Project Kickoff
This independent study project will be a 7-month project where I will be exploring bodily pain and the visualization of it.
Projective Objective
The objective of this project is to explore our relationship with pain and the ways that pain can be communicated by individuals with chronic pain. I believe there is an opportunity to explore how pain can be communicated and visualized through different mediums developing alternative methods of expression for individuals with chronic pain. By focusing on the expression of one’s pain, I hope to explore methods that would provide suffers of chronic pain with a sense of control over their pain by being able to contextualize their pain in a tangible way to others.
What I did this week
This week I started performing literature reviews on chronic pain to gain an understanding of chronic pain as an illness. I wanted to gain an understanding of the causes, symptoms, and prevalence, as well as the diseases that are associated with chronic pain. In addition, I began researching common methods used to evaluate pain in a medical setting, as well as the use of art as an alternative form of expression.
In addition, I have begun collecting patient experiences and descriptions of pain through online patient forums. I will be taking these descriptions and extracting the key themes and descriptive words and developing visual maps for each description throughout the next few months. My hope is that this exercise will help me identify patterns and the common themes that are used, which will inform the metaphors and mediums I will explore later in this project.
01 What is Chronic Pain?
When I started this project, I wanted to gain an understanding of what pain is and the role it plays in our body. Because during this project I will be looking at the subjective nature of pain, it is still important to have a basis on how pain is described from a medical standpoint.
So, What is Pain?
Pain is a common symptom that acts as a useful mechanism in the promotion of healing. It plays an important role in telling an individual to address a medical problem that may be present. When looking at pain, we must look at the two types: Acute Pain & Chronic Pain.
Acute vs Chronic
Acute pain is the pain you experience when you have been injured or after surgery, examples would include scraping your knee or burning your hand. It typically lasts less than 3 months and will go away completely once the source of the pain has healed. Now when looking at chronic pain, you are looking at the pain that is ongoing for an individual. People typically experience pain almost every day and this can last for more than 6 months and can even last for several years.
Prevalence of Chronic Pain in the United States
In the United States, chronic pain is becoming one of the most common reasons adults seek out medical care. It is estimated that 50 million US adults have chronic pain and 19 million US adults experience high-impact chronic pain (chronic pain that frequently limits life or work activities). It is reported that chronic pain is more common among women, older adults, and adults living in poverty.
Differences between Acute and Chronic Pain
One of the main differences between acute and chronic pain is the location of the source of the pain. With acute pain you can locate the source of the pain, you broke your leg and you have pain because of that. However, with chronic pain, the location of the source, from a biomedical viewpoint, is difficult to diagnose. People may experience chronic pain after an injury or illness that cause it has completely healed or gone away. People may experience chronic pain when there was no past injury or apparent body damage. People may experience chronic pain as a result of a disease, such as fibromyalgia and arthritis.
Effects of Chronic Pain
When looking at chronic pain from the biopsychosocial model (model that takes into account the biological, psychological, and social components of an illness), an individual may experience a range of symptoms that exist together and influence one another. These can include persistent physical pain, emotional disturbance, social withdrawal symptoms, and disabilities. These symptoms can affect multiple aspects of a person’s life including sleep patterns, their social network relationships, as well as their ability to complete daily tasks such as working or performing standard household chores.
How Does this Relate to my Project?
The element that I will be exploring when looking at the biopsychosocial model of chronic pain is the psychological and social element that is related to the difficulty that people experience with contextualizing their pain to others. Because of the invisible nature of pain, people can feel isolated from others because they feel that they do not either believe the existence or severity of their pain. I will continue to look at how this model can be applied to my project and the function it can play in the contextualization of one’s pain.
02 Measuring Pain
One element I wanted to look into was the current methods that are available to individuals to help them express their pain.
The subjective and individualized nature of pain can make it difficult to measure in an objective fashion. In most scenarios, the patient and physician will engage in a dialogue to identify the characteristics of the pain, time frame, and the severity of the pain the patient is experiencing. They may also use a pain scale or form that may help to further provide an objective lens to the pain. These pain scales/forms range detail and depth, as well as the investigative topics included.
