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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I like to be useful!

I’ve had a huge spike in blog visitors over the last few days and the popular post getting viewed a lot has been my representation of the McGill Pain Scale. My version is unusual because I’ve added an additional figure onto the scale – that of Fibromyalgia. It’s not a figure that we usually come across, and I found the information in one research paper which means that it’s a ball-park figure (only one sample group from one piece of research) but can still be helpful to some patients to share with others as many people still incorrectly think of Fibro’ as some sort of psychosomatic condition. It’s not. At all. There is plenty of scientific evidence to show to any doubters, but sometimes being able to show a quick piccy of the pain scale to demonstrate that the pain is scientifically ‘real’ can be a speedy and simple way to help someone to re-jig their understanding and treat Fibro’ patients with more thought.

The post is by far the most popular one to date (it includes CRPS as well). I am so pleased that fellow patients out there are finding it helpful. That is why I started this weblog in the first place, to share information and be as helpful as I can from my spot on the sofa with my laptop and my occasional brain!

I didn’t realise that a link to the post had been included on the Fibromyalgia News website, though. Not until yesterday, that is. Wow! Thank-you. That is good feedback suggesting that I’m on the right tracks and am managing to be useful. Exactly what I hoped I could do. 😀

There’s lots more to write about still, I shall keep on writing for as long as I can still be useful. Big hugs to you all, x

2013-10-27, Fibromyalgia news

2013-10-27, Fibro news

McGill Pain Index, CRPS and Fibromyalgia

Pain is a subjective experience. It is difficult to comprehend other people’s experience of pain without having a way to somehow compare pain levels. So, back in 1971, Ronald Melzack and Warren Torgerson published a paper showing a way they’d devised to do just that. It was the McGill Pain Questionnaire, (named after McGill University which they attended in Montreal in Quebec, Canada).

The McGill Pain Index that resulted from the questionnaire is not just a number on a scale. Each number, representing the pain level of an injury or condition, is compiled from lots of data which includes numerical scores as well as descriptive words which patients have used to answer various questions about their pain experience. The various components have been assessed for additional aspects such as consistency. This scientific scale has been rigorously tested over the years and has withstood all tests into reliability.

So it’s a really useful tool to get our heads around pain which we may not have experienced personally, and for putting our own pain into some kind of perspective for others.

There are several versions of the scale diagram visible on the internet which show the placement of various injuries and conditions on the scale of 0-50. But with the copyright issues online it is difficult to know which ones we can share.

So, with that in mind I started creating my own diagram from the scientific information which is readily available. There is an extra addition to my diagram, however, as I found one research paper which had used the McGill scale to assess pain levels for their participants with fibromyalgia, and I feel that this is important to include as it is another variable pain condition which many people are not really aware of. The research paper found the fibro’ patients’ pain levels to be at 29 and 30.

Here’s hoping that the diagram can help to reassure some friends, families, employers, teachers and so on that their CRPS and fibromyalgia contacts really are living with a genuinely high level of pain.

I will also upload my diagram as a photo’ on the Facebook page, and I’ll even create some different background colours that you can choose from. 🙂

Here’s my little diagramatic piece of techy(ish!) artwork…

McGill Pain Index, final

Although I have a copyright banner on this blog to protect my words and thoughts, and some personal pic’s, please be assured that if this diagram will help you then feel free to share it as that’s what I created it for.

Much love and best wishes from me,

x

References used:

Subspeciality Management, Anaesthesia  for Obstetrics, (for widely available information in usual McGill diagrams) http://web.squ.edu.om/med-Lib/MED_CD/E_CDs/anesthesia/site/content/v04/040302r00.HTM

Cork, R.C., Wood, P., Ming, N.,et al (2004) ‘The effect of cranial electrotherapy stimulation (CES) on pain associated with fibromyalgia’ in The Internet Journal of Anaesthesiology http://www.ispub.com/journal/the-internet-journal-of-anesthesiology/volume-8-number-2/the-effect-of-cranial-electrotherapy-stimulation-ces-on-pain-associated-with-fibromyalgia.html  NB: I’m only including this reference for where I found the fibromyalgia McGill Indexed data, I am not commenting on electrotherapy in any way

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