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The Complexities of Measuring Pain 

The Complexities of Measuring Pain
The Complexities of Measuring Pain
Pain: Dynamics and Complexities

Daniel M. Doleys


The nature of the problem of measuring a ‘subjective’ phenomenon is presented. The apparent lack of an ‘objective’ measure, the absence of any ‘litmus’ test for pain leaves the patient vulnerable to the biases of the evaluator. Various approaches to the assessment of pain have included. The numerical rating scale, visual analogue scale, scales for children and nonverbal patients, the McGill Pain Questionnaire, and Brief Pain Inventory, among others are described. Behavioral based assessment tools, questionnaires focusing of coping skills, catastrophizing, and acceptance are summarized. The difference in nociceptive vs. pain generators must be recognized. Psychological factors play a critical in chronic pain. The unique problems encounter when assessing the elderly, cognitively impairment, nonverbal patients, and infants present unique problems. Narrative analysis may have some unrecognized advantages. There is a brief discussion of systems theory and the concepts of chaos and nonlinearity as they may apply to pain assessment. Apkarian’s study using fractal analysis in the chronic pain population is reviewed. Chapman et al’s discussion of a supersystem with nested subsystems (nervous, endocrine, and immune) is illustrated. The attempt is to encourage the reader to look beyond mere scientific reductionism and materialism in our efforts to define, understand and measure ‘pain’.

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