Pain is always an unpleasant sensation. But its intensity can be different: it depends on what kind of disease has developed and what pain threshold the person has.

So that the doctor can understand exactly how it hurts - unbearably or more or less moderately - so-called pain scales were invented. With their help, you can not only describe your pain at the moment, but also say what has changed with the prescription of treatment.

Visual analogue scale

This is the scale most often used by anesthesiologists and oncologists. It provides an opportunity to assess the intensity of pain - without any prompting.

A visual analogue scale is a 10 cm long line drawn on a blank sheet of paper - without boxes. 0 cm is “no pain”, the rightmost point (10 cm) is “the most unbearable pain, which is about to lead to death.” The line can be either horizontal or vertical.

The patient must place a point where he feels his pain is located. The doctor takes a ruler and looks at what mark the patient’s point is:

• 0-1 cm – pain is extremely mild;
• from 2 to 4 cm – weak;
• from 4 to 6 cm – moderate;
• from 6 to 8 cm – very strong;
• 8-10 points – unbearable.

When assessing pain, the doctor not only looks at this point, but also at the person’s entire behavior. If a person can be distracted by questions, if he calmly walked through the office before leaving, perhaps he is overestimating the degree of pain. Therefore, he can be asked to re-rate his pain - on the same scale. And if this is a woman, then ask to compare it with pain during childbirth (it is estimated at 8 points for each woman). If she says: “What, giving birth was twice as painful,” then you should rate her pain at 4-5 points.

Modified visual analogue scale

The essence of pain assessment is the same as in the previous case. The only difference between this scale is the color marking, against which the line is drawn. The color comes in a gradient: from green, which starts at 0, to 4 cm it changes to yellow, and to 8 cm it changes to red.

Verbal ranking scale

It is very reminiscent of a visual analogue scale: it is also a 10 cm long line that can be drawn in front of the patient independently. But there is a difference: every 2 cm there is an inscription:

• at 0 cm – no pain;
• 2 cm – mild pain;
• at around 4 cm – moderate pain;
• at 6 cm – strong;
• at 8 cm – very strong;
• at the end point - unbearable pain.

In this case, it is already easier for a person to navigate, and he puts an end to it based on which epithet he most associates his own state with.

The positive aspects of this method of pain assessment are that it can be used to assess both acute and chronic pain syndromes. In addition, the scale can be used in children, starting from primary schoolchildren, as well as people with primary degrees.

Pain scale "in faces" (facial)

This scale can be used to determine the intensity of pain in people with advanced dementia. It consists of 7 drawings of faces with emotions, each of which schematically conveys the strength of the pain syndrome. They are arranged in order of increasing pain.

Why drawings, and why such primitive ones? Because from such drawings the emotion is easier to read and more difficult to misinterpret than from a work of art or photograph.

Before a person points to a face that displays the appropriate degree of pain, he needs to explain the picture. The doctor says: “Look, the first person is not in pain, then people are shown who feel pain - more and more each time. The person on the right is in terrible pain. Show me how much pain you feel." After this, the person points or circles the desired face.

Modified face scale

It consists of 6 faces, each of which depicts an emotion corresponding to the description of pain on a verbal ranking scale. It is also used to assess the intensity of pain in dementia and is also carried out after a short introductory speech.

Scale used for bedridden and speechless patients

Resuscitators use the CPOT scale, which allows them to assess the degree of pain without talking to the patient. They take into account 4 parameters:

1. Arm muscle tension.
2. Facial expression.
3. Attempts to speak or resistance to breathing apparatus.
4. Motor reactions.

Each parameter is scored from 0 to 2 points, after which the points are summed up.

The interpretation is this:

0-2 points – no pain;

3-4 points – mild pain;

5-6 points – moderate pain;

7-8 points – severe pain;

9-10 – very severe pain.

The most comprehensive pain assessment is the McGill questionnaire.

Thanks to this questionnaire (questionnaire), it is possible to evaluate three main systems for the formation and conduction of pain:

1. nerve fibers that directly transmit pain sensations;
2. structures that exist in both the spinal cord and the brain: the reticular formation and the limbic system;
3. sections in the cerebral cortex that are involved in the assessment and final interpretation of pain.

