Pain assessment as a social transaction: beyond the "gold standard".

Pain assessment conventionally has been viewed hierarchically with self-report as its "gold-standard." Recent attempts to improve pain management have focused on the importance of assessment, for example, the initiative to include pain as the "fifth vital sign." We question the focus in the conceptualization of pain assessment upon a "vital sign," not in terms of the importance of assessment, but in terms of the application of self-report as a mechanistic index akin to a biologic measure such as heart rate and blood pressure.

Lifetime exposure to adversity predicts functional impairment and healthcare utilization among individuals with chronic back pain

 Previous research has demonstrated an association between lifetime exposure to adverse events and chronic back pain (CBP), but the nature of this relationship has not been fully specified. Adversity exposure typically predicts undesirable outcomes, suggesting that lack of all adversity is optimal.

Race, care seeking, and utilization for chronic back and neck pain: population perspectives.

 e analyzed a statewide survey of individuals with chronic back and neck pain to determine whether prevalence and care use varied by patient race or ethnicity. We conducted a telephone survey of a random sample of 5,357 North Carolina households in 2006. Adults with chronic (>3 months duration or >24 episodes of pain per year), impairing back or neck pain were identified and were asked to complete a survey about their health and care utilization. 837 respondents (620 white, 183 black, 34 Latino) reported chronic back or neck pain.

Comfortably numb? Exploring satisfaction with chronic back pain visits.

BACKGROUND CONTEXT: Chronic back pain is a condition characterized by high rates of disability, health-care service use, and costs.
PURPOSE: The purpose of this study was to identify factors associated with patients' satisfaction with their last health-care provider visit for chronic low back pain (LBP).
STUDY DESIGN/SETTING: A cross-sectional, state-level, telephone survey was administered to patients with chronic LBP.
PATIENT SAMPLE: The sample consisted of 624 individuals with chronic LBP who reported seeing a health-care provider in the previous year.

Exercise prescription for chronic back or neck pain: who prescribes it? who gets it? What is prescribed?

  OBJECTIVE: To describe exercise prescription in routine clinical practice for individuals with chronic back or neck pain because, although current practice guidelines promote exercise for chronic back and neck pain, little is known about exercise prescription in routine care.

The Rising Prevalence of Chronic Low Back Pain

  Background National or state-level estimates on trends in the prevalence of chronic low back pain (LBP) are lacking. The objective of this study was to determine whether the prevalence of chronic LBP and the demographic, health-related, and health care–seeking characteristics of individuals with the condition have changed over the last 14 years.

Neonatal Pain Facial Expression: Evaluating the Primal Face of Pain

The primal face of pain (PFP) is postulated to be a common and universal facial expression to pain, hardwired and present at birth. We evaluated its presence by applying a computer-based methodology consisting of "point-pair" comparisons captured from video to measure facial movement in the pain expression by way of change across two images: one image before and one image after a painful stimulus (heel-stick).

Facial Expression and Pain Assessment in the Pediatric Patient: The Primal Face of Pain

PURPOSE: This paper aims to explore the role of facial expression in pediatric pain assessment. A comparison of tools employing facial expression methodology is presented. The concept of the primal face of pain (PFP) is introduced. CONCLUSION: The PFP offers an explanation to the utility and deficiency of facial pain scales and facial expression in pain assessment. PRACTICE IMPLICATIONS: The complexities of pain measurement should preclude the clinical application of untested instruments.

Is There a Primal Face of Pain? A Methodology Answer.

Pain assessment is of high priority in the clinical setting. Facial Pain Scales (FPSs) are pain assessment tools generally used with school-aged children. The implicit theoretical bases for the success of FPSs have seldom been explored. Explanations why and how FPSs work (or do not work) have not been addressed. We support the existence of a universal pain expression--the Primal Face of Pain (PFP), which is present at birth, evolved in nature, and modulated through sociocultural factors. We propose it to be key in understanding the applicability of FPSs.

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