Below are a collection of the common methods I have found so far.
Wong-Baker Faces
The Wong-Baker Faces were developed by Connie Baker and Dr. Donna Wong and follow the approach of the 0–10 pain rating scale but with added visual indicators (faces). They are used for children ages 3 and older and the patient is asked to choose the face that best describes their pain. Because this scale is designed for children, it is a simple and approachable method, however, the issues with this scale is that it may not be descriptive enough for most patients.
BPI (Brief Pain Inventory)
The Brief Pain Inventory was developed by the Pain Research Group of WHO. It focused on looking at the intensity of pain and how it interferes with the patient’s daily life. It takes the 0–10 scale approach and the patient is asked to rate various questions. It is available in a short version and long version.
Global Pain Scale
The Global Pain Scale is 0–10 ranking scale that takes into account the intensity of the physical pain, emotional affects, and the lifestyle affects the pain has on a patient.
Stanford Pain Scale
The Stanford Pain Scale takes the approach of the 0–10 pain rating scale, however, it tries to include the subjective nature of pain by incorporating:
- Descriptions of the type of pain — (Ex. 2 Discomforting: Minor pain, like lightly pinching the fold of skin between the thumb and first finger with the other hand, using the fingernails)
- Effects the patient would experience at a chosen level of pain — (Ex. 8 Utterly Horrible: Pain so intense you can no longer think clearly at all, and have often undergone severe personality change if the pain has been present for a long time)
- Effects the pain would have on their daily life — (Ex. Moderate: interferes with many activities. Requires lifestyle changes but patient remains independent . Unable to adapt to pain.)
Mc Gill Pain Scale
The McGill Pain Scale is a three-part assessment tool that looks at measuring several aspects of a patient’s pain experience (sensory, affective and evaluative dimensions). The tool contains:
- An anatomic drawing of a human form, where the patient will mark where their pain is located
- A VDS (verbal descriptor scale) where patients record their present pain intensity
- 78 descriptive adjectives that are divided into 20 sets that describe the sensory, affective, and evaluative quality of pain and each word is numerically rated. The patient selects the adjectives and then a total score is generated based on the number of words selected and the rating score of the selected words. In the short version, only 15 descriptive adjectives are presented to the patient.
It comes in a short version and a long version. This scale is interesting because it tries to bring the subjective nature of pain which would typically be achieved through dialogue and give it an objective ranking.
NRS 11: Numeric Rating Scale
The Numeric Rating Scale is one of the most common scales for pain. The patient is asked to rate their pain on a scale of 0–10. The issue with this scale is that it does not take into account the subjective and personalized nature of pain. So different patients will interpret the meaning of the number scores differently and then the physicians will interpret the answers differently.
VAS: Visual Analog Scale
The Visual Analog Scale is a unidimensional scale that is used for adults. The standard form is of a sliding scale in a fixed length straight line, however, it can vary and some may have middle points or irregular markers with verbal descriptors. This scale takes into account that pain is not measurable in fixed increments and tries to provide flexibility for the patient to rate their pain.
Now what?
I will continue to add to this list as I discover more pain scale methods used by physicians.
In the following week, I want to explore some of these methods in more detail. In particular, I am interest in looking at the McGill Pain Scale and the descriptive adjective section. I also want to look into diy pain scales developed by patients and see how they compare to the standardized methods. It will be interesting to compare the amount of subjective verse objective information collected by a patient on their own.
Sources
Dahlhamer J, Lucas J, Zelaya, C, et al. (2018). Prevalence of Chronic Pain and High-Impact Chronic Pain Among Adults — United States, 2016. MMWR Morb Mortal Wkly Rep Vol 67, 1001–1006.
Hylands-White N, Duarte R, Raphael J. (2017). An Overview of Treatment Approaches for Chronic Pain Management. Rheumatology International Vol 37, 29–42.
Dueñas M, Ojeda B, Salazar A, Mico JA, Failde I. (2016). A Review of Chronic Pain Impact on Patients, their Social Environment and the Health Care System. Journal of Pain Research Vol 9, 457–467.
