PSYCHOPHYSI CAL EVALUATI ON OF THE DESCRI PTORS OF PAI N
I N THE POSTOPERATI VE
Lilian Var anda Per eir a1
Fát im a Apar ecida Em m Faleir os Sousa2
Per eira LV, Sousa FAEF. Psychophy sical evaluat ion of t he descr ipt or s of pain in t he post operat ive. Rev Lat ino-am Enfer m agem 2007 m aio- j unho; 15( 3) : 474- 9.
This ex per im ent al st udy aim ed t o ev aluat e 20 descr ipt or s of t he post - oper at iv e pain consider ing t he
adequat e level of each in describing it . A t ot al of 48 post - operat ed pat ient s, age bet ween 14 and 70 years old,
6 0 . 4 % m ale, par t icipat ed in t he ex per im ent . They j udged t he descr ipt or s t hr ough t he Magnit ude Est im at ion
Met hod aim ing t o qualify and select t hose wit h t he highest and lowest frequency of at t ribut ions in t he descript ion
of t he post - operat ive pain. The result s showed t hat am ong t he descript ors evaluat ed, t errible, st rong, unbearable,
int ense and v iolent w er e t he m ost fr equent ly ones, w her eas t he least fr equent ly at t r ibut ed descr ipt or s w er e:
colossal, sm ashing, fulm inat ing, blinding and lacerat ing. The result s showed t hat t he m ost frequent ly at t ribut ed
descr ipt or s in t he descr ipt ion of post - oper at iv e pain ar e t hose t hat r epr esent high m agnit ude of pain.
DESCRI PTORS: pain, post oper at iv e; psy chophy sics; subj ect headings; m et hods
EVALUACI ÓN PSI COFÍ SI CA DE LOS DESCRI PTORES DE DOLOR EN EL POST-OPERATORI O
Est u dio ex per im en t al, a t r av és del cu al f u er on ev alu ados 2 0 descr ipt or es de dolor post - oper at or io,
consider ando el gr ado de adecuación que cada pacient e ut ilizó par a descr ibir lo, siendo par a ello ut ilizado el
Mét odo de Est im ación de Magnit ud. Par t icipar on 48 pacient es pos- oper ados, con edades ent r e 14 y 70 años,
siendo que 60,4% er an del sex o m asculino. El pr opósit o fue cuant ificar e ident ificar aquellos descr ipt or es con
m ayor o m enor at ribución dado al dolor pos- operat orio. Ent re los descript ores con m ayor at ribución dados por
los pacient es se encont raron, t errible, fuert e, insoport able, int enso y violent o; y com o los de m enor at ribución,
in m en su r able, opr esiv o, f u lm in an t e, qu e ciega y cr u el. Los descr ipt or es de m ay or at r ibu ción par a descr ibir
dolor pos- oper at or io fuer on aquellos que ex pr esaban una elev ada m agnit ud del dolor .
DESCRI PTORES: dolor ; post oper at or io; psicofísica; descr ipt or es
AVALI AÇÃO PSI COFÍ SI CA DE DESCRI TORES DE DOR NO PÓS-OPERATÓRI O
Tr a t a - se d e e st u d o e x p e r i m e n t a l , n o q u a l f o r a m a v a l i a d o s d e scr i t o r e s d a d o r p ó s- o p e r a t ó r i a ,
considerando o grau de adequação de cada um deles para descrevê- la. Part iciparam 48 pacient es pós- operados,
com idade ent r e 14 e 70 anos, 60,4% do sex o m asculino, os quais j ulgar am 20 descr it or es, pelo Mét odo de
Est im ação d e Mag n it u d e, com o p r op ósit o d e q u an t if icá- los e id en t if icar aq u eles d e m aior e os d e m en or
at r ibuição na descr ição da dor pós- oper at ór ia. Dent r e os descr it or es j ulgados pelos pacient es, t er r ív el, for t e,
insupor t ável, int ensa e violent a for am os de m aior at r ibuição, e colossal, esm agador a, fulm inant e, que cega e
dilacer an t e os de m en or at r ibu ição. Os descr it or es de m aior at r ibu ição n a descr ição da dor pós- oper at ór ia
for am aqueles que ex pr essar am elev ada m agnit ude de dor .
