WHY ASSESSING PAIN QUALITY MATTERS
The experience of pain is different for us all. Research suggests words that describe the experience of pain might be similar. Experts call these words ‘pain qualities’. An example of a pain quality would be burning or throbbing.
This article discusses the importance of tracking and documenting pain quality. What are common words used by patients? Moreover, do these words provide insight into sources of pain or signal meaningful changes?
LOOK BEYOND PAIN INTENSITY
Our past experiences, what an injury means, and even our sex can influence pain intensity ratings. Nevertheless, as a single rating, the intensity fails to capture the whole experience. To provide better care, we need to look beyond pain intensity. We need to look at other measures. So let us begin with pain qualities.
Pain qualities give insight. These words are clues to understanding a patient’s pain and the path to recovery.
PAIN QUALITIES ARE CLUES
Researchers emphasize the importance of pain qualities. This emphasis started in the early 2000s and continues to grow. There are two main reasons for this emphasis. Firstly, patients’ pain qualities are words to communicate their pain—for example, burning, stabbing, tingling, numbness, throbbing and itchy. Secondly, pain qualities can provide clues to the type of pain and which sensory fibres drive the pain experience.
C and A-delta (Aδ) sensory fibres convey information about pain and temperature and elicit burning, aching or stabbing sensations. On the other hand, damage or a reduction in blood flow to large sensory fibres reduces the ability to sense vibrations and touch. In such cases, patients may report numbness.
A CHANGE IN PAIN QUALITY IS MEANINGFUL
A study by Grunnesjö and colleagues (2006) showed changes in pain qualities could reflect improvements. Stabbing and dull-aching are sensations commonly reported at the onset (< 3 months) of low back pain (Grunnesjö et al., 2006). In their research, the ‘stabbing‘ quality reduced alongside recovery. So to did the number of pain sites, as drawn on a body chart.
Pain that extends beyond the waist and down the leg is known as radicular pain. The most common descriptors include stabbing and dull-aching pain. Patients with radicular pain report higher intensities of numbness, stabbing, pins and needles (tingling), dull-aching, stiffness and cramps. Patients with localized pain report higher intensities of numbing, pins and needles (tingling), and stabbing. Overall a higher reports of disability associate with numbness and stabbing (Grunnesjö et al., 2006). Thus, changes in pain qualities could indicate progression and give insight into recovery timeframes.
Individuals treated surgically for lumbar radiculopathy also report changes in pain qualities. A rapid decline in burning and stabbing sensations occurs after surgery (Huang et al., 2014). However, numbness and tingling tend to decline more slowly (Huang et al., 2014). A rapid decline in burning and stabbing sensations appar to signify recovery. A slower and evident decline in numbness and tingling is also expected and reflects an otherwise healthy healing time. These recovery times can extend over a year. Nonetheless, the change in pain qualities provides clues and discussion points during the consultations.
MAPPING PAIN QUALITIES
Pain qualities may provide a red thread between individual experiences within specific patient populations. Indeed this would enable a better understanding of certain diseases and conditions. It is the individual, however, at the forefront. Tracking individual changes and responses to treatment supports personalized care and is what matters most to the patient.
Navigate Pain, a software solution for mapping pain and symptoms, includes many pain and non-painful quality descriptors. The descriptors help patients communicate detailed information about their pain. The software also enables clinicians to track, document and observe meaningful changes in pain quality descriptors over time.
ARE PAIN QUALITIES PREDICTIVE?
Research recommends several pain qualities. The overlap between the recommendations is good news. These overlaps include the following words: dull-aching, throbbing, burning, stabbing, electric, tingling, numbness, cold, and itchy. As research continues, new meaningful words will emerge.
Pain quality descriptors provide clues to diagnosis in an area that relies on patients’ language (Fernandez et al., 2012).
To date, sharpness-related words are consistent with neuropathic pain. At the same time, dullness-related words associate with musculoskeletal pain (Fernandez et al., 2012). Pain reports by patients with osteoarthritis show a mixture of burning, sharpness, aching and throbbing (Victor et al., 2008). Pain quality can help distinguish between sources and types of pain, such as damaged sensory fibres. As we continue to learn about the words to describe pain, we will become better at evaluating treatments. An intelligent starting point is to allow patients to describe their pain and qualities often.
Huang P and Sengupta DK. How fast pain, numbness, and paresthesia resolves after lumbar nerve root decompression: a retrospective study of patient’s self-reported computerized pain drawing. Spine (Phila Pa 1976). 2014 Apr 15;39(8): E529-36. doi:10.1097/BRS.0000000000000240.
Grunnesjö M et al., The course of pain drawings during a 10–week treatment period in patients with acute and sub-acute low back pain. BMC Musculoskelet Disord. 2006 Aug 11;7:65.
Fernandez E et al., Descriptors of pain sensation: a dual hierarchical model of latent structure. J Pain. 2012 Jun;13(6):532-6. doi: 10.1016/j.jpain.2012.02.006. Epub 2012 Apr 25.
Victor TW et al. The dimensions of pain quality: factor analysis of the Pain Quality Assessment Scale. Clin J Pain. 2008 Jul-Aug;24(6):550-5. doi: 10.1097/AJP.0b013e31816b1058.