Skip to main content

Advertisement

SpringerLink
Log in

Pain assessment

  • Review
  • Published:
European Spine Journal Aims and scope Submit manuscript

Abstract

Pain usually is the major complaint of patients with problems of the back, thus making pain evaluation a fundamental requisite in the outcome assessment in spinal surgery. Pain intensity, pain-related disability, pain duration and pain affect are the aspects that define pain and its effects. For each of these aspects, different assessment instruments exist and are discussed in terms of advantages and disadvantages. Risk factors for the development of chronic pain have been a major topic in pain research in the past two decades. Now, it has been realised that psychological and psychosocial factors may substantially influence pain perception in patients with chronic pain and thus may influence the surgical outcome. With this background, pain acceptance, pain tolerance and pain-related anxiety as factors influencing coping strategies are discussed. Finally, a recommendation for a minimum as well as for a more comprehensive pain assessment is given.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. (2000) Glossary. Spine 25:3200–3202

  2. Von Baeyer CL, Bergstrom KJ, Brodwin MG, Brodwin SK (1983) Invalid use of pain drawings in psychological screening of back pain patients. Pain 16:103–107

    Article  Google Scholar 

  3. Beaton DE (2000) Understanding the relevance of measured change through studies of responsiveness. Spine 25:3192–3199

    Article  PubMed  CAS  Google Scholar 

  4. Bergstrom G, Jensen IB, Bodin L, Linton SJ, Nygren AL, Carlsson SG (1998) Reliability and factor structure of the multidimensional pain inventory—Swedish language version (MPI-S). Pain 75:101–110

    Article  PubMed  CAS  Google Scholar 

  5. Bird SB, Dickson EW (2001) Clinically significant changes in pain along the visual analog scale. Ann Emerg Med 38:639–643

    Article  PubMed  CAS  Google Scholar 

  6. Block AR, Ohnmeiss DD, Guyer RD, Rashbaum RF, Hochschuler SH (2001) The use of presurgical psychological screening to predict the outcome of spine surgery. Spine J 1:274–282

    Article  PubMed  CAS  Google Scholar 

  7. Bolton JE (1999) Accuracy of recall of usual pain intensity in back pain patients. Pain 83:533–539

    Article  PubMed  CAS  Google Scholar 

  8. Bolton JE, Wilkinson RC (1998) Responsiveness of pain scales: a comparison of three pain intensity measures in chiropractic patients. J Manipulative Physiol Ther 21:1–7

    PubMed  CAS  Google Scholar 

  9. Brown GK, Nicassio PM (1987) Development of a questionnaire for the assessment of active and passive coping strategies in chronic pain patients. Pain 31:53–64

    Article  PubMed  CAS  Google Scholar 

  10. Bryant RA (1993) Memory for pain and affect in chronic pain patients. Pain 54:347–351

    Article  PubMed  CAS  Google Scholar 

  11. Budzynski TH, Stoyva JM, Adler CS, Mullaney DJ (1973) EMG biofeedback and tension headache: a controlled outcome study. Psychosom Med 35:484–496

    PubMed  CAS  Google Scholar 

  12. Burton AK, Tillotson KM, Symonds TL, Burke C, Mathewson T (1996) Occupational risk factors for the first-onset and subsequent course of low back trouble. A study of serving police officers. Spine 21:2612–2620

    CAS  Google Scholar 

  13. Choiniere M, Amsel R (1996) A visual analogue thermometer for measuring pain intensity. J Pain Symptom Manage 11:299–311

    Article  PubMed  CAS  Google Scholar 

  14. Closs SJ, Barr B, Briggs M, Cash K, Seers K (2004) A comparison of five pain assessment scales for nursing home residents with varying degrees of cognitive impairment. J Pain Symptom Manage 27:196–205

    Article  PubMed  Google Scholar 

  15. Van Damme S, Crombez G, Eccleston C (2004) Disengagement from pain: the role of catastrophic thinking about pain. Pain 107:70–76