DESCRI TORES: dor pós- oper at ór ia; psicofísica; descr it or es; m ét odos
1
RN, Doct oral st udent ; 2 RN, Professor, e- m ail: rwgraziano@uol.com .br. Universit y of São Paulo, College of Nursing, Brazil
I NTRODUCTI ON
P
a i n h a s b e e n m e a s u r e d b y m e a n s o f f r e q u e n t l y o r d i n a l u n i d i m e n s i o n a l a n d m ult idim ensional inst r um ent s. Alt hough useful, t hese scales d o n ot p er m it m easu r in g t h e r at io b et w een d i f f er en t p ai n i n t en si t i es o r q u al i t i es. I t b eco m es im possible t o assess how m uch larger or sm aller one is t han t he ot her, or t he int ensit y of one descript or in r elat ion t o anot her t o descr ibe t he pain felt . Fr om a st at ist ical v iew point , t hese inst r um ent s do not allow for h igh er - lev el oper at ion s, becau se t h e or der does not pr ov ide infor m at ion about t he m agnit ude of t he differ ences am ong t he scale elem ent s( 1).Mor e m od er n an d p r ecise m et h od s, w h ich p r o d u ce scal i n g at r at i o l ev el , su ch as Mag n i t u d e Est im at ion and I nt er m odal Pair ing, per m it know ledge about t he rat io bet ween st im uli and responses. I t can be det erm ined if one st im ulus is great er t han anot her, i f o n e i n t en si t y i s st r o n g er t h an an o t h er, g u i d i n g decision m ak ing on analgesics in pain sit uat ions.
Th e p r o p e r t i e s o f a n i d e a l p a i n m e a su r e in clu de: a. pr ov idin g sen sit iv e m easu r es, f r ee f r om d i s t o r t i o n s i n h e r e n t i n t h e s u b j e c t ’ s a n d t h e ex per im en t er ’s ex pect at ion s, in t h e adv er se ef f ect s of t he used drugs and in psychophysical scaling it self; b. giv ing im m ediat e infor m at ion about t he subj ect s’ p r eci si o n a n d r el i a b i l i t y i n r ea l i zi n g t h e t a sk s ( i n psy ch oph y sical assessm en t m et h ods, t h e sen sit iv it y and v alidit y of ex per im ent al pain m easur es allow for t he ident ificat ion of individuals who, of t heir own choice or du e t o a lack of abilit y, u n sat isf act or ily per f or m t he t ask s r equir ed by t he m et hod) ; c. dist inguishing t h e s e n s i t i v e - d i s c r i m i n a t i v e a s p e c t s ( i n t e n s i t y, sen so r i al q u al i t y, l o cat i o n an d d u r at i o n ) f r o m t h e h e d o n i c q u a l i t i e s o f t h e p a i n ( e m o t i o n a l a n d m o t i v at i o n al – an x i et y, f ear, st r ess, av er si o n ) ; d . allow in g f or ex p er im en t al an d clin ical assessm en t , m ak in g possible r eliable com par ison s bet w een bot h and e. generat ing absolut e inst ead of relat ive scales, which perm it valid analyses am ong and inside different gr oups at differ ent m om ent s( 2).
When exam ining new m easur em ent m et hods wit h a view t o developing t echniques t hat approxim at e t he ideal m easure, it has been defended t hat language can help t o achieve t he ideal pain assessm ent t arget . Pain descript ors quant ified at rat io level could be used t o assess t he painful ex per ience, com ply ing w it h id eal p ain m easu r em en t p r op er t ies. Mor eov er, t hey would specify different dim ensions of t he painful
e x p e r i e n c e , a n c h o r i n g r e s p o n s e s t o s u b j e c t i v e st andar ds, t o be applied t o ex per im ent al and clinical pain assessm en t .
