Is there physician bias against eliciting affective qualities of pain?

GOALS: The purpose of this study is to determine the weight given to each of 3 pain dimensions by physicians who assess patients' pain experiences. BACKGROUND: Pain is a subjective experience that has profound impact on the quality of life. The 101-Multidimensional Affect and Pain Survey (101-MAPS) is currently the only available instrument that takes into account all 3 validated dimensions of pain by classifying 101 items into "superclusters" of sensory pain, suffering, and well-being. STUDY: Fourteen gastroenterologists, 11 internists, and 11 medicine residents from 2 teaching hospitals rated the items on the 101-MAPS based on their perception of the items' relevance to pain in gastrointestinal diseases, on a scale of 0 (least relevant) to 5 (most relevant). RESULTS: Of the 101 items in the MAPS rated by gastroenterologists, 25 items received a median rating of 4 or above. Of these, 23 were selected from the 57 items in the sensory pain supercluster (40%) and only 1 item each from the 26 in the suffering (3.8%), and the 18 in the well-being (5.5%) dimensions. These proportions were significantly lower for the suffering (P<0.01) and well-being (P<0.05) superclusters than for the sensory pain dimension. CONCLUSIONS: These findings suggest a bias among physicians toward sensory and against affective qualities when eliciting patients' pain experiences. The results also suggest that this bias is found as early as residency training and persists among specialists.

Validation of the Multidimensional Affect and Pain Survey (MAPS).

UNLABELLED: The concurrent construct validity of the Multidimensional Affect and Pain Survey (MAPS) was determined in a sample of 100 oncology outpatients. As recommended by Jensen, we examined the frequency pattern of correlations between MAPS and standard questionnaires that reached a criterion level of significance. As predicted, the 17 subclusters in the MAPS Somatosensory Pain supercluster showed a higher mean frequency of criterion correlations with the 4 sensory-related groups of items from the MPQ and, equally important, a lower frequency of criterion correlations with unrelated constructs, POMS, and the MPQ Affective Class. The 8 subclusters in the MAPS Emotional Pain supercluster revealed a high frequency of correlations with related POMS and FACT-G scales and (negatively) with the KPS score; equally important, there were far fewer criterion correlations of these scales with unrelated MPQ sensory classes. The 5 subclusters of the MAPS Well-Being supercluster showed a high frequency of criterion correlations with the POMS Vigor/Activity Scale, related FACT-G scales, and the KPS score and lower frequencies of correlation with the unrelated MPQ sensory groups. In conclusion, the 101-item MAPS yields more information about a patient's pain, emotional, physical, and cognitive status than does a much longer test battery consisting of 191 items contained in the MPQ, POMS, and FACT-G questionnaires. PERSPECTIVE: This study demonstrates the validity of a new pain questionnaire developed objectively by multivariate cluster analysis rather than subjectively by expert opinion. MAPS assesses patients' somatosensory and emotional experiences, and feelings of well-being with greater scope and accuracy than a battery of questionnaires, and it does so in much less time.

Item analysis of cancer patient responses to the Multidimensional Affect and Pain Survey demonstrates high inter-item consistency and discriminability and determines the content of a short form.

UNLABELLED: To construct a short form (SMAPS-CP), item analysis was used to select 30 items, 1 from each of the 30 subclusters in the 101-item Multidimensional Affect and Pain Survey (101-MAPS). Representation of each of the subclusters ensured that the structure of the MAPS dendrogram obtained by cluster analysis was maintained in SMAPS-CP. Responses of outpatients with cancer to the 101-MAPS were treated by item analysis to obtain measures of interitem consistency (criterion between .40 and .80) and discriminability (criterion above .35) for each of the 101-MAPS questions. Both of these criteria for acceptance were met by 53 of the 57 questions in Supercluster I, Somatosensory Pain, by 25 of the 26 questions in Supercluster II, Emotional Pain, and by all 18 of the questions in Supercluster III, Well-being. The item within each cluster that best met the item analysis criteria was selected for the 30-item SMAPS-CP questionnaire. PERSPECTIVE: Item analysis of responses by cancer patients to a 101-item questionnaire was used to develop a short questionnaire that can be used to identify and treat both physical and emotional levels of pain without the burden of a long questionnaire.

