Publications
APS Bulletin • Volume 17, Number 3, 2007
Special Interest Groups
David Williams, PhD, Department Editor
Measuring Pain to Improve Patient Care
Miroslav “Misha” Backonja
Three years ago, the APS Measurement of Pain and Its Impact Special Interest Group (SIG) was formed to spur discussion on how best to define and measure pain. SIG Chair Miroslav “Misha” Backonja, MD, the department of neurology, anesthesiology, and rehabilitation medicine at the University of Wisconsin-Madison, recently spoke to APS Bulletin to discuss the SIG’s accomplishments and future direction.
Q: What is the Measurement of Pain SIG?
A. This SIG was organized 3 years ago to facilitate discussion among APS members about how to define and measure pain. Its mission is to “identify, explore, and form strategies for addressing fundamental issues associated with the measurement of pain” and to prompt dialogue among researchers and clinicians.
Pain science needs more precise taxonomy and measurement tools. Without this, our communication is not clear. Although the International Association for the Study of Pain has a taskforce on taxonomy, their process has been closed to wider membership and progress has been slow. I organized this SIG to make this a much more open, ongoing, and productive process. We in the field of pain research and practice don’t have to agree on everything, but we should agree on the fundamentals so we can move forward. These are all issues viewed from the research end of things.
From the practice perspective, patients may receive suboptimal care because pain is considered a symptom that cannot be measured. Its subjectivity may be regarded as unworthy, less than legitimate, and easy to ignore. Again, if we do not use precise terminology among ourselves, how can we communicate with other clinicians and practitioners? Many terms, such as neuropathic pain, breakthrough pain, and hyperalgesia have lost their meaning through misuse and overuse. Imprecise communication has deleterious impact on the education of students across all areas of health care involved in pain, especially today when there are so many demands for their attention. We all suffer because of the current imprecision in pain definitions and assessment. But I am convinced that we can do better. It is really incumbent on us to get our house in order and straighten out these issues.
Q: What are top issues of concern to the SIG?
A. There are both immediate and long-term issues. One immediate issue is the state of the science and the state of the art in measuring pain. We need to address several questions right away, such as what is the state of the science when we measure pain in animals versus humans, or when do we measure acute pain versus chronic pain? There also are specific issues of measuring pain in infants versus children and adults or older adults that need to be addressed so that we all understand those measurements. Recently we’ve seen significant improvements in measuring certain types of pain (e.g., neuropathic pain), which we discussed at the 2007 annual meeting.
We need to build on these improvements to help form consensus about how best to assess pain across individuals and species. Another immediate issue is taxonomy because, simply put, we need to define what we’re measuring before we can measure it. How do we define types of painful phenomena, like allodynia and hyperalgesia?
A long-term issue is finding opportunities to improve measurements of pain in general and under specific circumstances. We rely on patients to tell us where the pain is, what it feels like, and how intense it is—that’s essentially the basis of all symptom-based tools and quantitative sensory testing. The approach in pain measurement has to be standardized so we all know that we are talking about the same thing. For example, there are opportunities offered by the latest advances in pain science: Is it possible to capture an image of pain by taking a picture of the brain? Of course a picture alone is not enough because the meaning and significance of that picture rests on what patients report to us about the pain. Other opportunities could potentially come from efforts to identify biomarkers for certain types of pain, such as inflammatory mediators, specific genes, magnetoencephalography, and other electrophysiological and biological signals. How do we, on an ongoing basis, assess when a tool is ready to be used?
The whole idea of the SIG is to discuss these and other related issues, meet to discuss advances in pain research, and form consensus so these advances are recognized and disseminated to the membership at large.
Q: What have you accomplished in the last 3 years?
A. We have had meetings at each APS annual meeting and organized presentations and discussions concerning issues in pain measurements. The high turnout of APS members who attended our two-part SIG meetings at the annual conference last May, nearly 500 people, clearly indicates a great interest in this area. That’s all good, but we still face a couple of big challenges. One is a lack of awareness among the pain community regarding this inadequate communication and poor application of measurement tools. Another problem is finding venues to allow us to reach consensus about these issues. We must define obstacles and problems and find ways to resolve them.
Q: What major initiatives do you have planned in the next year?
A. A major goal is to conduct ongoing discussions about pain measurement issues. These issues are here to stay and will need to be improved as advances are made in all areas of pain research and practice.
In terms of specific initiatives, we are considering reviewing imaging as a tool of pain measurement and discussing the status of translational pain research. What are the stumbling blocks in translating advances in basic science and human research and clinical practice? What areas of pain measurement are problematic rather than facilitating? Is there anything that we learned in measuring pain in people that we can translate back to improve animal research?
Q: What are some upcoming trends in pain measurement?
A. There are many trends and I already alluded to them, and many of them are only concepts while others are being tested in research and practice. One trend is the further development of specific measurement approaches, including a wider use of electronic devices such as electronic data capture using Web and cell-phone technology. More efficient and real-time data capture and standardization in the ways this information is used is a positive development. Another trend is relevant to translational pain research especially because so much progress is made in basic science and it still has to be translated into benefits for patients. The recently published consensus statement on this topic will hopefully prompt further discussion among APS members. There are still many issues to be discussed and resolved before translational pain research shows its full potential.
Q: Do you have any particular message for APS members?
A. Learn about the Pain Measurement SIG, think about how pain measurement impacts what you do, and get involved in the discussion because it affects us all in so many ways. We need standardization, but we have to find out what works and what doesn’t work for all of our pain communities. So get involved. Let us know what you agree and what you disagree about. There’s so much to be done and only wider participation can make this process move forward.
Acknowledgement
Special thanks are extended to Mark Jensen, PhD, professor, department of rehabilitation medicine, University of Washington, Seattle, WA, for contributing to this interview.