Comprehensive Assessment of Chronic Pain Outcomes

From The Lab
By Ted Swing, Ph.D

The experience of pain is one of the most important medical challenges of our time. Pain is the most common reason people seek medical care in the U.S. Chronic pain, defined as pain lasting several months or more, affects one third of American adults, with 9% experiencing moderate or severe chronic pain.

One of the first steps in treating painful conditions is assessing that pain, which generally includes the patient providing a numerical rating, often from zero (no pain) to ten (the worst pain imaginable). However, the effects of chronic pain go beyond the immediate suffering captured by such a number and can affect people’s lives in a number of ways.

Multiple Effects of Chronic Pain

Chronic pain can reduce a person’s quality of life. For example, chronic pain sufferers lose an average of 1.5 hours of sleep per night due to their pain. Chronic pain can also have consequences for mental well being. Those in moderate to severe chronic pain suffer from anxiety and depression at roughly twice the rate of those who don’t. The number of activities a person can do, such as spending time with family or friends or taking part in hobbies, is often affected by chronic pain. It also interferes with many adults’ ability to do paid work. Specifically, it is estimated that chronic pain causes losses of income of $280 billion each year in the U.S. due to the inability to work or reduced hours. All of these effects not only help to illustrate why chronic pain is so important to treat, but also show that the consequences of chronic pain show up in many facets of a person’s life.

Comprehensive Assessment of Pain

Because chronic pain affects people in such varied ways, it is important to assess it with more than just direct questions, such as average pain and current pain numbers. For example, suppose a patient came to their doctor with an average pain of 6 out of 10. They were unable to do most of the activities they used to enjoy and were depressed about that fact. After various treatments, their pain decreased to a 3 or 4 out of 10, and they finally felt good enough to start doing some of their old activities again. The patient may be quite happy about that, but at the same time the increased activity brings their pain back up to a 4 or 5 by the next time they visit their doctor. If one looked purely at the pain numbers, this might not seem like a significant improvement. Yet, to the patient, this may be quite substantial because they’re doing the things they enjoy again and this has improved their mood.

To capture changes such as this in a way that better informs the doctor when treatments are or aren’t effective it is important to assess outcomes such as loss of sleep, mood and daily activities. For this purpose, we’ve developed and validated a 20 item questionnaire called the Global Pain Scale. We will be expanding our use of this scale to better capture changes in patient well being to assist us in delivering the most effective treatments.

Ted Swing has more than ten years of research experience and four years of teaching experience in psychology, has published in top psychology and medical journals, and has presented his research at major conferences. He received his Ph.D. in Social Psychology from Iowa State University and has been the Research Director at Arizona Pain since May 2012.