Hi all.  I previously sent this to Tom (who was early in the thread),

I would think that there is very little regular meaning to the numerical value scale (VAS).  The absolute value is relative to the patient and the only way that it can be used is to compare before and after levels.  However, even the use in this setting is controversial.  I propose that we use one question and that should be "do you need more pain medication?"

Bet wishes

Dan Mayer MD

On Sat, Jul 22, 2017 at 11:40 AM, Pennington, Andy <[log in to unmask]> wrote:

I've heard that pain scales are now being used in the UK as part of the governments ('callous') mobility assessments to make (invalid) comparisons between people! All part of the cuts agenda. 

All the best, Andy.

On 22 Jul 2017, at 07:58, Owen Dempsey <[log in to unmask]> wrote:

Pain

Never clearly seen, a value determined subjectively depending on identity as well as physical matter which embraces the castration of a subject who does have experiences. Pain is an individual's  qualitative phenomenon along a continuum - to divide it by imposing  a scale is to misrecognise its continuous nature.  If there is no mind-body split - then  .... a reduction in positivised pain may well be exchangeable. 

No doubt pain can be turned into a calculable commodity and therefore be made useful for science under capitalism. Another question might be is: is science able to recognise at what point is pain pathological - or, is pain 'normal'? Does subjective pain sometimes serve a useful function in terms of an individual's health as a capacity of an individual to react constructively to threats to integrity. 

As might be expected there are calls for pain screening in e.g. patients with depression, which makes the attempt to recognise pain as pathological likely to intensify harms to health through overdiagnosis 

See: 

"Depression and Pain: the need for a new screening tool"

Cocksedge et al

progress in neurology and psychiatry Jan/Feb 2016

http://onlinelibrary.wiley.com/store/10.1002/pnp.414/asset/pnp414.pdf%3Bjsessionid=7B5BAC57C7B58C6E2E8F8A5B23B9048A.f03t01?v=1&t=j5exmaqp&s=f4cfe59cade471adff3b69e10d123c520b05db3f

On Sat, 22 Jul 2017 at 07:29, Owen Dempsey <[log in to unmask]> wrote:

No doubt pain can be turned into a calculable commodity and therefore be made useful for science under capitalism. Another question might be is: is science able to recognise any point at which  pain is pathological - or, when pain is  'normal'? Does subjective pain sometimes serve a useful function in terms of an individual's health as a capacity of an individual to react constructively to threats to integrity?

Owen 

On Sat, 22 Jul 2017 at 00:07, Anoop B <[log in to unmask]> wrote:

here is a podcast about the "new science of pain" by Moseley. very fascinating. Questions a lot of traditional approaches to pain treatment. 

http://indaily.com.au/podcasts/2017/03/28/podcast-the-revolution-in-managing-chronic-pain/

On Wed, Jul 19, 2017 at 7:00 AM, Jeremy Howick <[log in to unmask]> wrote:

Dear List Members,

Within the context of a trial or systematic review, is change in pain (for example with a visual analog scale): (a) physical outcome, (b) psychological outcome, or (c) both.neither?

I am aware that many causes of pain (such as bumping my head into a low door frame) are purely physical. What I am interested in is whether pain as an outcome measured by a visual analog scale itself is physical, psychological, or both/neither.

I’m specifically interested in what the scientific consensus is or, better, whether there is evidence of some kind that could resolve this.

Thanks in advance,

Jeremy

T: +44 (0)1865 289 258 E: [log in to unmask]

http://www.phc.ox.ac.uk/team/jeremy-howick

 

Nuffield Department of Primary Care Health Sciences, University of Oxford
Radcliffe Primary Care Building, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG

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