CATEGORI ZATI ON OF POSTOPERATI VE PAI N DESCRI PTORS I N THE SENSI TI VE,
AFFECTI VE AND EVALUATI VE DI MENSI ONS OF PAI NFUL EXPERI ENCES
Lilian Var anda Per eir a1 Fát im a Apar ecida Em m Faleir os Sousa2
Pereira LV, Faleiros Sousa FAE. Charact erizat ion of post operat ive pain descript ors in t he sensit ive, affect ive and evaluat ive dim ensions of t he painful experience. Rev Lat ino- am Enferm agem 2007 j ulho- agost o; 15( 4) : 563- 67.
The m ain purpose of t his st udy was cat egorizing 20 descript ors of post - operat ive pain sensory, affect ive an d ev alu at iv e dim en sion s. Six t y - on e ph y sician s par t icipat ed. Th ey w er e bet w een 2 4 an d 6 3 y ear s old an d cat egor ized 2 0 descr ipt or s by con sider in g t h eir lev el of at t r ibu t ion in t h e descr ipt ion of post - oper at iv e pain sen sor y , af f ect iv e an d ev alu at iv e q u alit ies. Th e cat egor izat ion sh ow ed t h at t h e m ost f r eq u en t ly at t r ib u t ed descript ors of sensit ive pain qualit ies w ere: lacerat ing, unbearable, fulm inat ing, int ense and deep; and, for t he affect iv e qualit ies: hallucinat ing, annihilat ing, m addening, despair ing, inhum an, blinding, t er r ible, m onst r ous an d dr eadfu l; w h er eas for t h e ev alu at iv e qu alit ies, t h ey w er e: u n bear able, st r on g, in t en se an d v iolen t . Th e m ost frequent ly at t ribut ed descript ors in t he descript ion of post - operat ive pain are t hose m ost ly j udged adequat e t o descr ibe t he affect iv e qualit ies of t his ex per ience.
DESCRI PTORS: pain, post oper at iv e; m et hods; subj ect headings; pain m easur em ent
CATEGORI ZACI ÓN DE LOS DESCRI PTORES DEL DOLOR POSTOPERATORI O EN LAS
DI MENSI ONES SENSORI AL, AFECTI VA Y EVALUADORA DE ESA EXPERI ENCI A
El principal obj et ivo de est e est udio fue caract erizar los 20 descript ores del dolor post operat orio en las dim ensiones sensorial, afect iva y evaluadora del dolor. Part iciparon 61 m édicos, con edad ent re 24 y 63 años, que car act er izar on 2 0 descr ipt or es, con sider an do el gr ado de at r ibu ción de los m ism os en la descr ipción de las calidades sensoriales, afect ivas y evaluadoras del dolor. Los result ados m ost raron que, ent re los 20 descript ores j uzgados por los m édicos, la cat egorización m ost ró que los de m ayor at ribución en la descripción de las calidades sensor iales del dolor fuer on: dilacer ant e, insufr ible, fulm inando, int enso pr ofundo; de las calidades afect iv as fuer on: alucinando, aniquilador , enloquecedor , desesper ador , desum ano, deslum br ando, t er r ible, m onst r uoso y pavoroso, y de las calidades evaluadoras: insufrible, fuert e, int enso y violent o. Los descript ores de m ayor at ribución en la descripción del dolor post operat orio describen, en su m ayoria, calidades afect ivas de esa experiencia.
DESCRI PTORES: dolor post oper at or io; m ét odo; descr ipt or es; dim ensión del dolor
CATEGORI ZAÇÃO DE DESCRI TORES DA DOR PÓS-OPERATÓRI A NAS DI MENSÕES
SENSI TI VA, AFETI VA E AVALI ATI VA DA EXPERI ÊNCI A DOLOROSA
O obj et iv o do est udo foi cat egor izar 20 descr it or es da dor pós- oper at ór ia, consider ando a adequação deles par a descr ev er a ex per iência dolor osa em suas dim ensões sensit iv a, afet iv a e av aliat iv a. Par t icipar am 61 cirurgiões e anest esist as, de am bos os sexos, com idades de 24 a 63 anos, os quais j ulgaram os descrit ores pelo m ét odo de Est im ação de Cat egor ias, u t ilizan do Escala Nu m ér ica de 7 pon t os. Os descr it or es j u lgados com o os m ais adequados par a descr ever a dor pós- oper at ór ia na dim ensão sensit iva, consider ando a m ediana dos escor es, f or am : dilacer an t e, in su por t áv el, f u lm in an t e, in t en sa e pr of u n da; n a dim en são af et iv a f or am : alucinant e, aniquiladora, enlouquecedora, desesperadora, desum ana, que cega, t errível, m onst ruosa e pavorosa e aqueles com m aior m ediana na dim ensão av aliat iv a: insupor t áv el, for t e, int ensa e v iolent a. Os descr it or es de m aior at ribuição na descrição da dor pós- operat ória foram , em sua m aioria, j ulgados com o adequados para descr ev er a dim en são af et iv a dessa ex per iên cia.
