, and you press harder and harder
-device will tell what the highest pressure it got to
Threshold
-when whatever the experience is, turns into pain
-threshold will come before tolerance
Tolerance
-person tells the participant when to stop
-must be done for ethical reasons
Latency
-Latency for them to say their threshold and tolerance
-the latency tells us (what we are measuring) is degrees (temp)
-at what temperature is ones threshold and tolerance
Threshold Problem
its hard to decide at what precise moment a sensation develops into pain, often a guess, pain is a continuum
Tolerance Problem
its entirely context dependent, external pressure, interest, initiative all bias the results
Problem w/ Tolerance and Threshold
does not account form the emotional aspect of pain, detection bias
-human pain is neither threshold or tolerance, its ongoing, its over threshold and under tolerance, tolerance max would be death so its basically irrelevant
-the biology of threshold and tolerance has very little to do with how/what ur pain is
-only appears to be objective
Numeric Pain Intensity Scale
NRS has a 0 bc its representative of no pain, can be an integer
Visual Analogue Scale
-VAS has no numbers and words only on the pegs, person marks with a pencil where they think their pain is, the stroke is measured and then compare it to NRS pegs
VAS vs NRS
-better than NRS bc its a bit more continuous, not as suggestive, VAS prevents ppl from memorizing what they told you last time so physician can see the actual progress of pain and if treatment is working or not
RIght vs Left Pegs
-the left peg is consistent as no pain
-what the right peg is can be many different things
-for the right peg, its not clear that anyone knows how to compare anything experienced to “worst pain imaginable”
FACES Scale
sed for young children, could be argued that it doesnt go high enough, theres a smile for no hurt it should be neutral, children may confuse emotion they are feeling for how much hut they have
Scales Inter-rater Reliability
-scales work very well on the same person, people are very reliable within person at being able to tell you what they want to tell you witht heir scales
-multiple scales can be used to separate components of pain, ie. unpleasantness vs intensity
-bc these things can be dissociated from one another
Problems with Ratings
-many times when ppl are giving you a rating its not the actual rating its someone trying to get you to take them seriously (high rating) or impress the physician (low rating)
-its argued that there are confounds in rating system made by how wide the range of human experience is
-ex worst pain ive ever had is a wider range for women than men (bc of childbirth), so if womens scales are bigger, it can lead to confounds
-ppl imagine pain to be worse than it actually is with the exception of childbirth
Issues w/Price Pain Ranking
-problem with Price’s experience is that thermode peak pain ratings mean nothing compared to timelines of actual pain
-some of these pain states last for different amount of time, the suffering of a level 4 for years is worse than the suffering of level 9 for a second, thats the apples to apples problem
- ppl have only experienced one or two of these things so they cant accurately compare
Components of a Pain Ranking
- Ongoing Pain
- Allodynia
- Hyperalgesia
- Functioning
FLACC Scale
-for babies
-face, legs,activity, cry, consolability
Facial Pain Scale
-when we are in pain we grimace, grimacing is almost completely invariant, hard to alter or fake
-looking for movements in parts of the face
Ekman
you can code the facial expression of every human emotion by looking at muscle pulling and movement, made FACS (facial action coding system)
McGill Pain Questionnaire Development
-divided into categories: temporal, spatial,, punctate pressure, incisive pressure, contrictive pressure, pulling pressure, bright pain, dull pain, emotional aspects of it
-had a panel of doctors and a panel of patients order the words of each category in order of least to most intense and both panels agreed
McGill Pain Questionnaire
-the patient is asked to pick the word from each category that best describes their pain, additionally asked to rate the pain on a NRS (PPI-present pain index)
-also asked about timing of pain
-asked to point out where pain is on the body map
-the pattern fo adjectives can label different types of pain disorders to diagnose
-this never really worked