Psy chophy sical m et hods, such as Magnit ude a n d I n t er m o d a l Pa i r i n g Est i m a t i o n m et h o d s, w i t h different answer m odalit ies, could be used t o quant ify such descr ipt or s, m ak ing t hem v alid for clinical pain m easu r em en t( 2 ).
St u dies h av e dem on st r at ed t h at people ar e c a p a b l e o f s a t i s f a c t o r i l y p e r f o r m i n g t h e t a s k s r e q u e st e d a t m o r e p r e ci se m e a su r e m e n t l e v e l s, ap p o i n t i n g t h e p r eci si o n o f m easu r i n g t h e p ai n f u l e x p e r i e n ce b y m e a n s o f d e scr i p t o r s. Th e y h a v e e m p h a si ze d t h e i m p o r t a n ce o f t h e se m e t h o d s t o ident ify subj ect s w hose per for m ance does not at t end t o t he research crit eria, alert ing t o t he im port ance of t he veracit y of pain report s in experim ent al and clinical sit uat ions( 3).
Th e pain descr ipt or s w er e in v est igat ed in a t rial st udy, in which 20 pat ient s part icipat ed, who were bet w een 19 and 39 years old and w ere subm it t ed t o d e n t a l p u l p s t i m u l a t i o n . Th e m e t h o d u s e d w a s I n t er m od al Pai r i n g . I t w as d em on st r at ed t h at t h e subj ect s w er e capable of accom plishing t he pr oposed t ask s ( pair ing dy nam om et r ic for ce w it h t he int ensit y of p ain f u l st im u li an d d escr ip t or s of in t en sit y an d displeasu r e) , pr odu cin g v alid scales f or n ocicept iv e st i m u l i an d f or t h e l an g u ag e t h at can b e u sed t o descr ibe t his st im ulus. The select ed w or ds pr ecisely r ef l ect ed t h e i n t en si t y o f t h e p a i n f u l ex p er i en ce, s t r e n g t h e n i n g t h e u s e o f p a i n d e s c r i p t o r s f o r ex per im en t al or clin ical pain assessm en t . As t o t h e h e d o n i c p a i n q u a l i t i e s, i t w a s o b se r v e d t h a t t h e su bj ect s w er e capable of r elat in g t h e discom f or t of t he st im ulus t o words from t his group, while t he graphs an d st at i st i cal t est s sh o w ed t h e su b j ect s’ g r eat er difficult y t o carry out t he t ask relat ed t o t he sensorial descr ipt or s. Accor din g t o t h e au t h or s, t h is cou ld be r e l a t e d t o t h e i n a d e q u a cy o f t h e w o r d s f o r t h e experim ent al sit uat ion, in which t he subj ect volunt arily cont r ols t he m ax im um int ensit y of t he st im ulus and can int er r upt it w henever ( s) he w ant s( 4).
m et hods. The result s showed t hat m ost pat ient s were capable of j udging pr opor t ions( 5).