DESCRI TORES: dor pós- oper at ór ia; m ét odos; descr it or es; m edição da dor
1
Adj unct Professor of Hospit al Care Nursing, Triângulo Mineiro Medical School, Brazil, e- m ail: lvaranda@t erra.com .br; 2 RN, Associat e Professor, Universit y of São Paulo at Ribeirão Pret o College of Nursing, WHO Collaborat ing Cent re for Nursing Research Developm ent , Brazil, e- m ail: faleiros@eerp.usp.br
I NTRODUCTI ON
P
a i n c a n b e m a n i f e s t e d i n m a n y w a y s . Pot ent ial ex pr essions of painful st at es include:non-v ocal ex pr essions w it h post ur al alt er at ions ( caut ious
or unusual post ures and inact ivit y) , facial expressions
( g r i m a ce, a r q u ed ey eb r o w s a n d d eep n a so - l a b i a l
folds) , m ot or act ivit y ( frict ion or prot ect ion of t he sore
ar ea, st ar t le) an d au t on om ical act iv it ies ( p alen ess,
f l u s h , s w e a t i n e s s ) ; a n d v o c a l e x p r e s s i o n s l i k e
par alinguist ic m anifest at ions ( cr ies, m oans, scr eam s
a n d s i g h s ) a n d l a n g u a g e ( p l e a s , e x c l a m a t i o n s ,
qualit at iv e descr ipt ions, com plaint s and appeals)( 1). Th r o u g h l a n g u a g e, o n e c a n v e r b a l l y
expr esses specific qualit ies of each painful sensat ion,
w h i ch d i f f e r f r o m e a ch o t h e r, l i k e i n t h e ca se o f
dysm enorrhea, which is charact erized by t he sensat ion
of pr essur e and cr am ps; gast r ic pain, by hear t bur n;
r h e u m a t i c p a i n , b y t h e s e n s a t i o n o f s o m e t h i n g
ch ew in g , b ot h er in g; cep h alea, w h ich h as q u alit ies
ex pr essed by cr ack ing and lik e a punch.
Pain is n ot a specif ic sen sit iv e qu alit y t h at
varies only in int ensit y, but rat her an infinit e range of
q u a l i t i es u n d er a si n g l e l i n g u i st i c l a b el - p a i n . A
sy st em ized st udy w as dev eloped, focusing on w or ds
used in t he clinical rout ine t o describe pain( 2). Su p p o r t e d b y st u d i e s( 3 ) t h a t a p p o i n t t h e sen sit iv e- d iscr im in at iv e, af f ect iv e- m ot iv at ion al an d
c o g n i t i v e - e v a l u a t i ve d i m e n s i o n s o f p a i n , s o m e
aut hor s( 2) hav e ar gued t hat w or ds denom inat ed pain descr ipt or s could r epr esent such dim ensions, t ur ning
t h em essen t ial in t h e elabor at ion of in st r u m en t s t o
m easu r e t h is ex per ien ce.
Fr om a list of 44 w or ds com piled in 1939( 2), 102 descript ors were select ed and cat egorized in t hree
dim ensions: - t he sensit ive, referring t o t he t em poral,
sp a t i a l , p r e ssu r e , t e n si o n , p u n ct u r e , t h e r m o a n d
v iv idness char act er ist ics of t he pain, det er m ined by
t h e act iv it y of sp in al f ib er s ( sy st em s) t h at r ap id ly
conduct t he nocicept ive st im ulus ( exam ple: pulsat ing,
t ear in g , cu t t in g , p ier cin g , cr am p s, b u r n in g , am on g
ot hers) ; t he affect ive- m ot ivat ional - which is t ranslat ed
by feelings of t ir edness, fear, punishm ent , aut onom ic
react ions, due t o act ivit ies in t he lim bic syst em ( cruel,
cu r sed, t er r ify in g, su ffocat in g an d fr igh t en in g) ; an d
t he cognit iv e- ev aluat iv e - w hich r efer s t o t he global
e v a l u a t i o n o f t h e s i t u a t i o n e x p e r i e n c e d b y t h e
in d iv id u al, st r on g ly in f lu en ced b y p r ev iou s p ain f u l
ex p er ien ces ( ex am p le: b or in g , u n b ear ab le, st r on g ,
cr ushing)( 2, 4).
