The Difficult Task of Assessing Pain

Abstract

Edited by Dennis C. Turk and Ronald Melzack Published by Guilford Publications, New York, NY, 2001 798 pages, $75.00 How does one measure the subjective sensation termed pain? It is this simple question that has baffled scientists and clinicians for decades. With the nationwide movement to make pain the “fifth vital sign,” we focus more intensely on this question. The answer seems more elusive than ever as we are overwhelmed by the enormity of the task. Quantifying nociceptive intensity, the processing of this signal by higher brain centers and, finally, the suffering component of the experience is a daunting endeavor. The latter is possibly the most difficult, given the wide variety of factors that impact on a patient's sense of suffering. Psychosocial variables play into the experience of pain just as significantly as the nociceptive signal intensity. Unfortunately, we don't have the “black box,” with wires connected to the patient, reading out a real-time digital display of the pain experience. But what we can have at our fingertips is the second edition of the Handbook of Pain Assessment, edited by Dennis Turk, PhD and Ronald Melzack, PhD. The book is divided in to six parts, comprising 36 chapters, written by a total of 59 authors mainly from the United States and Canada. In the Introduction, Drs. Turk and Melzack address the complexity of the task of “measuring pain.” Part I devotes seven chapters to the actual measurement of pain, including self-report scales, the McGill Pain Questionnaire, complicating factors in pain assessment scales, and peripheral and central nervous system physiological measurements of nociceptive input. Specific chapters are devoted to assessment of pain in children, the elderly, and those with impaired communication skills. Part II consists of two chapters discussing assessment of pain by observing the patient's behavioral expressions. Part III attempts to cover the broad subject of Medical and Physical Evaluation of Patients with Pain in four chapters. An exhaustive review of this subject could fill a two-volume book, therefore these chapters focus on assessing function in low back pain, physical therapy assessment, diagnostic blocks and disability evaluation. Part IV focuses on the psychological evaluation of pain patients, including assessment of specific psychiatric disorders, self-report instruments, coping skills, social support networks, and two interesting chapters on pre-surgical psychological screening and the matching of treatment to assessment in chronic pain patients. Part V includes chapters on assessment of specific pain syndromes, such as low back pain, headache, orofacial pain, myofascial pain, neuropathic pain states, complex regional pain syndromes, pelvic pain and cancer pain. These chapters are well-written, but vary widely in their focus on physical assessment (chapter 27 on Neuropathic Pain) versus psychological assessment (chapter 28 on Complex Regional Pain Syndrome) for each condition. Finally, Part VI discusses methodological issues, such as study methods, assessing treatment outcomes and clinical trial methodology. The editors conclude the book with a chapter looking at the future trends in human pain assessment. For any pain practitioner who is interested in assessing pain and the resulting treatment outcomes of their patients, this book is an important addition to their library. The fact that there is a heavy emphasis on the psychological assessment of pain reflects the importance of this aspect of the pain experience. Because many pain practitioners are anesthesiologists or neurologists with little to no educational training in psychological disciplines, this book provides a concise review of the psychological variables in pain assessment. And until we have the “black box,” measuring an individual's pain intensity as the culmination of nociception and suffering, the pain assessment tools discussed in this well-written handbook are the state-of-the-art.