Numerical rating scales and mechanical visual analogue scales (M-VAS) were compared for their capacity to provide ratio scale measures of experimental pain. Separate estimates of experimental pain sensation intensity and pain unpleasantness were obtained by each method, as were estimates of clinical pain. Orofacial pain patients made numerical scale and VAS ratings in response to noxious thermal stimuli (45-51 degrees C) applied for 5 sec to the forearm by a contact thermode. The derived stimulus-response function was well fit as a power function only in the case of sensory M-VAS. The power function derived from sensory M-VAS ratings predicted temperatures chosen as twice as intense as standard temperatures of 47 degrees C and 48 degrees C, thereby providing evidence for ratio scale characteristics of M-VAS. The stimulus-response function derived from sensory numerical ratings differed from that obtained with M-VAS and did not provide accurate predictions of temperatures perceived as twice intense at 47 degrees C or 48 degrees C. Both M-VAS and numerical rating scales produced reliably different stimulus response functions for pain sensation intensity as compared to pain unpleasantness and both provided consistent measures of experimental and clinical pain intensity. Finally, both mechanical and pencil-and-paper VAS produced very similar stimulus-response functions. The ratio scale properties of M-VAS combined with its ease of administration and scoring in clinical settings offer the possibility of a simple yet powerful pain measurement technology in both research and health care settings.

Ph6,f and i A n d r e w Fantl, MDSoss of urinary control can have a sigmficant impact on the psychological and social well-being of the affected individual. Research has con-L centrated on the prevalence, etiology, and management of urinary incontinence, but relatively little is known about the effects of this chronic condition on psychosocial functioning in daily life.This article reviews the literature related to psychosoaal impact of urinary incontinence in the communitydwelling adult population. The focus is on the individual with incontinence who is otherwise healthy, mentally intact, and residing independently in the community. Issues related to the definition and measurement of psychosocial impact are discussed. Relevant research findings are presented on the type and degree of psychosocial effects resulting from incontinence, differences in impact related to the underlying etiology of incontinence, and the relationship of psychosocial impact to severity measures of urinary incontinence. Recommendations for future research are also proposed. DEFINITION AND MEASUREMENT OF PSYCHOSOCIAL IMPACTUrinary incontinence has been defined as a "condition of involuntary urine loss that is a social or hygienic problem and is objectively demonstrable."' Although much attention has been focused on the objective measurements of urinary incontinence, what constitutes a "social or hygienic" problem has not been clearly characterized or defined in operational terms.Studies reporting psychosocial impact of inconti-

Different types of pain patients used visual analogue scales (VAS) to rate their level of pain sensation intensity (VAS sensory) and degree of unpleasantness (VAS affective) associated with pain experienced at its maximum, usual, and minimum intensity. Women used the same VAS to rate their labor pain during early, active, and transition phases of stage I and in pushing (stage II). Consistent with the hypothesis that the affective dimension of clinical pain can be selectively augmented by perceived degree of threat to health or life, cancer pain patients and chronic pain patients gave higher VAS affective ratings as compared to VAS sensory ratings of their clinical pain, whereas labor patients and patients exposed to experimental pain gave lower VAS affective ratings compared to their VAS sensory ratings of pain. Affective VAS but not sensory VAS ratings of pain were considerably reduced when women in labor focused on the birth of the child as compared to when they focused on their pain. The results underscore the importance of utilizing separate measures of the sensory intensity versus the affective dimension of clinical pain and provide evidence that the affective dimension of different types of clinical pain is powerfully and differentially influenced by psychological contextual factors.

The effects of 2 personality traits, extraversion and neuroticism, on experimental and clinical pain were characterized in a group of myofascial pain dysfunction (MPD) patients. Extraverts did not differ from introverts in visual analogue scale (VAS) sensory or VAS affective ratings of graded 5-sec nociceptive temperature stimuli (43-51 degrees C) nor in VAS sensory-VAS affective relationships related to their clinical pain. However, high extravert patients scored lower on affective inhibition (Pilowsky Illness Behavior Questionnaire; IBQ) compared to low extravert patients. This result is consistent with previous suggestions that extraverts inhibit overt expressions of suffering less than do introverts. High neurotic patients did not differ from low neurotic patients in their VAS sensory ratings of either experimental or clinical pain. Their VAS affective ratings of both types of pain were marginally higher as compared to low neurotic patients. As hypothesized, high neurotic score patients gave higher VAS ratings of emotions related to suffering and scored higher on items related to affective disturbance on the IBQ as compared to low neurotic score patients. Overall, the results indicate that the personality traits of neither extraversion nor neuroticism affect sensory mechanisms of nociceptive processing but appear to exert their influence by means of cognitive processes related to the ways in which people constitute the meanings and implications of pain.

Based on clinical populations, chronic orofacial pain of temporomandibular disorders (TMD) occurs more frequently (range: 2:1 to 9:1) in women than men. The reasons for this difference are not clear. The present study evaluated symptom presentation, sensitivity to pain, personality, and illness behavior in 2 samples of patients suffering with orofacial pain. Also, pain responses were studied in pain-free volunteers, controlling for experimenter-gender effects. The results showed few gender differences based on ratings of chronic or experimental pain, pain-related illness behavior, and personality. The higher ratio of women versus men seeking TMD care is consistent with greater health awareness or interest in symptoms by women than by men.