A s t u d y( 2 ) p r o v i d e d t h e b a s e s f o r t h e el ab or at i on of a m u l t i d i m en si on al i n st r u m en t , t h e
McGill Pain Quest ionnaire ( MPQ)( 5), which cont ains 78 p a i n d escr i p t o r s, d i st r i b u t ed i n f o u r l a r g e g r o u p s
( sen sit iv e, af f ect iv e, ev alu at iv e an d m ix ed) an d 2 0
su b g r o u p s. Si n ce i t s p u b l i ca t i o n , w e o b se r v e i t s
s i g n i f i c a n t u s e i n t h e s c i e n t i f i c a r e a , a i m i n g t o
c h a r a c t e r i z e c h r o n i c a n d a c u t e p a i n , e v a l u a t e
analgesic t echniques and discr im inat e sev er al painful
sy n d r o m es.
I t s validit y and reliabilit y have been explored
a n d su p p o r t e d b y r e se a r ch , r e co g n i zi n g t h i s
quest ionnair e as t he best inst r um ent t o ev aluat e t he
m ult idim ensionalit y of pain so far. How ev er, t he MPQ
pr esent s lim it s in it s applicat ion t o differ ent cult ur al
groups, since t he lit eral t ranslat ion of t he descript ors,
originat ed in t he English language, present s sem ant ic
problem s. The language differences can be confounded
with differences in the expression of pain, and the patient
can be led t o ch oose descr ipt or s t h at ar e n ot v er y
appropriat e t o describe t he pain ( s) he experienced, t o
the detrim ent of others m ore used in his( er) own language
but absent from t he present ed list .
A r g u i n g t h a t w o r d s c a n b e u s e d i n t h e
elab or at ion of an id eal p ain m easu r e an d t h at t h e
v er bal descr ipt ion of pain in t en sit y an d it s qu alit ies
by t he individual him / her self is r elevant for t he ideal
m e a su r e m e n t a n d e v a l u a t i o n o f t h i s e x p e r i e n ce ,
s t u d i e s h a v e b e e n p e r f o r m e d i n B r a z i l( 6 - 8 ) t o i n v est i g at e t h e p ai n d escr i p t o r s o r i g i n at ed i n t h e
Po r t u g u ese l an g u ag e. Th e au t h o r s q u an t i f i ed 1 1 9
descr ipt or s, u sin g dir ect psy ch oph y sical m et h ods of
scaling, and select ed m or e and less at t r ibut ed w or ds
in t he descr ipt ion of post oper at iv e pain.
Th er ef o r e, co n si d er i n g t h a t ex p l o r i n g t h e
knowledge of t he language used in t he descript ion of
pain an d com pr eh en din g w h at is bein g t r an sm it t ed
t hr ough t his language is essent ial t o adv ance in t his
a r e a , t h i s s t u d y w a s d e v e l o p e d a n d a i m e d t o
ca t e g o r i ze 2 0 d e scr i p t o r s o f p o st o p e r a t i v e p a i n ,
s e l e c t e d i n o n e s t u d y( 8 ), c o n s i d e r i n g t h e a p p r o p r i a t e n e ss o f e a ch t o d e scr i b e t h e p a i n f u l
ex per ience in t he sensit iv e, affect iv e and ev aluat iv e
d im en sion s.
MATERI AL AND METHOD
Th i s s t u d y w a s a p p r o v e d b y t h e Et h i c s
Pr et o Medical Sch ool Hosp it al d as Clin icas, Pr ocess
HCRP No7481/ 98.
We p e r f o r m e d a n e x p e r i m e n t f o r t h e
cat eg or izat ion of 2 0 p ost op er at iv e p ain d escr ip t or s
select ed fr om a st udy( 8) , in t he t hr ee dim ensions of t he painful ex per ience. A pilot st udy w as per for m ed
w it h f ou r p ar t icip an t s, w h ich w er e in clu d ed in t h e
sam p l e.