APS position statement on the use of placebos in pain management.

In the spring of 2003, the board of directors of the American Pain Society asked the APS Ethics Committee to formulate a position statement for the Society concerning the use of placebos in clinical practice (cf, reference ). A subset of the Ethics Committee under my direction composed such a statement based on the available scientific and ethical literature. We then sought feedback from the entire ethics committee as well as numerous prominent voices in the literature and presented the statement to the membership for discussion at the 2004 annual APS meeting in Vancouver, British Columbia, at both a symposium and an ethics special interest group meeting. The resultant document was approved by the APS Board and is published here for widespread distribution to the membership.

A translation of the Multidimensional Affect and Pain Survey (MAPS) from English to Japanese.

This paper introduces the Japanese translation of the Multidimensional Affect and Pain Survey (MAPS), a 101 item questionnaire which has been demonstrated to possess a number of advantages over the McGill Pain Questionnaire (MPQ). We also review validation and other studies which used translations of MAPS into Chinese, Czech, Italian and Russian to study cancer related and chronic pain.

A novel method for the construction of verbal rating scales at the ratio scale level of measurement precision: the multidimensional-psychophysical scaling procedure (M-PSP).

The multidimensional-psychophysical scaling procedure was employed to construct verbal rating scales at the ratio scale level of measurement precision. The multidimensional individual differences scaling model (INDSCAL) demonstrated a one-dimensional solution in the group stimulus space, with the eight verbal descriptors and the eight electrical stimulus intensities interdigitated with respect to their perceived strength. A plot of these stimulus coordinates against a scale of electrical intensities in milliwatts yielded an exponential function. To construct the rating scales, the four attributes that could be discerned within the dimension-namely, perceived intensities of the electrical stimuli and the attributes of the subjective experiences evoked by the electrical stimuli: pain qualities, somatosensory qualities, and emotional qualities-were plotted as separate scales against a subjective intensity scale. Although not presented here, INDSCAL also yields a subject coordinate space that quantifies the importance or saliency to each subject of each pole, stoical or complainer, of the dimension.

Increased colonic pain sensitivity in irritable bowel syndrome is the result of an increased tendency to report pain rather than increased neurosensory sensitivity.

OBJECTIVE: The aim was to determine whether lower visceral pain thresholds in irritable bowel syndrome (IBS) primarily reflect physiological or psychological factors. METHODS: Firstly, 121 IBS patients and 28 controls underwent balloon distensions in the descending colon using the ascending methods of limits (AML) to assess pain and urge thresholds. Secondly, sensory decision theory analysis was used to separate physiological from psychological components of perception: neurosensory sensitivity (p(A)) was measured by the ability to discriminate between 30 mm Hg vs 34 mm Hg distensions; psychological influences were measured by the report criterion-that is, the overall tendency to report pain, indexed by the median intensity rating for all distensions, independent of intensity. Psychological symptoms were assessed using the Brief Symptom Inventory (BSI). RESULTS: IBS patients had lower AML pain thresholds (median: 28 mm Hg vs 40 mm Hg; p<0.001), but similar neurosensory sensitivity (median p(A): 0.5 vs 0.5; p = 0.69; 42.6% vs 42.9% were able to discriminate between the stimuli better than chance) and a greater tendency to report pain (median report criterion: 4.0 ("mild" pain) vs 5.2 ("weak" pain); p = 0.003). AML pain thresholds were not correlated with neurosensory sensitivity (r = -0.13; p = 0.14), but were strongly correlated with report criterion (r = 0.67; p<0.0001). Report criterion was inversely correlated with BSI somatisation (r = -0.26; p = 0.001) and BSI global score (r = -0.18; p = 0.035). Similar results were seen for the non-painful sensation of urgency. CONCLUSION: Increased colonic sensitivity in IBS is strongly influenced by a psychological tendency to report pain and urge rather than increased neurosensory sensitivity.