Pain: measuring pain

Psychology A2 · Health Psychology. The idea in plain words, the rules to remember, the mistake to avoid and a worked example, written and checked by Mega Lecture.

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The idea

Pain cannot be seen, so it has to be measured indirectly. Self-report measures ask the patient. In a clinical interview the patient describes the pain in their own words, which gives rich qualitative data. The McGill pain questionnaire offers lists of words to choose from, and a visual analogue scale is a line on which the patient marks how strong the pain is.

Behavioural measures do not ask the patient. In the UAB pain behaviour scale a trained observer scores what the patient does.

Brudvik et al. (2016) compared ratings of the same child's pain by the child, a parent and a physician in an outpatient emergency department in Norway. Physicians rated the pain lower than the children did.

Rules to remember

Clinical interview: open questions about where the pain is, what it feels like and how it affects life; qualitative and idiographic.
McGill pain questionnaire (Melzack): words in sensory, affective and evaluative groups (plus miscellaneous), giving a pain rating index.
Sensory = what it feels like (burning); affective = emotional effect (exhausting); evaluative = overall strength (unbearable).
Visual analogue scale: a line, usually 10 cm, from 'no pain' to 'worst pain'; the score is the distance from the 'no pain' end.
UAB pain behaviour scale: an observer scores 10 behaviours (such as grimacing, limping, verbal complaints) as 0, 0.5 or 1, giving a total out of 10.
Brudvik et al. (2016): physicians underestimated children's pain most; parents' ratings were closer to the child's; pain relief was not given often enough.
Psychometric tests give quantitative data that can be compared across patients (nomothetic).

Common mistake

Do not call the UAB scale a self-report. The patient is not asked anything: an observer scores behaviour. It can lack validity for people who hide their pain.

Worked example

A nurse wants to know how pain affects one patient's sleep, work and mood, in the patient's own words. Which measure should she choose?

A visual analogue scale gives only one number for intensity, so it cannot show effects on daily life.
The UAB scale records behaviour seen by an observer, not the patient's own words.
A clinical interview uses open questions, so the patient can describe the effects in detail.

Answer: A clinical interview, because it gives detailed qualitative data about that individual.

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