Also, w it h r esp ect t o p ain d escr ip t or s an d psy ch oph y sical m et h ods, au t h or s h av e in v est igat ed t he r eliabilit y and v alidit y of v er bal descr ipt or scales in a double- blin d t r ial st udy. Tw o ex per im ent s w er e car r ied ou t . Par t icip an t s w er e 2 0 m ale an d f em ale su b j ect s, b et w een 1 8 an d 3 8 y ear s old , w h o w er e subm it t ed t o surgical ext ract ion of t he t hird m olar and m a d e j u d g m e n t s t h r o u g h t h e i n t e r m o d a l p a i r i n g m et hod, w it h dy nam om et r ic for ce and pr essur e t im e m odalit ies on a but t on. I n t he second experim ent , 20 m en and 20 w om en, bet w een 18 and 42 y ear s old, M= 2 1 y ear s, assessed t h e pain f u l f eelin g pr ov ok ed b y elect r ic st im u li ap p lied t o t h e d en t al p u lp . Th e r esu l t s sh o w ed t h at t h e d escr i p t o r s w er e r el i ab l y quant ified t hr ough t he I nt er m odal Pair ing m et hod( 6). I n t his cont ex t , consider ing t hat people ar e ca p a b l e o f j u d g i n g t h e p a i n t h ey f eel u si n g r a t i o sca l e s, a n d t h a t p a i n d e scr i p t o r s ca n r e f l e ct t h e d if f er en t d im en sion s of t h e p ain f u l ex p er ien ce, w e consider ed it im por t ant t o develop t his st udy, in t he a t t em p t t o co l l a b o r a t e t o t h e r esea r ch o n v er b a l inform at ion in our cult ure. Thus, t his st udy aim ed t o: - I dent ify t he m ean est im at es of 20 pain descript ors, select ed from a st udy( 5), considering t he adequacy of each t o descr ibe post oper at iv e pain.
MATERI AL AND METHOD
We assessed 2 0 p ain d escr ip t or s, select ed fr om a st udy( 5), using t he Psy chophy sical Magnit ude Est im at ion m et h od. Th e pilot t est w as don e at t h e st ar t of t h e t r ial w it h f ou r p ar t icip an t s, w h o w er e included in t he sam ple. This st udy w as appr ov ed by t h e I n st it u t ion al Rev iew Boar d at t h e Un iv er sit y of São Paulo at Ribeir ão Pr et o Medical School Hospit al das Clínicas, Process HCRP No7481/ 1998, and by t he I n st i t u t i o n a l Re v i e w Bo a r d a t t h e Fa c u l d a d e d e Med icin a d o Tr iân gu lo Min eir o, locat ed in Ub er ab a,
Minas Ger ais, Pr ot ocol CEP/ FMTM No 0152/ 00.
Par t icipan t s
St udy par t icipant s w er e 48 pat ient s bet w een 1 4 an d 7 0 y ear s old , of w h om 6 0 . 4 1 % w er e m en . Th e s e p a t i e n t s w e r e i n t h e f i r s t o r s e c o n d p o st o p e r a t i v e d a y a f t e r o r t h o p e d i c, g y n e co l o g i c, v ascu lar an d ab d om in al su r g er ies. All p ar t icip an t s
w er e unaw ar e of t he k ind of scaling per for m ed and signed t he Consent Term , aft er being inform ed about t he r esear ch and it s obj ect iv e.
Met h od
The Magnit ude Est im at ion m et hod w as used, w h i ch i s o n e o f t h e m o st el eg a n t p sy ch o p h y si ca l m et h ods, in w h ich t h e su bj ect s is or ien t ed t o scale st im u li, at t r ibu t in g t h em w it h n u m ber s pr opor t ion al t o t he v alue ( m odule) est ablished by t he r esear cher for a st im ulus t aken as t he st andard. I f t he present ed st im ulus has t w ice t he int ensit y, adequacy, qualit y or any ot her charact erist ic t hat is being invest igat ed, t han t he st andar d st im ulus, it w ill r eceive a num ber t w ice as high. I f it is t wice as sm all, it will receive half t he value of t he st andard st im ulus and so on.
