Articles: pain-measurement.
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Research on the assessment and management of pain in infants and children has increased dramatically, with the consequence that a wide variety of behavioral, physiological, and psychological methods are now available for measuring pediatric pain. Although the criteria for a pain measure for children are identical to those required for any measuring instrument, special problems exist in pediatric pain measurement because the influence of developmental factors, previous pain experience, and parental attitudes on children's perceptions and expressions of pain is not known. This article reviews the recent advances in the measurement of pain in children, with special emphasis on the methods that satisfy the criteria for reliability and validity, the methods that can be used to assess multiple dimensions of pain, and the methods that may be appropriate for assessing all types of acute, recurrent, and chronic pediatric pain.
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The development of a new scale, the Somatic Amplification Rating Scale (SARS), for the quantification of exaggerated (nonorganic) motor, sensory, and pain responses occurring during a standardized physical examination is described. This 13-item scale, partially based on a measure of nonorganic physical signs developed by Waddell et al, was administered to 127 low-back pain patients at an outpatient pain center. ⋯ Interrater reliability of the finalized seven-item scale was excellent (R = 0.93). Finally, it was determined that patients with high SARS scores were significantly more likely to be receiving workers' compensation benefits and to endorse physical symptoms with greater intensity on psychologic testing (Symptom Checklist 90).
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In repeated clinical studies a preponderance of pain syndromes on the left side of the body has frequently been observed. Experimental studies in humans revealed a lower pain threshold on the left, nondominant side. On the other hand, some studies do not confirm this lateralization. ⋯ For pain induced by pressure, lateral asymmetry increased with pain intensity, for the other two methods it was constant. Lateral asymmetry was found in all subjects, but significant differences could only be demonstrated in female Ss. It is concluded that both gender and handedness contribute to lateral asymmetry of pain sensitivity in man.
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A short form of the McGill Pain Questionnaire (SF-MPQ) has been developed. The main component of the SF-MPQ consists of 15 descriptors (11 sensory; 4 affective) which are rated on an intensity scale as 0 = none, 1 = mild, 2 = moderate or 3 = severe. Three pain scores are derived from the sum of the intensity rank values of the words chosen for sensory, affective and total descriptors. ⋯ The correlations were consistently high and significant. The SF-MPQ was also shown to be sufficiently sensitive to demonstrate differences due to treatment at statistical levels comparable to those obtained with the standard form. The SF-MPQ shows promise as a useful tool in situations in which the standard MPQ takes too long to administer, yet qualitative information is desired and the PPI and VAS are inadequate.
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This article reviews the methods currently in use for the measurement of chronic pain. The most important items for inclusion in questionnaires about the history and in pain diaries to elicit data on the time-course of pain are presented, and both the aims and the advantages and disadvantages of various strategies are discussed. The documentation of chronic pain in outpatients would allow answers to some questions concerned with medical epidemiology if practiced in a large number of therapeutic institutions, especially if the data were processed and evaluated by microcomputer.