Current status and future direction of pain behavior observation

Abstract

T om could tell that Mary's arthritis pain was bothering her more today. Although she didn't complain, Mary's movements were much more slow and stiff and she kept rubbing the fingers on her right hand. Because Mary's pain seemed so severe, Tom decided to cancel his plans to surprise Mary by taking her to the big college basketball game that night.Joe was eager to get back to work after his surgery and told Dr. Winter that his pain wasn't too bad and that he could handle it. Dr. Winter, however, noticed that Joe was still limping, braced himself when sitting, and grimaced when he got onto and off of the examining table. Dr. Winter increased Joe's pain medication and told him that he should not return to work for another 2 weeks.When people have pain they engage in nonverbal behaviors that communicate to others that pain is being experienced. These behaviors, called pain behaviors [1], not only serve to signal pain but can also influence the responses of significant others and health care professionals. Interestingly, as illustrated in the two cases described above, nonverbal pain behaviors are often seen as quite salient even if the person fails to report their pain or minimizes their own pain experience.Pain behaviors are overt and thus can be observed and recorded. Over the past 15 years, there has been growing interest in using pain behavior observation methods as a strategy for assessing patients with persistent pain [2,3]. The purpose of this paper is to provide an overview of the current status of pain observation methods. The paper is divided into two parts. In the first part, observation methods currently used to assess chronic pain patients are described and critically evaluated. In the second part, I highlight future directions for clinical and research applications of pain behavior observation methodologies. Pain Behavior Observation MethodsA hallmark of the behavioral approach to pain management is its emphasis on understanding and modifying pain behaviors [1]. Behaviorally oriented pain clinicians have developed and refined a number of strategies for observing pain behavior. These strategies can be grouped into two major categories: self-observation and direct observation. Self-observationIn the self-observation strategy patients can be asked to observe and record their own pain behavior. The earliest approaches to pain behavior assessment consisted of daily diaries. A good example of such diaries is a diary developed by Fordyce [1], in which patients are asked to indicate how much time each hour they spend engaging in three categories of behavior: 1) sitting, 2) standing or walking, and 3) reclining. The patient is also asked to make an Individuals who have pain engage in certain pain-related behaviors that tend to communicate their pain to others. There is growing recognition that the careful observation of such pain behaviors is an important component of a comprehensive pain assessment.This paper provides an overview of the current status of behavioral observation methods used to assess pain behavi...

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