    Article  PubMed  Google Scholar 

  16. Dawson EG, Kanim LE, Sra P, Dorey FJ, Goldstein TB, Delamarter RB, Sandhu HS (2002) Low back pain recollection versus concurrent accounts: outcomes analysis. Spine 27:984–993; discussion 994

    Article  PubMed  Google Scholar 

  17. van den Hout JH, Vlaeyen JW, Houben RM, Soeters AP, Peters ML (2001) The effects of failure feedback and pain-related fear on pain report, pain tolerance, and pain avoidance in chronic low back pain patients. Pain 92:247–257

    Article  PubMed  Google Scholar 

  18. Duncan GH, Bushnell MC, Lavigne GJ (1989) Comparison of verbal and visual analogue scales for measuring the intensity and unpleasantness of experimental pain. Pain 37:295–303

    Article  PubMed  CAS  Google Scholar 

  19. Eich E, Reeves JL, Jaeger B, Graff-Radford SB (1985) Memory for pain: relation between past and present pain intensity. Pain 23:375–380

    Article  PubMed  CAS  Google Scholar 

  20. Fairbank JC, Couper J, Davies JB, O’Brien JP (1980) The Oswestry low back pain disability questionnaire. Physiotherapy 66:271–273

    PubMed  CAS  Google Scholar 

  21. Farrar JT, Portenoy RK, Berlin JA, Kinman JL, Strom BL (2000) Defining the clinically important difference in pain outcome measures. Pain 88:287–294

    Article  PubMed  CAS  Google Scholar 

  22. Farrar JT, Young JP Jr, LaMoreaux L, Werth JL, Poole RM (2001) Clinical importance of changes in chronic pain intensity measured on an 11-point numerical pain rating scale. Pain 94:149–158

    Article  PubMed  CAS  Google Scholar 

  23. Folkman S, Lazarus RS (1985) If it changes it must be a process: study of emotion and coping during three stages of a college examination. J Pers Soc Psychol 48:150–170

    Article  PubMed  CAS  Google Scholar 

  24. Freyd M (1923) The graphic rating scale. J Educ Psychol 43:83–102

    Article  Google Scholar 

  25. Gaston-Johansson F (1996) Measurement of pain: the psychometric properties of the Pain-O-Meter, a simple, inexpensive pain assessment tool that could change health care practices. J Pain Symptom Manage 12:172–181

    Article  PubMed  CAS  Google Scholar 

  26. Gaston-Johansson F, Hofgren C, Watson P, Herlitz J (1991) Myocardial infarction pain: systematic description and analysis. Intensive Care Nurs 7:3–10

    Article  PubMed  CAS  Google Scholar 

  27. Geiser D (1992) A comparison of acceptance-focused and control-focused psychological treatments in a chronic pain treatment center. Unpublished doctoral dissertation, University of Nevada, Reno

  28. Gracely RH, McGrath P, Dubner R (1978) Validity and sensitivity of ratio scales of sensory and affective verbal pain descriptors: manipulation of affect by diazepam. Pain 5:19–29

    Article  PubMed  CAS  Google Scholar 

  29. Group CSA (1994) Back pain: report of CSAG committee on back ain. Group CSA, London

    Google Scholar 

  30. Haas M, Nyiendo J, Aickin M (2002) One-year trend in pain and disability relief recall in acute and chronic ambulatory low back pain patients. Pain 95:83–91

    Article  PubMed  Google Scholar 

  31. Hagg O, Fritzell P, Romberg K, Nordwall A (2001) The general function score: a useful tool for measurement of physical disability. Validity and reliability. Eur Spine J 10:203–210

    CAS  Google Scholar 

  32. Hagg O, Fritzell P, Hedlund R, Moller H, Ekselius L, Nordwall A (2003a) Pain-drawing does not predict the outcome of fusion surgery for chronic low-back pain: a report from the Swedish Lumbar Spine Study. Eur Spine J 12:2–11