Therefore, the questionnaire is conditionally divided into 4 groups:

• to determine the sensory characteristics of pain;
• to assess which emotional components the pain involves;
• to assess how pain is assessed by the brain;
• a group of words that are aimed at assessing all criteria at once.

Physically, the questionnaire looks like 20 columns, each of which contains from 1 to 5 epithets, arranged in order - in accordance with the intensity of pain. A person needs to circle as many of them as will help him accurately describe his feelings.

The pain index is scored by how many words were used to describe pain for each of the 4 parameters. It is also important which serial numbers were used to evaluate each aspect. And finally, the serial numbers of the selected epithets are summed up and their arithmetic mean is calculated.

What are pain scales for?

Not all doctors use pain scales. They are used mainly by anesthesiologists-resuscitators, therapists and oncologists. Sometimes doctors of other specialties encounter them when it comes to chronic patients.

Depending on how the pain is assessed, an anesthetic will be prescribed:

• For mild pain, use a non-narcotic pain reliever: Ibuprofen, Analgin, Diclofenac, Paracetamol.
• For moderate use, 2 non-narcotic analgesics with slightly different points of application, or a combination of a weak narcotic and a non-narcotic analgesic.
• Severe pain requires the prescription of strong narcotic and non-narcotic analgesics. Often it is necessary to resort to additional methods: blockades of nerve pathways, alcoholization (injection of ethanol) into nerve endings, which cause chronic severe pain.

Any of these drugs has a lot of side effects. Therefore, it is in the patient’s interests to assess his own pain as objectively as possible, and if it changes, to report it to the doctor. Now, if the doctor does not react in any way, then he needs to be changed to another specialist.

To assess the severity of pain syndrome, as well as the effectiveness of its elimination, the so-called ranking scales. The visual analogue scale (VAS) is a straight line segment 10 cm long, the beginning and end of which reflect the absence of pain and the extreme limit of its sensation (Fig. 2.15).

The patient was asked to mark a straight line segment, the value of which approximately corresponded to the intensity of the pain he experienced. After measuring the marked area, the conditional pain intensity was determined in points (corresponding to the length in cm). The verbal ranking scale is the same as VAS, but with pain ratings located along a straight line: weak, moderate, strong, etc. The numerical rating scale is the same straight line with numbers from 0 to 10 printed on it. Pain assessments obtained using horizontal scales are considered the most objective. They correlate well with the assessment of pain sensations and more accurately reflect their dynamics.

We obtained qualitative characteristics of the pain syndrome using the McGill pain questionnaire (183). This test includes 102 pain parameters, distributed into three main groups. The first group (88 descriptive expressions) is associated with the nature of pain, the second (5 descriptive expressions) with the intensity of pain, and the third (9 indicators) with the duration of pain. The parameters of the first group are distributed into 4 classes and 20 subclasses. The first class is the parameters of sensory characteristics (pain “pulsating, shooting, burning,” etc.).

Rice. 2.15. Visual scales for subjective pain assessment

The second class is parameters of affective characteristics (pain is “tiring, terrifying, exhausting”, etc.), the third class is evaluative parameters (pain is “irritating, suffering, unbearable”, etc.), the fourth is mixed sensory-affective parameters (pain “annoying, excruciating, tormenting”, etc.). Each indicator in the subclass is located according to its ranking value and has a weighted mathematical expression (first = 1, second = 2, etc.). Subsequent analysis took into account the number and rank position of selected parameters for each class.

Quantitative assessment of pain was carried out using a dolorimeter (Kreimer A. Ya., 1966). The operating principle of the dolorimeter is based on measuring the pressure at which pain occurs at the point being examined. The pressure measurement is recorded using a rod with a rubber tip connected to a spring mechanism. On the flat surface of the rod there is a scale, graduated into 30 divisions in increments of 0.3 kg/cm. The amount of displacement of the rod is recorded using a fixing ring.

