The social dimension of chronic pain: problems of measurement

Rennell, Beverley (1997) The social dimension of chronic pain: problems of measurement. Doctoral thesis, London Guildhall University.


The research question investigated was, can chronic pain be measured? Two commonly used pain measurements, the McGill Pain Questionnaire and Visual Analogue Scale were compared to individual accounts of pain obtained by semi-structured interviews with people who had rheumatoid arthritis. The research was part of a wider study of cultural differences in the pain experience. Forty patients (18 men and 22 women) were included in the study. There has been little research into patients own accounts of their pain and in particular how the measurements relate to their experiences. The findings in this study suggest that the pain measurements are both methodologically and theoretically problematic. For the VAS there were problems determining what the score was actually representing. By comparing the scores with the interview data it was found that the scores represented different aspects of the pain experience for each individual. For some it represented the intensity of the pain while for others it represented their unhappiness about the effect of the pain on their lives. For the MPQ, the words appeared to be interpreted differently by each individual and therefore raises questions about the validity of the weightings used.

Theoretically, the pain measurements were found to be problematic for several reasons. The main problem being the narrow definition of 'chronic pain' upon which the measurements were based. Through analysis of the interviews, certain features of the chronic pain experience were identified. The first is the importance of 'context'. On the one hand this includes `factors' such as attention and expectation but more importantly it refers to the wider social context and its influence on the perception and interpretation of pain. In other words, there are different meaning systems which people draw upon to make sense of their experience. These form the 'lifeworld' - the background stock of knowledge which is used to construct a narrative. It is through constructing a narrative that self-identity is formed. Self-identity and the construction of self is an integral part of the way people make sense of and communicate the experience of chronic pain; the measurement scores and the interviews are not just representations of the pain but representations of 'self' - how the person wants to be seen by others. This is an important element which has been neglected in the construction of pain measurements and it is argued here that by quantifying the pain experience vital elements such as self-identity are lost. The issue then is not how to measure chronic pain but whether chronic pain should be measured at all. The argument of this thesis is that current pain measurements do not assist us in understanding and assisting those who live with chronic pain.

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