    CAS  Google Scholar 

  33. Hagg O, Fritzell P, Nordwall A (2003b) The clinical importance of changes in outcome scores after treatment for chronic low back pain. Eur Spine J 12:12–20; discussion 21

    PubMed  CAS  Google Scholar 

  34. Jamison RN, Gracely RH, Raymond SA, Levine JG, Marino B, Herrmann TJ, Daly M, Fram D, Katz NP (2002) Comparative study of electronic vs. paper VAS ratings: a randomized, crossover trial using healthy volunteers. Pain 99:341–347

    Article  PubMed  Google Scholar 

  35. Jensen MP, Karoly P, Braver S (1986) The measurement of clinical pain intensity: a comparison of six methods. Pain 27:117–126

    Article  PubMed  CAS  Google Scholar 

  36. Jensen MP, Karoly P, O’Riordan EF, Bland F Jr, Burns RS (1989) The subjective experience of acute pain. An assessment of the utility of 10 indices. Clin J Pain 5:153–159

    Article  PubMed  CAS  Google Scholar 

  37. Jensen MP, Turner JA, Romano JM, Strom SE (1995) The chronic pain coping inventory: development and preliminary validation. Pain 60:203–216

    Article  PubMed  CAS  Google Scholar 

  38. Joyce CR, Zutshi DW, Hrubes V, Mason RM (1975) Comparison of fixed interval and visual analogue scales for rating chronic pain. Eur J Clin Pharmacol 8:415–420

    Article  PubMed  CAS  Google Scholar 

  39. Kelly AM (1998) Does the clinically significant difference in visual analog scale pain scores vary with gender, age, or cause of pain? Acad Emerg Med 5:1086–1090

    Article  PubMed  CAS  Google Scholar 

  40. Kelly AM (2001) The minimum clinically significant difference in visual analogue scale pain score does not differ with severity of pain. Emerg Med J 18:205–207

    Article  PubMed  CAS  Google Scholar 

  41. Kerns RD, Turk DC, Rudy TE (1985) The West Haven-Yale Multidimensional Pain Inventory (WHYMPI). Pain 23:345–356

    Article  PubMed  CAS  Google Scholar 

  42. Von Korff M, Miglioretti DL (2005) A prognostic approach to defining chronic pain. Pain

  43. Von Korff M, Saunders K (1996) The course of back pain in primary care. Spine 21:2833–2837; discussion 2838–2839

    Article  Google Scholar 

  44. Von Korff M, Ormel J, Keefe FJ, Dworkin SF (1992) Grading the severity of chronic pain. Pain 50:133–149

    Article  Google Scholar 

  45. Von Korff M, Jensen MP, Karoly P (2000) Assessing global pain severity by self-report in clinical and health services research. Spine 25:3140–3151

    Article  Google Scholar 

  46. Kremer E, Atkinson JH, Ignelzi RJ (1981) Measurement of pain: patient preference does not confound pain measurement. Pain 10:241–248

    Article  PubMed  CAS  Google Scholar 

  47. Linton SJ (1991) Memory for chronic pain intensity: correlates of accuracy. Percept Mot Skills 72:1091–1095

    Article  PubMed  CAS  Google Scholar 

  48. Linton SJ, Gotestam KG (1983) A clinical comparison of two pain scales: correlation, remembering chronic pain, and a measure of compliance. Pain 17:57–65

    Article  PubMed  CAS  Google Scholar 

  49. Linton SJ, Melin L (1982) The accuracy of remembering chronic pain. Pain 13:281–285

    Article  PubMed  CAS  Google Scholar 

  50. McCracken LM (1998) Learning to live with the pain: acceptance of pain predicts adjustment in persons with chronic pain. Pain 74:21–27

    Article  PubMed  CAS  Google Scholar 

  51. McCracken LM, Zayfert C, Gross RT (1992) The Pain Anxiety Symptoms Scale: development and validation of a scale to measure fear of pain. Pain 50:67–73

