- Email: [email protected]
A note on the description of pain and its causes
Press
P~N
A N D ITS C A U S E S
LOndon Psychiatric Hospital,
SUgARy
•
The adjectives used by 72 psychiatric paHents to describe pa~n were e~ am° ined. Patien~ with physic~ lesions tended to have physical precipitan~ ~
INTR~DUCTION
There has been increasing in.rest in the fan.age of pain with reco~tion of the fact that it is important to listen to the patient% description. Devine and Merskey [4] examined p~ adjectives in psychiatAc and general medical p~i~n+~ Melzackand Torgerson [ 5] classified pa~ adjectives inio subjective, affective and eva!ua%ive; and Agnew and Merskey [I] looked at pah~i adjec-
~in admissions t o a psychiatric hospitio has given previo [3]. Briefiy, 227 consecutive admissions to the s reporfed m 86 of %hese patients and
~ULTS A relevant physical di osis was found more often for m e n (58oi% of 31 men, 2 2 o ~ of4~ womeni (P < 0.005).
Of 29 patients reporting °°aching" or "dull' these 17 men, 14 had an organic cause. In c Lng '°stabbing" pain (n = i0} were women were women. All 4 patiet Eighty percent of pe precipitants of the~ pal equally in the two sexe organic causes for thei women (n = 7) who did patients with a recognizable organic basis for th only psychological factors made the pain worse, chological factors were hnportant in giving them relief. However, of the 45 patients with no organic cause for pain, 15 (33%)gave psychological factors alone as p~ecipi~ant% 4 {8.8%) gave psychologic~ plus physical factors as precipitants and 11 (24.4%) only gave psycholo~dcal factors as being ~ portant relieving factors (P < 0.005). ~Aching" is an adjective reported by all ages. " S t a b b i n g " on the ,other hand is a response given by younger p a t i e n t . (Note that 17127 (63%) of the organic group are under 45 as compared with 35/45 {77.8%) of the nonorganic group (P <: 0.05). Only 11% of patients with aching pain felt it ~vas severe whereas 40% of s~abbing pains were described as severe (P < 0~05). A relevant ~-s~,.~, ~ " d l a ~ i s was found in nora of 4 patients whose p~in was helped by psychological measures alone, ~n 58% of patients whose pain was relieved by analgesics and in 71% of patients where physical m~,~--~~ helped the pain. Patients describing only psychological precipitants had headache (43%), abdominal pain (29%) and chest pain (29%). Physical precipitants alone were r e p o s e d by 80% of patients with pain i n the low back or side. Delaptaine et al° [3] have shown ~ a t headache was commoner in those~wi~ p ~ c h ~ $ c a l causes for pain, whereas backache was commoner in ~ o s e ~~ t h physical causes. With respect to frequency of adjectives repor~d, the '~senso~ulh~ess" ca~egol~] ('°aching'~ ~%ore '~)was by far the most c o m m o n -- 61% -- followed by ~'sensory--puncta%e" (~%tabbh~g", '~b--n-"u~ ~ 2, 15%, and "sensor,--constrictive" (~crampy'), 10%. In~restingiy, '~affective"adjectives were seldom used (4.1%) and ~'evaluative" adjectives only once. DuU or aching paros %end to have physic~d prec~pi%mnts and are helped by physical n~easures (~f anything). Th~s compares with observations by us [2] on !4~ pai~en~ with chronic pa~n, in which 2@/4~ (@0%) of s~eady pains were organ~ca~y based and only ~0/82 (31%) of throbbing pains were physicS° ~/so~ patients who have physical re1~ef factors for %he~ pain are most ]~ke]y ~o have physical precipitant ~oo (86%) and~ under,dab]y, physic~ causes.
DISCUSSION
almost
en~ely
sensor,
although they are psychia%ric patients.
ACKNOWLEDGEMENTS
We wish to thank Ms, Mary Ellen Walker, B.A. for invaluable assis~nce with computer programming. REFERENCES 1 Agnew, D.C. and Merskey, H., Words of chronic pain, Pain, 2 (197C~ 73--81o 2 Boyd, D.B.and Merskey, H., Emotional adjustment and chronic pain, Pmn, 5 (1978) in press.
3 Delaphine, R., Ifabumuyi, O.I., Merskey, H. and ZarTw, J., Significance of pain in psychiatric hospital patient, Pain, 4 (1978) 361--366. 4 Devine, R. and Merskey, H., The description of pain in psychia~ic and general rnedic~ patients,Psychosorn. Res., 9 (1965) 311--316. 5 Melzack, R. and Torgerson, W.S., On the language of pain, Anesthes~olo~, 34 {.1971) 50--59.
6 Reading, A.E. and Newton, J.Ro, A comparison of primary dysrnenorrhea and intrauterine device related pain, Pain~ 3 ([[977) 265--276.
.... :){!i ¸ !i !~
. . . .
