Assessment of adult cancer pain: Shortcomings of current methods

Abstract

The evaluation of cancer pain remains a problematic clinical problem, not only due to the subjective and multidimensional nature of pain per se, but also because of its specific characteristics. Cancer pain has an insidious onset, often involves many sites, and is frequently multicausal. Tools have been developed to quantify pain, the most commonly used being the verbal rating scale (VRS), the visual analogue scale (VAS), and the McGill Pain Questionnaire (MPO). The first 2 scales are short, easy to administer and to score, but only measure pain intensity. The VRS is assumed to be an ordinal scale although unequal differences between pain descriptors have been demonstrated; it offers a restrictive choice of words that may not represent pain experience with sufficient precision, and is not sensitive to change especially for mild pain. The VAS on the other hand, represents pain as a continuum and is sensitive to change. The MPQ has the advantage of evaluating the sensory, affective and evaluative dimensions of pain. However, it is lengthy to administer and some words are not readily understandable. In addition, the words within a given category are considered to be equidistant, the number of words in each category are unequal, and the number of categories evaluating a given dimension are not taken into account when calculating the total pain rating index. A further issue in assessing pain, other than the choice of a valid and reliable tool, is the frequency with which pain evaluations should be repeated. To date no studies have addressed this problem.(ABSTRACT TRUNCATED AT 250 WORDS)

Pain experience during initial alignment with three types of nickel-titanium archwires: A prospective clinical trial

“…25,26 When compared to other pain/discomfort assessment methods like the verbal rating scales, VAS is more precise and demonstrates better sensitivity between small changes in pain intensity. 27,28 The general time-course of pain intensity concurs with previous studies as the pain level peaked within the first 2 days after archwire insertion, and then gradually declined to near baseline levels 6 to 7 days postoperatively, 4,5,16,17 which indicates that any differences in pain/discomfort are likely to be minimal after 7 days. This observed pain time-course correlates well with the underlying biologic response to orthodontic forces.…”

Pain and dysesthesia in patients with spinal cord injury: A postal survey

“…17 Two scoring systems have been developed in an attempt to consider the true relative intensity of the pain descriptors. 19,20 For comparison with other studies we have used both these scoring systems. The rank values within the subclasses were therefore adjusted between 0% and 100% as suggested by Deschamps et al 19 and converted to weighted-rank values which are equivalent to scale values as suggested by Melzack et al 20 Finally patients were asked a few questions regarding P/D above lesion.…”

The Significance of Intrathecal Opioid Therapy for the Treatment of Neuropathic Cancer Pain Conditions

“…It has been discussed whether or not the dosage of the orally taken opioid medication could predict success [13,14]. Rather the opioid sensitivity of the individual patient, disease progression, pain characteristics and treatment structures must be considered as predictors of a promising pain therapy [14].…”