Pr o ced u r e
The pat ient s w er e indiv idually int er v iew ed in t he preoperat ive phase and received inst ruct ions about t he t ask t hey had t o perform during t he post operat ive ph ase, t h at is, t o scale st im u li ( pain descr ipt or s in t h is st u dy ) , m ak in g pr opor t ion al j u dgm en t s. I n t h e post oper at iv e ph ase, t h e obser v er qu est ion ed each pat ient about t he occur r ence of pain dir ect ly r elat ed wit h t he surgical procedure and, in t hose cases when t he pat ient agreed, rem em bered t he t ask report ed in t he preoperat ive phase, adding t hat t he words ( st im uli) could be appr opr iat e or not t o descr ibe t he sit uat ion t hey felt . They should at t ribut e scores t o each of t he 20 descript ors, using t he m odule 100 as a reference, at t r ib u t ed t o t h e d escr ip t or m on st r ou s, w h ich w as t ak en as t he st andar d. I n t hose sit uat ions w hen t he pat ient j udged t hat a cert ain descript or w as t w ice as adequat e as t he descript or m onst rous t o describe t he post oper at iv e pain, ( s) he w as or ient ed t o at t r ibut e a value t wice as high, t hat is, equal t o 200. On t he ot her hand, if t he descript or were t wice less adequat e t han m on st r ou s t o d escr ib e t h e p ain f u l ex p er ien ce, t h e scor e w ould be 50. Thus, t he par t icipant s j udged all descr ipt or s, w hich w er e pr esent ed r andom ly.
Mat er ial
RESULTS AND DI SCUSSI ON
Th is r esear ch pr esen t s a r at io scale, w h ich allow s for t he use of all m at hem at ical propert ies. We c a l c u l a t e d t h e g e o m e t r i c m e a n s ( GM ) a n d t h e geom et r ic st andar d dev iat ion ( GSD) of t he est im at es t he pat ient s at t ribut ed t o each descript or. The obt ained values ar e show n in Table 1.
Table 1 – Geom et ric m eans ( GM) , geom et ric st andard deviat ion ( GSD) of m agnit ude est im at es at t ribut ed t o pain descr ipt or s and r espect iv e posit ion or der ( PO)
r o t p i r c s e
D GM GSD PO Descriptor GM GSD PO
e l b i r r e
T 115,56343,27 1st Tremendous1.5xterr 75,9 93,48 11th
g n o r t
S 113,78144,93 2nd Brutal1.5ofterrand g
n o r t
s 75,61 41,1812th
e l b a r a e b n
U 111,92147,82 3rd Inhuman 71,72103,4213th e s n e t n
I 110,35188,46 4th Annihliaitng 70,72 89,6814th t n e l o i
V 104,22 110,53 5th Tearing 68,36 89,6815th p
e e
D 103,7 238,2 6th Bilnding 68,22 49,3216th s u o r t s n o
M 100 0 7th Hallucinaitng 67,3 54,5717th g n i s i a r -r i a
H 98,17 180,97 8th Fulminaitng 64,6 86,2518th g n i r i a p s e
D 88,66 134,44 9th Crushing2xte 62,46 91,4219th g n i n e d d a
M 77,71 150,4 10th Colossal2xterr 59,32 34,7720th
I n t his research, t errible, st rong, unbearable, i n t e n se a n d v i o l e n t w e r e a p p o i n t e d a s t h e m o st a d e q u a t e a n d c o l o s s a l , c r u s h i n g , f u l m i n a t i n g , hallucinat ing and blinding as t he least adequat e words t o d escr ib e p ost op er at iv e p ain. On ce q u an t if ied , a p r o p o r t i o n o f t w o t i m e s m o r e o r t w o t i m e s l e ss adequacy bet w een t he m ost and t he least adequat e w or d w as obser v ed. Thus, t er r ible ( GM= 115.56) w as con sid er ed 1 . 9 5 t im es m or e ad eq u at e t o d escr ib e post operat ive pain t han colossal ( GM= 59.32) and 1.85 m o r e a d e q u a t e t h a n c r u s h i n g ( GM = 6 2 . 4 6 ) . Trem endous ( GM= 75.90) was 1.5 t im es less adequat e t h an t er r ible, w h ich w as 1 . 4 9 t im es m or e adequ at e t han m addening ( GM= 77.71) and so on.