~i~
iii!ii~i ~( /
~i ~
ii~
•
•
P~N
A N D ITS C A U S E S
LOndon Psychiatric Hospital,
SUgARy
•
The adjectives used by 72 psychiatric paHents to describe pa~n were e~ am° ined. Patien~ with physic~ lesions tended to have physical precipitan~ ~
INTR~DUCTION
There has been increasing in.rest in the fan.age of pain with reco~tion of the fact that it is important to listen to the patient% description. Devine and Merskey [4] examined p~ adjectives in psychiatAc and general medical p~i~n+~ Melzackand Torgerson [ 5] classified pa~ adjectives inio subjective, affective and eva!ua%ive; and Agnew and Merskey [I] looked at pah~i adjec-
~in admissions t o a psychiatric hospitio has given previo [3]. Briefiy, 227 consecutive admissions to the s reporfed m 86 of %hese patients and
~ULTS A relevant physical di osis was found more often for m e n (58oi% of 31 men, 2 2 o ~ of4~ womeni (P < 0.005).
Of 29 patients reporting °°aching" or "dull' these 17 men, 14 had an organic cause. In c Lng '°stabbing" pain (n = i0} were women were women. All 4 patiet Eighty percent of pe precipitants of the~ pal equally in the two sexe organic causes for thei women (n = 7) who did patients with a recognizable organic basis for th only psychological factors made the pain worse, chological factors were hnportant in giving them relief. However, of the 45 patients with no organic cause for pain, 15 (33%)gave psychological factors alone as p~ecipi~ant% 4 {8.8%) gave psychologic~ plus physical factors as precipitants and 11 (24.4%) only gave psycholo~dcal factors as being ~ portant relieving factors (P < 0.005). ~Aching" is an adjective reported by all ages. " S t a b b i n g " on the ,other hand is a response given by younger p a t i e n t . (Note that 17127 (63%) of the organic group are under 45 as compared with 35/45 {77.8%) of the nonorganic group (P <: 0.05). Only 11% of patients with aching pain felt it ~vas severe whereas 40% of s~abbing pains were described as severe (P < 0~05). A relevant ~-s~,.~, ~ " d l a ~ i s was found in nora of 4 patients whose p~in was helped by psychological measures alone, ~n 58% of patients whose pain was relieved by analgesics and in 71% of patients where physical m~,~--~~ helped the pain. Patients describing only psychological precipitants had headache (43%), abdominal pain (29%) and chest pain (29%). Physical precipitants alone were r e p o s e d by 80% of patients with pain i n the low back or side. Delaptaine et al° [3] have shown ~ a t headache was commoner in those~wi~ p ~ c h ~ $ c a l causes for pain, whereas backache was commoner in ~ o s e ~~ t h physical causes. With respect to frequency of adjectives repor~d, the '~senso~ulh~ess" ca~egol~] ('°aching'~ ~%ore '~)was by far the most c o m m o n -- 61% -- followed by ~'sensory--puncta%e" (~%tabbh~g", '~b--n-"u~ ~ 2, 15%, and "sensor,--constrictive" (~crampy'), 10%. In~restingiy, '~affective"adjectives were seldom used (4.1%) and ~'evaluative" adjectives only once. DuU or aching paros %end to have physic~d prec~pi%mnts and are helped by physical n~easures (~f anything). Th~s compares with observations by us [2] on !4~ pai~en~ with chronic pa~n, in which 2@/4~ (@0%) of s~eady pains were organ~ca~y based and only ~0/82 (31%) of throbbing pains were physicS° ~/so~ patients who have physical re1~ef factors for %he~ pain are most ]~ke]y ~o have physical precipitant ~oo (86%) and~ under,dab]y, physic~ causes.
DISCUSSION
almost
en~ely
sensor,
although they are psychia%ric patients.
ACKNOWLEDGEMENTS
We wish to thank Ms, Mary Ellen Walker, B.A. for invaluable assis~nce with computer programming. REFERENCES 1 Agnew, D.C. and Merskey, H., Words of chronic pain, Pain, 2 (197C~ 73--81o 2 Boyd, D.B.and Merskey, H., Emotional adjustment and chronic pain, Pmn, 5 (1978) in press.
3 Delaphine, R., Ifabumuyi, O.I., Merskey, H. and ZarTw, J., Significance of pain in psychiatric hospital patient, Pain, 4 (1978) 361--366. 4 Devine, R. and Merskey, H., The description of pain in psychia~ic and general rnedic~ patients,Psychosorn. Res., 9 (1965) 311--316. 5 Melzack, R. and Torgerson, W.S., On the language of pain, Anesthes~olo~, 34 {.1971) 50--59.
6 Reading, A.E. and Newton, J.Ro, A comparison of primary dysrnenorrhea and intrauterine device related pain, Pain~ 3 ([[977) 265--276.
.... :){!i ¸ !i !~
. . . .
~i~
iii!ii~i ~( /
~i ~
ii~
•
•