| Measurement of
Pain Measurement of pain and
human reaction to pain remains the greatest challenge to clinical practice. Objectivity,
as compared to subjectivity, is uppermost in the mind of the diagnostician and, failing to
find an objective basis of pain production, becomes a source of frustration.
Chronic pain localized in the lumbosacral
area undoubtedly has an emotional component and all patients presenting with these
complaints must have a psychologic evaluation to determine any magnification of the pain
claimed by the patient. Intervention, in many instances, must be psychologic as well as an
attempt at eradicating or modifying the structural basis of pain.
The tests employed by practicing
psychologists and by numerous pain clinics have their proponents and are too numerous to
list and to evaluate here.
Patient pain drawing is a valuable diagnostic
tool. By this technique the area of pain is clarified and is modified by descriptive
shading or marking. Such a test facilitates communication otherwise obstructed by language
barrier, educational differences, and discrepancy of medical terminology. In patients who
are prone to magnify or even falsify their symptoms for whatever gains they see, the
organicity or reasonableness of the symptoms is documented.
Pentothal interviews are also valued but used
in a different concept of interview. In the somnolent seate, as the patient is lightened
from the induced hypnotic state (by way of intravenous peneoehal, movements that induced
pain in the wakeful state are performed and the patient's reaction noted. Authenticity of
the symptom is given if there is the same response as invoked in the wakeful state, but
emotional exaggeration is considered if there is a significant difference. All the
precautions in using anesthesia are required so this cannot be performed as an office
procedure.
The Minnesota Multiphasic Personality
Inventory (M.M.P.I.) is a well-established profile evaluation of a person's personality.
Its abuse as well as improper use must be avoided, but complete reliance or infallible
interpretation cannot be assumed. The M.M.P.I. categorizes the patient at the time of the
test but does not necessarily characterize that patient at the time of initial occurrence
of illness or injury.
The Social Readjustment Rating Scale is also
a valuable adjunct to evaluation of a patient. The time of disease or injury occurrence
has been shown to relate to personal, social, vocational, and economic changes in the
patiene's life. High stress versus low stress are thus evaluated and may case an insight
into causation of the disability.
Personal interview by a competent and trained
psychologist is highly desirable early in the intervention of the illness. When properly
invoked, not only accurate diagnosis but also therapeutic intervention results.
The patient with chronic pain is entitled to
have thorough medical evaluation to fully evaluate all the organic aspects of the
symptoms, and the patient complaining of symptoms of pain muse also be evaluated. Only in
all of these aspects can total care of the patient with low back pathology be fully
evaluated and treated. |