Ankylosing Spondylitis on the McGill Pain Scale

Recently Ankylosing Spondylitis (AS) has been found to involve neuropathic pain. A question from a fellow patient about the McGill Pain Scale score for the condition resulted in me pottering off to see what research had found regarding AS pain scores.

A recent research paper that involved a small AS sample group of 17 participants who completed the McGill Pain Questionnaire (MPQ). The MPQ score for this sample group was 28.

Please note that with such a small sample group this is a ‘ball-park’ figure for reference only.

I’ve added this to my MPQ diagram below, in case this helps any other AS patients out there to explain the pain levels they experience on a day-to-day basis.

McGill Pain Index, final 2

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The main objection you are likely to hear when showing this pain scale to others is that pain is subjective and so cannot be scientifically compared, so here’s some info’ about this scale…

There was no scale of the sort for many years because yes, pain is subjective.

The use of the basic 1-10 pain scale is simply to compare our own pain to our own pain – it is only relevant to us as individuals because only we know a) what pain we are experiencing, and b) what the numbers on the scale represent to us pain-wise.

The McGill Pain Scale (named after the university it was developed at) was introduced in the 70’s by Ronald Melzack and Warren Torgerson and was initially doubted by his contemporaries for the same reason. Of course no scale is perfect, but the MPQ has been rigorously scientifically tested over and over since it’s creation and has actually proved to be scientifically very robust indeed. (There is also a short-form of the MPQ available (S-F MPQ) ).

The reason it works is that it involves asking many patients (so it’s not a small sample group) and they are not asked to just name a number in a subjective way…
The MPQ asks various questions involving both numbers and words that are descriptive of pain. The words used to describe pain have been found to indicate different levels of pain when the similar groups of words keep cropping up in the answers. The set-up of the MPQ is complicated in that it cross references all of the answers with each other to assess things like consistency, but it is designed to be easy to use and easy to score. The complexity used has been found to be very robust for a general pain score.

This scale is a good guideline, therefore, for our understanding of condition pain levels in a general sense.

So yes, pain scales as a whole are still as subjective as ever. But the McGill Pain Scale is a reliable way of comparing conditions as a whole.

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References:

Melzack, R. & Torgerson, W.S. (1971) ‘On the language of pain’, Anesthesiology, Vol. 34, pp 50-59

Melzack, R. (1975) ‘The McGill Pain Questionnaire: Major Properties and Scoring Methods’, Pain, Vol. 1, Issue 3, pp 277-299

Melzack, R. (1983) ‘The McGill Pain Questionnaire’, Pain Measurement and Assessment, pp 41-47

Melzack, R. (1987) ‘The Short-Form McGill Pain Questionnaire’, Pain, Issue 30, pp 191-197

Melzack, R. (2005) ‘The McGill Pain Questionnaire: From Description to Development’, Anesthesiology, Issue 103, pp 199-202

Wu, Q., Inman, R.D. & Davis, K.D. (2013) ‘Neuropathic Pain in Ankylosing Spondylitis: a Psychophysics and Brain Imaging Study’ in Arthritis & Rheumatology, Vol. 65, Issue 6, pp 1494-1503

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10 thoughts on “Ankylosing Spondylitis on the McGill Pain Scale

  1. Hi there. I am extremely concerned about your placement of “arthritis” on this scale. I am a person with rheumatoid arthritis. RA is MUCH different than osteoarthritis. Osteoarthritis (OA) is an arthritis often described like your grandma’s arthritis. One or two joints become diseased due to ‘wear and tear’. Both RA and OA are painful but RA is a debilitating systemic, progressive disease. The pain is certainly at the higher end of the scale for many with the severe, erosive type of RA. It’s not exactly equivalent to a toothache.

    I was a researcher before the onset of RA. It effectively ended my career overnight. The systemic symptoms include low grade fever, flu like symptoms, fatigue, malaise and SEVERE PAIN. RA is an autoimmune disease that attacks synovial fluid in the joints, as well as ligaments, tendons, bursa, muscle and organs. It is an incredible disservice to the RA community for you to create such a misleading diagram. Please consult the research or people with RA prior to making such a poorly supported medical judgment.

    • Hi Mary, rest assured that this isn’t my placement of arthritis it’s the official placement on the scale which is available online. The only ones I’ve added I have specified as ‘ballpark’ figures only.

      And yes, I also thought it was strange that ‘arthritis’ is all lumped under one heading. As it’s the official rating it’s not something that I can change but it would be interesting to do some journal searches to see if we can gain some clearer info’. As you were a researcher you may well have a collection of RA articles on your computer just as I have of CRPS ones on my laptop here so if you want to send me any links to good quality research regarding types of arthritis with McGill Scale scores in them them please do feel free to post them in a reply here because a) I’m always up for learning more and reading good info’ and b) I bet you have some fellow patients out there who have thought the same thing and would most likely really appreciate some research papers for reference too 🙂

    • This person did not create the universally used Mcguill pain scale. It was a kind gesture to search for copy and paste to help these CRPS patient some with the intractable form which causes very poor morbidity rate from living with a pain so consistent and severe it’s considered terminal because this pain shortens life expectancy. In the medical profession it’s known as the suicide disease. Mostly when spreading to scalp and face. Human beings can not live beyond a certain level of pain 24/7 always. I cousin 42 died it causes a stroke. Knew her my whole life but that kind of pain change her completely. Memory loss couldn’t even follow a conversation just remember either moans is screams slamming her body against walls to feel any other pain but CRPS even for a minute. I

  2. Greetings. I am wanting to know if I could use this image in an article I am writing for my own soon-to-be blog. I am writing an article on Pain Scales and Pain with a focus on chronic illness/pain and I want to be sure I have permission before I use it. I have had Fibromyalgia for nearly 2 decades and, finally, was diagnosed with Palindromic Rheumatoid Arthritis (on top of it) that went undiagnosed/overlooked due to both myself and physicians not communicating well. I am hoping to save others years of suffering by putting more info out there on this topic (Pain Scales).
    Thanks.

    • Absolutely Meretisa, I created it to help my fellow patients so yes feel free to use it 🙂

      I’d love to have a read of your new blog and support you on your new venture, so feel free to pop in and share the weblink. Health bloggers can make such a difference to fellow patients around the world so welcome to the blogging family 😀

  3. This person was kind enough to research copy and paste this scientificly clinical researched McGill pain scale. The person copied and pasted, not created it to be helpful. This pain scale is used throughout many other countries. I know people in pain have every right to shout and complain, anything that helps…I get it. I will add some info about many of these CRPS patients, especially the 30% considered intractable pain meaning 24/7 uncontrollable and live at a high level 8 on good days. Please think of these people living with what is known in the medical field as “the suicide disease”. Many live with this on facial area and skull. Pain is so severe, I’ve seen it cause AWFUL neurologic impairments as well. Many will slam their head into walls anything to hurt somewhere else so just for a minute or so they feel something other than the CRPS.
    Unfortunately those with intractable CRPS that are not being properly medicated can continue that life. The is a certain amount of pain that human beings can live with. I pray doctor’s BECOME aware of the new laws regarding medicating these intractable CRPS pain patients. Once this diagnosis is backed up many states simply have the write it on the form from the DEA and the drs. Won’t be bothered by the govt regarding this patient again.
    I pray for all of you to have the pain relief you need

  4. Pingback: Fragile Egg Syndrome | Life, CRPS & Everything

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