Measure Pain: Is There an Equation?

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SUMMARY

This discussion centers on the complexities of measuring pain, highlighting the inadequacy of subjective pain scales like the 1-10 scale commonly used in EMS. Participants emphasize that pain is inherently subjective and varies significantly among individuals, making it challenging to create a consistent objective pain measurement system. Research into facial expressions and other indirect measures, such as vital sign monitoring, offers some insights but lacks sensitivity and specificity. The conversation also references the work of Daniel Kahneman in "Thinking, Fast and Slow," which discusses how individuals perceive and remember pain differently over time.

PREREQUISITES
  • Understanding of subjective pain assessment methods
  • Familiarity with the 1-10 pain scale used in emergency medical services (EMS)
  • Knowledge of facial expression analysis in pain assessment
  • Awareness of central nervous system (CNS) sensitization concepts
NEXT STEPS
  • Research the effectiveness of facial expression analysis in pain assessment
  • Explore the concept of CNS sensitization and its implications for pain perception
  • Study the book "Explain Pain" by David Butler for insights into pain management
  • Investigate alternative pain assessment tools beyond subjective scales
USEFUL FOR

This discussion is beneficial for healthcare professionals, particularly emergency medical technicians (EMTs), pain management specialists, and researchers interested in the subjective nature of pain and its assessment methodologies.

Psyguy22
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I was just wondering if there's a way to measure pain. I figured it'd be and equation like current. Like voltage would be the amount of pain, ohm would be a persons resistance to pain, and current would be the pain they actually felt.
 
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Psyguy22 said:
I was just wondering if there's a way to measure pain. I figured it'd be and equation like current. Like voltage would be the amount of pain, ohm would be a persons resistance to pain, and current would be the pain they actually felt.

I'm not aware of any direct electrical measurements that can assess pain, but there has been some research into using facial expressions to assist in assessing pain:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2706565/

http://www.google.com/url?sa=t&rct=...70WRKA01PXIuUW6EvUAeC7A&bvm=bv.65058239,d.aWc

Summary of various pain scales: http://pain.about.com/od/testingdiagnosis/a/pain_scales.htm

.
 
I've had various occasions to have nurses or doctors ask me how much pain I'm in and there has never been any attempt to quantify it. It was always purely subjective and I've talked to a couple of them and they agree that the answers they get to that question are utterly meaningless in any objective sense. I do think that the facial expression test mentioned about would be at least closer to realistic than just asking.
 
In EMS, we use the 1-10 scale for pain (where a 10 is the worst pain you've ever felt in your life). Yeah, for middle numbers it doesn't hold a lot of meaning, since folks' pain tolerance varies quite a bit. But for trending a patient over the time that you are working with them, it can be very helpful.

For example, if I'm called to assess a patient who is complaining of chest pain, I'll ask how long ago it started, and on the 1-10 scale, how much did it hurt then, and how much does it hurt now. I can ask the same question later in the assessment, to see if things are getting worse or holding steady for a while...

And usually, when a reliable patient says the pain is an 8 or a 9, that's a pretty big flag that things may be serious...
 
berkeman said:
In EMS, we use the 1-10 scale for pain (where a 10 is the worst pain you've ever felt in your life). Yeah, for middle numbers it doesn't hold a lot of meaning, since folks' pain tolerance varies quite a bit. But for trending a patient over the time that you are working with them, it can be very helpful.

For example, if I'm called to assess a patient who is complaining of chest pain, I'll ask how long ago it started, and on the 1-10 scale, how much did it hurt then, and how much does it hurt now. I can ask the same question later in the assessment, to see if things are getting worse or holding steady for a while...

And usually, when a reliable patient says the pain is an 8 or a 9, that's a pretty big flag that things may be serious...

pain_rating.png


http://hyperboleandahalf.blogspot.be/2010/02/boyfriend-doesnt-have-ebola-probably.html
 
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:smile:
 
The lead instructor for a Wilderness First Aid course (that I help out at) says that her "10" was a couple days of dealing with kidney stones. She has some stories that will curl your toes! :eek:
 
Brian Regan has a great bit about this:


There has also been some interesting work done on perception of pain that suggests that most people do not remember it in terms of intensity integrated over duration. Sorry I don't have any links on that. I remember reading about it in Khaneman's "Thinking Fast and Slow."
 
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Choppy said:
Brian Regan has a great bit about this:


There has also been some interesting work done on perception of pain that suggests that most people do not remember it in terms of intensity integrated over duration. Sorry I don't have any links on that. I remember reading about it in Khaneman's "Thinking Fast and Slow."


Yeah, they say that if women really remembered how painful childbirth is, they would never do it more than once. I'm just GUESSING at how painful it is, and I wouldn't want to do it EVEN once.
I think that's probably a legitimate 10.
 
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  • #10
Pain is an inherently subjective experience and may fall into the hard problem of consciousness in neuroscience. Therefore constructing a precise and consistent objective pain scale is difficult, maybe even impossible. The best we can do is what others have mentioned, subjective scales and indirect measures. The latter may involve vital sign monitoring, grimacing, infant crying and such but are not very sensitive or specific and are useful in tracking individual progress through treatment. So you can't exactly claim that two people giving a 5/10 pain rating as having he same amount of pain, but you can be more confident that a person who presents with a 9/10 rating which progresses to a 3/10 is on the right track.

Not only can two people give different ratings to similar stimuli but the same stimulus may elicit wildly different responses in an individual at different times. There is the phenomenon of CNS sensitization after acute or chronic pain, for example. You can read a little about it here: http://www.medscape.org/viewarticle/481798

For a pretty good, and fairly comprehensive, read you can check out book(s) by (David?) Butler, I think the one I have read is called Explain Pain.
 

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