The application, along with similar tools, may assist medical professionals and caregivers. These could prove particularly beneficial in the treatment of individuals who are unable to express their feelings.
However, they are not without flaws. Moreover, they raise a host of complex issues regarding our understanding, expression, and management of pain.
Describing pain can be notoriously challenging, as nearly everyone who has been asked would agree. At a recent consultation, my physician requested that I rate my pain on a scale from 1 to 10. I found this task exceedingly difficult. A score of 10, she indicated, represented “the worst pain imaginable,” which reminded me of the unpleasant experience of appendicitis.
Not long before the issue that brought me in, I had fractured my toe in two locations, which was quite painful—but less so than appendicitis. If I deemed appendicitis a 10, then breaking a toe felt more like an 8. In that context, perhaps my current pain could be a 6. As a pain rating, it didn’t seem to align with how I really felt. I wondered if I might have indicated a higher score had my appendix still been intact. I also contemplated how another individual with my medical issue might assess their pain.
In reality, we all perceive pain uniquely. Pain is subjective and is influenced by our previous experiences, our emotions, and our expectations. The way in which individuals articulate their pain can also differ greatly.
This has been understood for a long time. In the 1940s, anesthesiologist Henry Beecher observed that injured soldiers were significantly less likely to seek pain relief compared to those with similar injuries in civilian hospitals. They might have been displaying courage, or perhaps they felt fortunate to be alive under their circumstances. We cannot definitively ascertain the actual level of pain they were experiencing.
Considering this complicated scenario, I recognize the allure of a straightforward assessment that quantifies pain and aids healthcare workers in determining the best treatment for their patients. This is what PainChek, the smartphone application Deena discussed, aims to provide. The app evaluates minor facial movements, such as lifting lips or furrowing brows. A user is then asked to complete an additional checklist to pinpoint other indicators of pain that the patient may exhibit. It appears to perform well and is already implemented in medical facilities and caregiving environments.
Nevertheless, the app is assessed against personal pain reports. It could prove beneficial for gauging the pain of those unable to articulate it themselves—perhaps due to conditions like dementia—but it may not offer much additional insight for those who can already express their pain levels.
There are further complexities. Suppose a test could identify that a person was in pain. What actions can a physician take with that information? They might provide pain relief—but most existing pain medications were developed to address acute, short-term pain. For someone suffering from a chronic pain disorder, treatment options become considerably restricted, according to Stuart Derbyshire, a pain neuroscientist at the National University of Singapore.
The last time I consulted with Derbyshire was in 2010, when I reported on researchers in London studying brain scans to assess pain. That was 15 years ago. Still, pain-measurement brain scans have yet to become a standard aspect of clinical practice.
This scoring method was also based on subjective pain reports. As Derbyshire describes it, these reports are “embedded in the system.” It’s not optimal, but when it comes down to reality, we must depend on these fluctuating, variable, and at times contradictory self-reports of pain. It is the best available option.
Derbyshire expresses doubt that we will ever develop a “pain-o-meter” capable of determining an individual’s true experience. “Subjective report is the gold standard, and I believe it will always remain so,” he states.
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