    Article  PubMed  CAS  Google Scholar 

  52. McCracken LM, Spertus IL, Janeck AS, Sinclair D, Wetzel FT (1999) Behavioral dimensions of adjustment in persons with chronic pain: pain-related anxiety and acceptance. Pain 80:283–289

    Article  PubMed  CAS  Google Scholar 

  53. Malchaire JB, Roquelaure Y, Cock N, Piette A, Vergracht S, Chiron H (2001) Musculoskeletal complaints, functional capacity, personality and psychosocial factors. Int Arch Occup Environ Health 74:549–557

    Article  PubMed  CAS  Google Scholar 

  54. Margolis RB, Tait RC, Krause SJ (1986) A rating system for use with patient pain drawings. Pain 24:57–65

    Article  PubMed  CAS  Google Scholar 

  55. Melzack R (1975) The McGill Pain Questionnaire: major properties and scoring methods. Pain 1:277–299

    Article  PubMed  CAS  Google Scholar 

  56. Melzack R, Katz J (1990) The McGill Pain Questionnaire: appraisal and current status. In: Turk DC, Melzack R (eds) Handbook of pain assessment. Guilford Press, New York, pp 152–168

    Google Scholar 

  57. Mercado AC, Carroll LJ, Cassidy JD, Cote P (2005) Passive coping is a risk factor for disabling neck or low back pain. Pain 117:51–57

    Article  PubMed  Google Scholar 

  58. Morley S (1989) The dimensionality of verbal descriptors in Tursky’s pain perception profile. Pain 37:41–49

    Article  PubMed  CAS  Google Scholar 

  59. Morley S, Pallin V (1995) Scaling the affective domain of pain: a study of the dimensionality of verbal descriptors. Pain 62:39–49

    Article  PubMed  CAS  Google Scholar 

  60. Nachemson A, Bigos SJ (1984) The low back. In: Cruess J, Rennie WRJ (eds) Adult orhopedics. Churchill-Livingstone, New York, pp 843–937

    Google Scholar 

  61. Neubauer E, Pirron P, Junge A, Seemann H, Schiltenwolf M (2005) What questions are appropriate for predicting the risk of chronic disease in patients suffering from acute low back pain? Z Orthop Ihre Grenzgeb 143:299–301

    Article  PubMed  CAS  Google Scholar 

  62. Ohnhaus EE, Adler R (1975) Methodological problems in the measurement of pain: a comparison between the verbal rating scale and the visual analogue scale. Pain 1:379–384

    Article  PubMed  CAS  Google Scholar 

  63. Oron Y, Reichenberg A (2003) Personality traits predict self-referral of young male adults with musculoskeletal complaints to a general practitioner. J Psychosom Res 54:453–456

    Article  PubMed  Google Scholar 

  64. Pawl R (1973) Chronic pain primer. Yearbook, Chicago

    Google Scholar 

  65. Price DD, McGrath PA, Rafii A, Buckingham B (1983) The validation of visual analogue scales as ratio scale measures for chronic and experimental pain. Pain 17:45–56

    Article  PubMed  CAS  Google Scholar 

  66. Price DD, Harkins SW, Baker C (1987) Sensory–affective relationships among different types of clinical and experimental pain. Pain 28:297–307

    Article  PubMed  CAS  Google Scholar 

  67. Price DD, Bush FM, Long S, Harkins SW (1994) A comparison of pain measurement characteristics of mechanical visual analogue and simple numerical rating scales. Pain 56:217–226

    Article  PubMed  CAS  Google Scholar 

  68. Raspe H, Huppe A, Matthis C (2003) Theories and models of chronicity: on the way to a broader definition of chronic back pain. Schmerz 17:359–366

    Article  PubMed  CAS  Google Scholar 

  69. Rosenstiel AK, Keefe FJ (1983) The use of coping strategies in chronic low back pain patients: relationship to patient characteristics and current adjustment. Pain 17:33–44