Algesimetry data are expressed in absolute units - kg/cm. The degree of pain of 9.2±0.4 kg/cm or more, determined in 30 practically healthy people, was taken as the norm. To standardize the indicators, the pain coefficient (KB), which shows the ratio of normal algesimetric indicators to the corresponding indicators at the points under study. Normally it is equal to one relative unit. The test was also used during the treatment process to determine the effectiveness of the chosen treatment method.

The described approach allowed us to carry out objective differential diagnostics and, based on the results of complex diagnostics, an individual treatment and rehabilitation regimen in the postoperative period was selected.

Visual Analog Scale (VAS)

The visual analogue scale (VAS) was originally created for use in medicine - on it the patient had to assess the intensity of pain currently experienced. Using the VAS method, on a straight line 10 cm long, the patient notes the intensity of pain. The beginning of the line on the left corresponds to the absence of pain, the end of the segment on the right corresponds to unbearable pain. For convenience of quantitative processing, divisions are applied on the segment every centimeter. The line can be either horizontal or vertical.

The use of VAS is quite common in the medical field because it has the following advantages:

1) the method allows you to determine the actual intensity of pain;

2) most patients, even children (aged 5 years and older), easily understand and correctly use the VAS;

3) the use of VAS allows you to study the distribution of ratings;

4) research results are reproducible over time;

5) more adequate assessment of the treatment effect compared to verbal description of pain. The VAS has been used successfully in many studies to examine the effectiveness of therapy.

However, VAS also has certain disadvantages compared to other methods. First, patients can mark the scale quite arbitrarily. Often such marks do not reflect reality and do not correspond to verbal assessments of pain given by the patients themselves. Secondly, the distance to the mark made must be measured, which requires time and accuracy, and errors in measurement are also possible. Third, the VAS is difficult to explain to older patients who do not understand the connection between the line and the position of their mark on it. Finally, photocopying sometimes results in line distortion, which affects the measurement. Therefore, VAS is not considered the optimal method for measuring pain intensity in adults and elderly patients, but is recommended as successful in children.

As already mentioned, in the medical field, the use of VAS in various studies is much more common than in any other field. In particular, this applies to psychology.

The visual analog scale was first described in 1921 by Hayes & Patterson. . Only since 1969 has it become the subject of serious study, after the publication of Aitken’s work, which is still relevant today, due to the small number of works devoted to VAS.

Aitken used this scale in his study to assess the feelings of patients with depressive disorder. He believed that a digital system was being imposed on the observer when an analogue system would have been more appropriate.

If different people use the same word, this does not mean that they experience the same emotions - this also applies to the location of the marks on the scale. An emotion experienced twice as intense cannot be correlated with a value multiplied by two. There is a tendency to limit the divisions into categories, since only the most basic ones are usually used. This makes such scales ineffective in studying specific associations to given concepts, for example, the physical magnitude of a stimulus. These scales are unable to mark shades of feelings.

Aitken was convinced that analogies should be visual and not simply phrases, otherwise extreme ratings (eg 0 or 5) would occur too often (Yerkes & Urban 1906).

In his study, patients were asked to mark the intensity of their condition on a visual analogue scale every day for several weeks. In this situation, the scale was indeed very suitable for measuring changes and assessing their importance. However, Dr. Raymond Levy (Department of Psychiatry, Middlesex Hospital Medical School, London) believed that he had underestimated all the difficulties encountered when working with such scales. He suspected that such scales were especially effective in assessing patients with mild symptoms who knew exactly what the doctor meant, who began to use the same terminology. Patients suffering from both moderate and more severe forms of depression experienced difficulties when working with these scales.

Dr. J.P. Watson (Maudsley Hospital, London) believed that the problems of defining the terms and scales that Dr Aitken presented were no different from the problems of using any rating scale. He wondered whether Dr Aitken had evidence that patients were deliberately giving results that they knew were wrong.

Dr Aitken noted that Dr Levy's point was important and he agreed with Dr Watson that it applies to all types of self-assessment. In his experience, patients today use words like "depression" without thinking, but there is no doubt that their words may mean something very different from what psychiatrists meant when they used them. Clarification of the exact nature of the symptom is required, as given in the clinical assessment of all symptoms. Analog scales can accurately determine what patients want to communicate, but not what the doctor intended.

