Measuring and Treating Pain:  Selected Scales and Tools  

Paul Pursley PT

January 9, 2006

Prevalence of Pain

n      Pain as primary complaint

¡      Clinic dependent, 60-90%   

n      Pain as limiting factor for work    

n      Pain as limiting factor for sport

Scales for Measuring Pain

n      Verbal Descriptor Scale

n      Faces Pain Scale

n      Iowa Pain Thermometer

n      Numeric Rating Scale

FACES Pain Scale

Integrated Pain Scales

n      Shoulder

¡      SPADI

¡      UCLA

n      Knee

¡      KOOS

¡      WOMAC

Shoulder Pain and Disability Index (SPADI)

n      Two item sub-scales: Pain and Disability

n      Higher scores=greater pain and greater disability

n      Good internal consistency

n      Inconsistent factor loading

n      Patients may not distinguish well between pain and function

UCLA Shoulder Scale

n      Two sub-scales: Pain and Functional Level

n      Higher scores indicate less pain and greater function

n      Minimal testing for validity and reliability

n      Single item scales=less reliability than multiple item scales

Knee Injury and Osteoarthritis Outcomes Score (KOOS)

n      Assesses 5 outcomes: Pain, Symptoms, ADL’s, Sport and Recreation Function, and Knee related quality of life

n      42 self-administered questions

n      Good reliability, internal consistency, validity

n      Useful for osteoarthritis, TKA, PFA

Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC)

n      Measures Pain, Stiffness, and Physical Function

n      Test-Retest Reliability >.80 for pain and function sub-scales

n      Questionable validity of stiffness sub-scale

Bias in Pain Reporting

n      Gender

n      Race

n      Athletic Population?

Gender Differences

n      Males report less pain and greater “stoicism” with standard noxious stimuli

n      Pain threshold and rating may be related to phase of menstrual cycle for female reporting

Race Differences   

n      Caucasian, African-American, and Hispanic

n      No difference in number or intensity of reported painful episodes

n      Site differences

n      Differences noted in coping strategy

Race Differences   

n      Multiple presentations of pain

¡      Ischemic

¡      Heat

¡      Cold Pressor

n      No difference in pain threshold

n      African-Americans were less tolerant of painful stimuli

Therapeutic Intervention for Pain

n      Electrical Stimulation

¡      NMES

¡      TENS

n      Tissue Mobilization

¡      A/AAROM

¡      Soft tissue/Myofascial release

¡      Joint mobilization

Transcutaneous Electrical Stimulation (TENS)

n       Effect of the Frequency of TENS on the Postoperative Opiod Analgesic Requirment and Recovery Profile.  Anesthiology.  91(5):1232.  Nov 1999  Hamza, Mohamed A, White, Paul, Ahmed Hesham E, Ghoname El-sayed A

Therapeutic Intervention for Pain

n      Neuromuscular Electrical Stimulation

¡      12 week home protocol

¡      Muscle contraction-10 to 20% MVC, progressing to 40% MVC weeks 9-12

¡      Short-term pain reduction following NMES

NMES

Therapeutic Intervention for Pain

n      Tissue Mobilization

¡      Soft tissue

¡      A/AAROM

¡      Myofascial Release-Barnes/Cyriax

What do we do next?

n      Early education

¡      Young gymnasts’ understanding of sport-related pain: a contribution to prevention of injury.  Nemeth RL, von Baeyer CL, Rocha EM.  Child: Care, Health & Development 31(5): 615-25, 2005 Sep.