Par t icipan t s
A t ot al of 61 surgeons and anest hesiologist s,
b e t w e e n 2 4 a n d 6 3 y e a r s o l d a n d 8 3 . 6 % m a l e
part icipat ed in t he st udy. All of t hem were unaware of
t h e m e t h o d u s e d a n d h a d a t l e a s t o n e y e a r o f
e x p e r i e n c e w i t h p a t i e n t s i n t h e t r a n s a n d
post operat ive period. All of t hem signed t he free and
i n f o r m ed co n sen t t er m af t er r ecei v i n g v er b al an d
w r i t t e n cl a r i f i ca t i o n s a b o u t t h e r e se a r ch a n d i t s
ob j ect iv e.
Mat er ial
A n o t e b o o k w a s e l a b o r a t e d , c o n t a i n i n g
specific inst r uct ions for t he Est im at ion of Cat egor ies
m e t h o d o n t h e f i r st p a g e a n d a l i st w i t h t h e 2 0
descr ipt or s of post oper at iv e pain an d it s r espect iv e
definit ions on t he follow ing pages.
Pr o ced u r e
The phy sicians w er e int er v iew ed indiv idually
at t he sur gical cent er of a hospit al in t he int er ior of
Minas Ger ais, and in pr ivat e m edical offices in a cit y
in t h e in t er ior of São Pau lo, Br azil. Af t er r eceiv in g
v er bal and w r it t en or ient at ions about t he t ask t o be
per for m ed, t hey st ar t ed t o j udge t he 20 descr ipt or s
by t he Est im at ion of Cat egories m et hod. Scores were
at t r ibut ed t o each, consider ing it s appr opr iat eness t o
d e scr i b e t h e p a i n f u l e x p e r i e n ce i n t h e se n si t i v e ,
affect iv e and ev aluat iv e dim ensions, using a sev
en-point scale w it h num er ical alt er nat iv es v ar y ing fr om
on e t o sev en . Th e p ar t icip an t s w er e in st r u ct ed t o
at t r ibut e a num er ical value t o each descr ipt or, w hich
cor r esp on d ed t o t h e d eg r ee of ap p r op r iat en ess t o
d e s c r i b e e a c h o f t h e t h r e e d i m e n s i o n s o f t h e
post operat ive pain. Score 1 ( one) indicat ed t he sm aller
d eg r ee o f ap p r o p r i at en ess, w h i l e sco r e 7 ( sev en )
indicat ed t he highest degree a descript or could receive
in a cer t ain dim ension. Scor es 2 ( t w o) , 3 ( t hr ee) , 4
( four ) , 5 ( fiv e) and 6 ( six ) r epr esent ed int er m ediat e
levels of appropriat eness of t he descript or t o describe
a cer t ain dim ension.
Analy sis and st at ist ics
Friedm an’s t est was used and t he values were
ex pr essed in m edian, m inim um and m ax im um .
RESULTS AND DI SCUSSI ON
As sh ow n i n Tab l e 1 , t h e d escr i p t or s t h at
obt ained t he highest scor e m edians in t he sensit iv e
dim en sion , at t r ibu t ed t h r ou gh t h e Nu m er ical Scale,
w er e: t ear in g, an n ih ilat in g, m adden in g, despair in g,
inhum an, blinding, t errible, m onst rous and hair- raising,
w h ile t h ose w it h h ig h er m ed ian s in t h e ev alu at iv e
d i m en si o n w er e: u n b ear ab l e, st r o n g , i n t en se a n d
v iolen t . Th e scor es at t r ib u t ed t o t r em en d ou s w er e
ex pr essed by Med= 4 in t he sensit iv e and ev aluat iv e
dim ensions, t hough t he difference was not significant .
B r u t a l h a d a h i g h e r m e d i a n i n t h e e v a l u a t i v e
d i m e n si o n , t h o u g h n o t si g n i f i ca n t . Co l o ssa l a n d
crushing were expressed by Med= 4 in all dim ensions,
w it h p= 0.7100 e 0.2650, r espect ively.