This study explains in some detail why the VAS may be better, more convenient, more reliable, and more valid than measures with scores or limited divisions. Obviously, people suffering from depression fall into different categories, and the use of a “digital system” can distort the results from the point of view of the fact that the patient simply does not try to think about the intensity of his experiences and chooses one of the extreme values. The use of similar scales, but only with a description of the condition, again gives rise to the feeling that they are choosing for the patient without obtaining a truly reliable result. However, this is only one study in which the subject is a psychological state that is quite complex to be able to clearly select the best measurement system for it.

In general, there are not many studies that compare Likert scales and visual analogue scales. For example, in a study conducted by Torrance, Feeny, and Furlong, the VAS was shown to have greater reliability than the Likert scale. . Another study by Flynn comparing a 5-point Likert scale and 65mm. VAS, using the example of measuring coping, shows that subjects, when answering the same question, show higher results when working with a Likert scale, compared to VAS.

Jennifer A. Cowley and Heather Youngblood, in their study in which they compared differences in responses on visual analog, numerical, and mixed scales, report that they found it emotionally more difficult to use analog scales than numerical ones because the divisions were left blank , did not contain explanations.

Scales in which each division contained a detailed textual explanation showed more reliable results than those in which some divisions contained gaps. Also, the advantage of using numerical data, for example, when working with variational analysis, is that in this case it is possible to evaluate certain variable interactions, which is impossible when working with nonparametric data.

However, some researchers may prefer analog scales because, unlike numerical scales, they can use efficient parametric statistical analyses.

Also in this study, mixed scales were used - analogue scales with the addition of various divisions: digital or with selective text explanations. At the same time, the opportunity to put your rating at any point on the scale was preserved.

The mixed scales here showed much higher mean scores than the analog scales. Also, the responses collected from the numerical and mixed scales did not differ much from each other, while the responses from the analog and numerical scales diverged greatly.

Thus, we can conclude that the VAS, like the Likert scale, have their own sets of pros and cons. However, the first study, like the last, raised the main question that may subsequently resolve the problem of choosing a measuring instrument - can we measure characteristics such as depression, anxiety, or any other continuous condition with ordinal scales? In this case, we should use a nonparametric scale, because when using an ordinal scale, we risk getting a rough result that is far from the true attitude of the subject, as well as losing a significant amount of data.

It is possible that the solution to this issue will also be the idea of ​​​​using mixed scales. Given that numeric and mixed produce higher average grades in many studies, researchers may wonder whether this depends on the fact that the person marks without reference to or in accordance with the numeric and text divisions. While this issue is not yet resolved, researchers can use mixed scales to make it easier for subjects to complete the questionnaire, ensuring the reliability of the results of parametric analysis using analogue data.

Verbal Rating Scale

The verbal rating scale allows you to assess the intensity of pain through a qualitative verbal assessment. Pain intensity is described in specific terms ranging from 0 (no pain) to 4 (worst pain). From the proposed verbal characteristics, patients choose the one that best reflects the pain they experience.

One of the features of verbal rating scales is that verbal characteristics of the pain description can be presented to patients in a random order. This encourages the patient to select a pain grade that is based on semantic content.

Verbal Descriptive Pain Rating Scale

Verbal Descriptor Scale (Gaston-Johansson F., Albert M., Fagan E. et al., 1990)

When using a verbal descriptive scale, you need to find out if the patient is experiencing any pain right now. If there is no pain, then his condition is assessed as 0 points. If painful sensations are observed, it is necessary to ask: “Would you say that the pain has gotten worse, or the pain is unimaginable, or is this the worst pain you have ever experienced?” If this is the case, then the highest score of 10 points is recorded. If there is neither the first nor the second option, then you need to clarify further: “Can you say that your pain is weak, average (moderate, tolerable, not strong), strong (sharp) or very (especially, excessively) strong (acute) "

Thus, there are six possible pain assessment options:

• 0 - no pain;
• 2 - mild pain;
• 4 - moderate pain;
• 6 - severe pain;
• 8 - very severe pain;
• 10 - unbearable pain.