Th e m ost at t r ib u t ed d escr ip t or s ex p r essed sensor y ( int ense) , affect iv e (t er r ible) and ev aluat iv e (unbearable, st rong and violent) aspect s of t he painful ex per ience, in accor dance w it h t he cat egor izat ion of t he Por t uguese v er sion of t he MPQ( 7).
Lit erat ure appoint s descript ors from t he t hree g r ou p s, ch osen b y p at ien t s su b m it t ed t o d if f er en t surgical procedures. A st udy carried out( 8) wit h 40 adult p a t i e n t s a f t e r s u r g e r y, a i m e d a t e x a m i n i n g t h e applicabilit y and validit y of t he MPQ- short form , showed t hat t he m ost frequent ly chosen descript ors were: acut e, colic, bit e, painful, sensit iv e, ex haust iv e, st ab, bur n,
h eav y , b r eak in g , sick , f r ig h t en in g , ch ast en in g an d cruel, in t he sensory and affect ive cat egories. I n anot her
st udy( 9) of 88 adult and post operat ive pat ient s, aim ed at get t ing t o know t he qualit y of post operat ive pain, it w as descr ibed as: st ab, pr ick , squ eeze, st r et ch in g, heavy and sensit ive from t he sensit ive group; t iresom e and exhaust ive from t he affect ive group and dull from t he ev aluat iv e gr oup.
I n a sam ple of 52 adult pat ient s subm it t ed t o d if f er en t su r g ical p r oced u r es, it w as ob ser v ed t h at 8 4 % of t h em ch ose a m ax im u m of 1 0 d escr ip t or s f r o m t h e 2 0 e x i s t i n g MPQ s u b g r o u p s , w i t h o n e descr ipt or fr om t he affect iv e gr oup being chosen by 75% of t he sam ple( 10). I n anot her double blind st udy, aim ed at com p ar in g t h e ef f ect of an alg esia b ef or e and aft er t he sur gical incision, car r ied out am ong 42 adult pat ient s subm it t ed t o elect iv e sur ger ies, it w as shown t hat t he m ost frequent ly chosen descript ors in t h e p ost op er at iv e p h ase, t h r ou g h t h e MPQ, w er e: v ague, painful, sensit iv e, annoy ing and t ir esom e( 11). A w i d e - r a n g i n g c o m p a r i s o n a m o n g a l l descript ors in t his st udy and t hose chosen by pat ient s w ho used t he MPQ is not possible, as t he num ber of descript ors ranked in t his t rial is sm all ( 20 descript ors) in r elat ion t o MPQ descr ipt or s. Mor eov er, t hey w er e not r ank ed in t he differ ent dim ensions of t he painful ex p er ien ce as in t h e ab ov e m en t ion ed in st r u m en t . How ev er, som e of t h e m ost at t r ib u t ed d escr ip t or s belonged t o t he Port uguese version of t he MPQ( 7) and d e s c r i b e d d i f f e r e n t d i m e n s i o n s o f t h e p a i n f u l ex per ience, as obser v ed in ot her st udies( 9- 11).
I n t h i s s t u d y, t h e f o l l o w i n g d e s c r i p t o r s appear ed in t he fir st fiv e posit ions: t er r ible, st r ong, unbearable, int ense and violent ; in t he second st udy( 5), it w as obser v ed t h at t h ese posit ion s w er e occu pied by t he w or ds t er r ible, unbear able, m addening, deep a n d t r em en d o u s w h i l e, i n t h e t h i r d st u d y( 1 2 ), t h e descr ipt or s w er e annihilat ing, hallucinat ing, colossal, fulm inat ing and unbearable. The descript or unbearable a p p ea r s a m o n g t h e f i r st d escr i p t o r s i n t h e t h r ee ex p er im en t s, occu p y in g t h e t h ir d , secon d an d f if t h posit ions, while t errible appears in t he first posit ion in t his and anot her st udy( 5).