Table 1 - Descr ipt ive behav ior and com parat iv e t est
r esult s for each of t he 20 descr ipt or s r egar ding t heir
sensit iv e, affect iv e e ev aluat iv e dim ensions
s r o t p i r c s e
D Sensitive Affective Evaluative .
n i
M Med.Max.Min.Med.Max.Min.Med.Max.Value-p g n it a n i c u ll a
H 1 3 7 1 5 7 1 4 7 0.04*
g n i r a e
T 1 5 7 1 4 7 1 3 7 <0.0001*
g n it a li h i n n
A 1 2 7 1 5 7 1 3 7 0.0007*
l a s s o l o
C 1 4 7 1 4 7 1 4 7 0.7100
g n i n e d d a
M 1 4 7 1 6 7 1 4 7 0.0006*
l a t u r
B 1 4 7 1 4 7 1 5 7 0.7950
g n i r i a p s e
D 1 4 7 1 6 7 1 4 7 <0.0001*
g n i h s u r
C 1 4 7 1 4 7 1 4 7 0.2650
n a m u h n
I 1 2 7 1 6 7 1 3 7 <0.0001*
e l b a r a e b n
U 1 6 7 1 4 7 1 6 7 0.0070*
g n o r t
S 1 5 7 1 3 7 1 6 7 0.0005*
g n it a n i m l u
F 1 6 7 1 3 7 1 5 7 0.0224*
g n i d n il
B 1 3 7 1 5 7 1 3 7 0.0005*
e s n e t n
I 1 6 7 1 3 7 1 6 7 <0.0001*
p e e
D 1 5 7 1 4 7 1 4 7 0.0002*
e l b i r r e
T 1 4 7 1 6 7 1 5 7 0.0020*
s u o d n e m e r
T 1 4 7 1 3 7 1 4 7 0.6880
s u o r t s n o
M 1 4 7 1 5 7 1 4 7 0.0060*
g n i s i a r r i a
H 1 3 7 1 6 7 1 3 7 <0.0001*
t n e l o i
V 1 4 7 1 4 7 1 5 7 0.0060*
Th e d e s c r i p t o r s u n b e a r a b l e a n d i n t e n s e
pr esent ed Med= 6 and significant differ ences for t he
sen sit iv e an d ev alu at iv e d im en sion s. Accor d in g t o
scholars, t he words cat egorized in t he evaluat ive group
suffer st r ong influence fr om t he sensit iv e dim ension,
and can m ake subj ect s at t ribut e est im at ive values t o
t he sam e descr ipt or w hich ar e t oo sim ilar in t he t w o
gr oupin gs( 5 ).
Th e e v a l u a t i v e g r o u p i n g r e p r e s e n t s t h e
ev alu at ion of im por t an ce or u r gen cy of t h e gen er al
sit u at ion . Su ch w or ds r eflect a j u dgm en t in flu en ced
b y t h e af f ect iv e an d sen sit iv e q u alit ies, as w ell as
b y p r ev iou s ex p er ien ces, b y t h e cap acit y t o j u d g e
r esu l t s a n d b y t h e m ea n i n g o f t h e si t u a t i o n t h a t
g e n e r a t e d t h e n o c i c e p t i v e s t i m u l u s . A s t h e
cir cum st ances in w hich one is ex per iencing a cer t ain
m om en t in t er fer e in t h e ch oice of descr ipt or s, su ch
w o r d s p o s i t i o n t h e p a i n f u l e x p e r i e n c e i n a
m ult idim ensional space for t he one w ho ex per iences
i t , a n d i t i s t h e p r o f e s s i o n a l s ’ r o l e t o r a i s e
h y p ot h eses ab ou t t h e ch oice of t h ese d escr ip t or s,
s i n c e t h e y a r e i n d i c a t i n g h i g h m a g n i t u d e a n d ,
co n se q u e n t l y, i n a d e q u a t e r e l i e f o f p o st o p e r a t i v e
p a i n .
I n a st u d y( 2 ) in w h ich u n iv er sit y st u d en t s, physicians and pat ient s grouped 102 words in 3 large
gr ou ps ( sen sit iv e, af f ect iv e an d ev alu at iv e) an d 1 6
s u b g r o u p s , w e o b s e r v e d t h a t , a c c o r d i n g t o t h e
t r anslat ion pr oposed for Por t uguese, t he descr ipt or s
m addening and t er r ible w er e j udged in t he affect iv e
grouping, and unbearable and st rong in t he evaluat ive
g r ou p in g .