    Article  PubMed  CAS  Google Scholar 

  70. Scott J, Huskisson EC (1976) Graphic representation of pain. Pain 2:175–184

    Article  PubMed  CAS  Google Scholar 

  71. Seymour RA, Simpson JM, Charlton JE, Phillips ME (1985) An evaluation of length and end-phrase of visual analogue scales in dental pain. Pain 21:177–185

    Article  PubMed  CAS  Google Scholar 

  72. Sherbourne CD (1992) Pain measures. In: Steward AL, Ware JE (eds) Measuring functioning and well-being: the medical outcomes study approach. Duke University Press, Durham, pp 220–234

    Google Scholar 

  73. Smedley J, Inskip H, Buckle P, Cooper C, Coggon D (2005) Epidemiological differences between back pain of sudden and gradual onset. J Rheumatol 32:528–532

    PubMed  Google Scholar 

  74. Smith BH, Penny KI, Purves AM, Munro C, Wilson B, Grimshaw J, Chambers WA, Smith WC (1997) The Chronic Pain Grade questionnaire: validation and reliability in postal research. Pain 71:141–147

    Article  PubMed  CAS  Google Scholar 

  75. Stewart WF, Lipton RB, Simon D, Liberman J, Von Korff M (1999) Validity of an illness severity measure for headache in a population sample of migraine sufferers. Pain 79:291–301

    Article  PubMed  CAS  Google Scholar 

  76. Summers JD, Rapoff MA, Varghese G, Porter K, Palmer RE (1991) Psychosocial factors in chronic spinal cord injury pain. Pain 47:183–189

    Article  PubMed  CAS  Google Scholar 

  77. Taylor WP, Stern WR, Kubiszyn TW (1984) Predicting patients’ perceptions of response to treatment for low-back pain. Spine 9:313–316

    Article  PubMed  CAS  Google Scholar 

  78. Tiplady B, Crompton GK, Brackenridge D (1995) Electronic diaries for asthma. BMJ 310:1469

    PubMed  CAS  Google Scholar 

  79. Todd KH, Funk KG, Funk JP, Bonacci R (1996) Clinical significance of reported changes in pain severity. Ann Emerg Med 27:485–489

    Article  PubMed  CAS  Google Scholar 

  80. Truchon M, Cote D (2005) Predictive validity of the Chronic Pain Coping Inventory in subacute low back pain. Pain 116:205–212

    Article  PubMed  Google Scholar 

  81. Vasseljen O Jr, Westgaard RH, Larsen S (1995) A case-control study of psychological and psychosocial risk factors for shoulder and neck pain at the workplace. Int Arch Occup Environ Health 66:375–382

    Article  PubMed  Google Scholar 

  82. Waddell G, Newton M, Henderson I, Somerville D, Main CJ (1993) A Fear-Avoidance Beliefs Questionnaire (FABQ) and the role of fear-avoidance beliefs in chronic low back pain and disability. Pain 52:157–168

    Article  PubMed  CAS  Google Scholar 

  83. Woby SR, Watson PJ, Roach NK, Urmston M (2005) Coping strategy use: does it predict adjustment to chronic back pain after controlling for catastrophic thinking and self-efficacy for pain control? J Rehabil Med 37:100–107

    Article  PubMed  Google Scholar 

  84. Zung WW (1965) A Self-Rating Depression Scale. Arch Gen Psychiatry 12:63–70

    PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Centre for Spinal Surgery, University of Zurich, University Hospital Balgrist, Forchstrasse 340, 8008, Zurich, Switzerland

    Mathias Haefeli

  2. Department of Psychology, University of Berne, Berne, Switzerland

    Achim Elfering

Authors
  1. Mathias Haefeli
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Achim Elfering
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Mathias Haefeli.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Haefeli, M., Elfering, A. Pain assessment. Eur Spine J 15 (Suppl 1), S17–S24 (2006). https://doi.org/10.1007/s00586-005-1044-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00586-005-1044-x

Keywords

Search

Navigation