If the patient experiences pain that cannot be characterized by the proposed characteristics, for example, between moderate (4 points) and severe pain (6 points), then the pain is rated as an odd number that is between these values ​​(5 points).

The Verbal Descriptive Pain Rating Scale can also be used in children over seven years of age who are able to understand and use it. This scale can be useful for assessing both chronic and acute pain.

The scale is equally reliable for both children of primary school age and older age groups. In addition, this scale is also effective in various ethnic and cultural groups, as well as in adults with minor cognitive impairments.

Faces Pain Scale (Bien, D. et al., 1990)

The facial pain scale was created in 1990 by Bieri D. et al. (1990).

The authors developed a scale to optimize the child's assessment of pain intensity by using changes in facial expression depending on the degree of pain experienced. The scale is represented by pictures of seven faces, with the first face having a neutral expression. The next six faces depict increasing pain. The child should choose the face that he thinks best demonstrates the level of pain he is experiencing.

The Facial Pain Scale has several features compared to other facial pain rating scales. Firstly, it is more of a proportional scale rather than an ordinal one. In addition, the advantage of the scale is that it is easier for children to correlate their own pain with a drawing of a face presented on the scale than with a photograph of a face. The simplicity and ease of use of the scale make it possible for its widespread clinical use. The scale has not been validated for use with preschool children.

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The Faces Pain Scale-Revised (FPS-R)

(Von Baeyer C. L. et al., 2001)

Carl von Baeyer and students from the University of Saskatchewan (Canada), in collaboration with the Pain Research Unit, modified the facial pain scale, which was called the modified facial pain scale. The authors, instead of seven faces in their version of the scale, left six, while maintaining a neutral facial expression. Each of the images presented in the scale received a digital rating ranging from 0 to 10 points.

Instructions for using the scale:

“Look carefully at this picture, where the faces are drawn, which show how much pain you can have. This face (show the leftmost one) shows a person who is not in pain at all. These faces (show each face from left to right) show people whose pain is increasing, increasing. The face on the right shows a person in unbearable pain. Now show me a face that indicates how much you are hurting at the moment.”

Visual Analog Scale (VAS)

Visual Analogue Scale (VAS) (Huskisson E. S., 1974)

This method of subjective pain assessment involves asking the patient to mark a point on a non-graduated 10 cm line that corresponds to the severity of pain. The left border of the line corresponds to the definition of “no pain,” the right border corresponds to “the worst pain imaginable.” Typically, a paper, cardboard or plastic ruler 10 cm long is used.

On the reverse side of the ruler there are centimeter divisions, according to which the doctor (and in foreign clinics this is the responsibility of the nursing staff) notes the obtained value and enters it into the observation sheet. The undoubted advantages of this scale include its simplicity and convenience.

Also, to assess the intensity of pain, you can use a modified visual analogue scale, in which the intensity of pain is also determined by different shades of colors.

The disadvantage of the VAS is its one-dimensionality, i.e., on this scale the patient notes only the intensity of pain. The emotional component of the pain syndrome introduces significant errors into the VAS score.

During dynamic assessment, a change in pain intensity is considered objective and significant if the current VAS value differs from the previous one by more than 13 mm.

Numerical Pain Scale (NPS)

Numeric Pain Scale (NPS) (McCaffery M., Beebe A., 1993)

Based on the principle stated above, another scale was built - a numerical pain scale. The ten-centimeter segment is divided by marks corresponding to centimeters. According to it, it is easier for the patient, in contrast to the VAS, to assess pain in digital terms; he determines its intensity on the scale much faster. However, it turned out that during repeated tests the patient, remembering the numerical value of the previous measurement, subconsciously reproduces an intensity that does not really exist

pain, but tends to remain in the region of the previously mentioned values. Even with a feeling of relief, the patient tries to recognize a higher intensity, so as not to provoke the doctor to reduce the dose of opioids, etc. - the so-called symptom of fear of recurrent pain. Hence the desire of clinicians to move away from digital values ​​and replace them with verbal characteristics of pain intensity.

Pain scale by Bloechle et al.