Th e c a t e g o r i z a t i o n o f t h e r e m a i n i n g
d escr ip t or s in t h e g r ou p in g s w as n ot d iscu ssed in
r elat ion t o t he r esult s of ot her r elev ant st udies( 2, 5, 9), because t hese are words used in t he Brazilian cult ure,
w it h ou t a v alidat ed t r an slat ion for ot h er lan gu ages.
I n Br azil, t her e ar e no st udies t hat inv est igat ed t he
cat egor izat ion of descr ipt or s in differ en t dim en sions
of t he painful ex per ience, m ak ing dat a com par isons
and discussion difficult .
I n t his ex per im ent , fr om t he 2 0 descr ipt or s
st u died, sev en w er e con sider ed t h e m ost adequ at e
t o d escr ib e t h e sen sit iv e or ev alu at iv e d im en sion s
o f t h e p a i n f u l e x p e r i e n c e , a c c o r d i n g t o t h e
p h y s i c i a n s ’ o p i n i o n , a n d n i n e f o r t h e a f f e c t i v e
d i m en si o n .
As seen b ef o r e, t h e d i f f er en ces w er e n o t
s i g n i f i c a n t f o r c o l o s s a l , c r u s h i n g , b r u t a l a n d
t r em endous, w hich in t he aut hor s’ opinion m ight hav e
h ap p en ed d u e t o t h e su b j ect s’ d i f f i cu l t y t o j u d g e
w o r d s t h at ar e n o t v er y co m m o n i n t h e Br azi l i an
cu lt u r e.
The lit er at ur e show s t hat , in ot her cult ur es,
acut e pain is described by a higher num ber of words
fr om t he sensit iv e gr ouping, t hough descr ipt or s fr om
t h e af f ect iv e gr ou pin g em er ge in t h e descr ipt ion of
post oper at iv e pain as chosen by a gr eat per cent age
of pat ient s( 10,13). I n addit ion, t he inst r um ent used by t he aut hor s m ent ioned w as t he MPQ( 5), in w hich t he descr ipt or s ar e som ew h at dispr opor t ion al r egar din g
t h e n u m b er of w or d s in each g r ou p in g , 4 2 in t h e
sensit iv e, 14 in t he affect iv e one and 5 ( fiv e) in t he
ev aluat iv e gr ouping, w hich can bias t he r esult s.
The j udgm ent of t he descr ipt or s, consider ing
t h e i r a p p r o p r i a t e n e s s t o d e s c r i b e t h e p a i n f u l
ex p er ien ce in t h r ee d im en sion s, p oin t t o t h e n eed
f o r n e w r e s e a r c h , s i n c e t h e s t u d y o f w o r d s ’
dim ensions, in t he Br azilian cult ur e, is a fundam ent al
issue for t he dev elopm ent of inst r um ent s t hat allow
f or m u lt idim en sion al m easu r em en t of post oper at iv e
p ain .
CONCLUSI ON
Aft er t he ev aluat ion of t he 20 post oper at iv e
p a i n d e scr i p t o r s b y t h e Est i m a t i o n o f Ca t e g o r i e s
m et hod, it could be concluded t hat :
- Th e m o s t a d e q u a t e d e s c r i p t o r s t o d e s c r i b e
p o s t o p e r a t i v e p a i n i n t h e s e n s i t i v e d i m e n s i o n ,
considering t he score m edians at t ribut ed t hrough t he
n u m e r i c a l s c a l e , w e r e : t e a r i n g , u n b e a r a b l e ,
f u lm in at in g, in t en se an d deep; t h e descr ipt or s w it h
higher score m edians in t he affect ive dim ension were:
h allu cin at in g , an n ih ilat in g , m ad d en in g , d esp air in g ,
inhum an, blinding, t errible, m onst rous and hair- raising,
a n d t h o se w i t h h i g h er m ed i a n s i n t h e ev a l u a t i v e
dim ension: u n bear able, st r on g, in t en se an d v iolen t .
A l l o f t h e m p r e s e n t e d a s i g n i f i c a n t d i f f e r e n c e
( p< 0 . 0 0 5 ) .
- The j udgm ent s of t he descript ors t rem endous, brut al,
colossal an d cr u sh in g d id n ot p r esen t a sig n if ican t
d if f er en ce.
- Th e m ost at t r ib u t ed d escr ip t or s in p ost op er at iv e
p ai n d escr i p t i o n w er e m o st l y j u d g ed as ad eq u at e
t o d e s c r i b e t h e a f f e c t i v e d i m e n s i o n o f t h i s
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