I n a st u d y( 1 3 ) ca r r i ed o u t t o ex a m i n e t h e post operat ive pain language, nurses at t ribut ed higher s c o r e s t o t h e d e s c r i p t o r s i n t e n s e , s t r o n g a n d unbearable, which occupied t he first , second and t hird posit ions in t he observed order and, in t his st udy, t he sam e descr ipt or s appear ed in t he second, t hir d and f ou r t h p osit ion s, r esp ect iv ely. I n an ot h er st u d y( 1 4 ), carried out am ong pat ient s in t he t hird decade of t heir l i f e , s u b m i t t e d t o p o s t e r i o r c o l p o p e r i n e o p l a s t y post erior and Burch, in which t he pain descript ors were used, it was observed t hat t he m ost at t ribut ed words in t he pat ient s’ j udgm ent s were: unbearable, t errible, d e s p a i r i n g , i n t e n s e a n d t r e m e n d o u s . Te r r i b l e , unbearable and int ense were also select ed in t his st udy.
Lit er at ur e appoint s unnecessar y suffer ing in t he post operat ive phase( 15), and t he great er at t ribut ion of w or ds indicat ing high m agnit udes, w het her in t he af f ect i v e, sen so r y o r ev al u at i v e d i m en si o n o f t h e p a i n f u l e x p e r i e n ce , se e m s t o co n f i r m t h e r e a l i t y o b s e r v e d b y t h e r e s e a r c h e r s , t h a t i s , t h a t post operat iv e pain has been assessed inadequat ely. As t o t he descript ors select ed in t he different exper im ent s, it w as obser ved t hat nur ses, physicians an d p at ien t s d escr ib ed p ost op er at iv e p ain t h r ou g h w or ds t hat r epr esent m ult iple qualit ies of t he painful ex p er i en ce.
An ot h er aspect obser v ed w as t h e su bj ect s’ abilit y t o sat isf act or ily per f or m t h e t ask s r equ est ed b y t h e Mag n it u d e Est im at ion m et h od . Th e p at ien t s were capable of j udging proport ions, alt hough subj ect s w i t h l o w e r e d u c a t i o n l e v e l s p r e s e n t e d g r e a t e r
difficult ies t o accom plish t he request ed t ask( 5). I n t his sense, w e agr ee in t his st udy t hat subj ect s w ho ar e capable of m ak ing t his j udgm ent cannot be depr iv ed o f t h i s t a s k . Re s e a r c h e r s a r e r e s p o n s i b l e f o r det erm ining what psychophysical m et hod is t o be used t o m easur e t he differ ent cont inua.
I t should be highlight ed t hat t he adv ant age of ver bal scales is t hat t hey pr opose t o m easur e t he d if f er en t d im en sion s of t h e p ain f u l ex p er ien ce an d are used in experim ent al and clinical pain assessm ent , r ef lect in g su b j ect iv e ex p er ien ces. Fu r t h er m or e, t h e su ppor t of su bj ect iv it y der iv es fr om t he su pposit ion t h a t i t i s n o t a l w a y s p o s s i b l e t o e l i m i n a t e a l l int erpret at ions and dist ort ions, as t hese can be relat ed t o t h e obser v er h im - / h er self. Th e gr eat est con cer n m u st f ocu s on t h e m ot iv es t h at m ade t h e su bj ect s dist or t t hem , and not only on t he fact of pr esent ing dist or t ion s.
CONCLUSI ON
Af t er assessin g t h e descr ipt or s t h r ou gh t h e Magnit ude Est im at ion m et hod, it can be concluded t hat , in t er m s of adequacy t o descr ibe post oper at iv e pain, t h e d e scr i p t o r s w i t h t h e h i g h e st m e a n e st i m a t e s r esu l t i n g f r o m p a t i en t s’ j u d g m en t w er e: t e r r i b l e , st rong, unbearable, int ense and violent and t hose wit h
t h e l o w e s t m e a n e s t i m a t e s : c o l o s s a l , c r u s h i n g , fulm inat ing, blinding and t ear ing.
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