Wednesday, June 3, 2009

Da model to assess pain

I am reading this chapter in the Handbook of pain. Although I have yet to finish the chapter, I came up with thoughts in purple texts when trying to understand the above based on my painful mental model... 8-O lol sigh

In this chapter, the authors adopted the pain context model within which pain is considered as a latent construct, similar to depression or anxiety, that cannot be observed directly and can only be inferred. At the same time, when it comes to the measurement of latent constructs, all too often, even the best measures or indicators might not be closely related. It is because the components of the same construct might not always occur synchronously or in the same configuration.

For instance, some people might report pain but not manifest non-verbal pain behavior; other people might manifest non-verbal pain behavior but do not report pain; still others might show non-verbal pain behavior and report pain at the same time.

Due to the multidimensional nature of pain, we have to identify the relevant dimensions before we could proceed with its measurement. Despite the discrepancies among the different measures available in the market, four dimensions are currently assessed in all patients including the intensity (e.g., 7 on a 10 point scale), affect (e.g., distress), quality (e.g., dull, sharp) and location (e.g., cervical, lumbar, finger) of pain. Among these four dimensions, pain affect is possibly more complex than the rest. It is because pain affect is a mental state triggered by the individual appraisal of the threat; it, thus, could be manifested as a heterogeneous group of emotional reactions.

This reminds me of a conversation I had with my workers’ com adjuster. I called her while I was really in pain and found myself inable to lift my feet or something like that. So she talked and talked… till I had to tell her to slow down because I was in really bad pain and could not process what she was saying when she was speaking so very fast. She replied, “I didn’t know because you sound fine.”

Take, also, for example, my day today. Other than the occasional verbal cues such as “Ouch”… People couldn’t really tell that I am in pain despite the fact that the pain seemed to be flowing at their will—weak or strong, sharp or dull, in my neck, back or finger tip.

In addition, it also reminds me of the story Jan told me about this patient who was highly sensitive to pain. After she was administered global anesthesia and when the doctors were trying to apply local anesthesia on her eye lid, even when she was absolutely out of it… she actually still showed non-verbal painful expression. 8-O

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