Pain scale of Bloechle et al. (Bloechle C., Izbicki J. R. et al., 1995)

The scale was developed to assess pain intensity in patients with chronic pancreatitis. It includes four criteria:

1. Frequency of pain attacks.
2. Pain intensity (pain rating on a VAS scale from 0 to 100).
3. The need for analgesics to eliminate pain (the maximum severity is the need for morphine).
4. Lack of performance.

NB!: The scale does not include such characteristics as the duration of the pain attack.

When using more than one analgesic, the analgesic requirement for pain relief is equal to 100 (maximum score).

If there is continuous pain, it is also assessed at 100 points.

The rating on the scale is made by summing the ratings for all four characteristics. The pain index is calculated using the formula:

Overall scale rating/4.

The minimum score on the scale is 0, and the maximum is 100 points.

The higher the score, the more intense the pain and its impact on the patient.

Observational ICU Pain Rating Scale

Critical Care Pain Observation Tool (CPOT) (Gelinas S., Fortier M. et al., 2004)

The CPOT scale can be used to assess pain in adult patients in the ICU. It includes four signs, which are presented below:

1. Facial expression.
2. Motor reactions.
3. Muscle tension in the upper limbs.
4. Speech reactions (in non-intubated) or resistance to the ventilator (in intubated) patients.

8371 0

Pain is a subjective phenomenon and therefore difficult to assess objectively.

A comprehensive pain assessment, including both subjective and objective data, is essential to determine the extent of intervention required.

It is known that methods of evidence-based medicine, in particular, analytical meta-analyses of randomized trials, make it possible to obtain integrated assessments of the effectiveness of diagnostic programs used in various clinics.

However, in practice it turns out that, despite the abundance of developed tests, firstly, there is still no unified diagnostic method that would allow one to obtain a starting point when conducting an exhaustive analysis; secondly, it is extremely difficult to compare the methodology for diagnosing pain in various clinical conditions (diagnosis of postoperative pain and cancer pain, etc.); thirdly, it is necessary to distinguish and consider two completely independent programs for assessing acute and chronic pain; fourthly, it is not possible to track the dynamics of revision of diagnostic tests during repeated clinical trials of drugs used in pain relief; and, finally, in order to converge data on the use of various testing methods, the introduction of an additional generalizing value is required.

However, the minimum amount of basic diagnostic testing is sufficiently standardized and can be used to assess all types of pain, regardless of the cause. It includes several sections according to the multifactorial conceptual model of pain.

First, you need to pay special attention to the patient's description of pain. This can provide important information regarding the causes of its occurrence and intensity, and lead to the recognition of its source. A good example is the "hot, burning sensation" described by patients with herpetic neuralgia. Nerve or neuropathic pain is usually described as "searing, searing, scalding, scorching."

It is difficult for the patient to find the right words and expressions and to describe his feelings. He tries to create in the doctor a certain emotional state, similar to the one he is experiencing, to achieve empathy. Patients should be allowed to be as specific as possible in describing their sensations, while being respectful and sensitive to the description of the nature and location of the pain.

In order to facilitate communication between the doctor and the patient, objectify the patient’s experiences, differential diagnostic and therapeutic comparison of data, questionnaires were created, consisting of sets of standard verbal descriptors, the most common for all patients.

The standard examination method abroad is the McGill Pain Questionnaire (MPQ), which uses verbal characteristics of sensory, affective, and motor-motivational components of pain, ranked according to five intensity categories (Table 3).

Table 3. Survey questionnaire: What words can you use to describe your pain?

First class - descriptors of sensory characteristics
shimmering fluttering pulsating vibrating knocking tingling		jumping flashing shooting					piercing boring drilling piercing jerking
sharp cutting tearing		pinching pressing gnawing convulsive crushing					pulling tugging twisting
hot burning scorching	tingling itchy raw stinging			muffled brainy aching cruel dull				superficial contractive tearing splitting
Second class - descriptors of affective characteristics
tiring exhausting			nauseating suffocating			terrifying, terrifying nightmare
oppressive, tormenting, ferocious, evil, killing									defiant blinding despair
Third class - general descriptive evaluative descriptors
irritating, disturbing, causing suffering strong, intolerable
Fourth class - mixed sensory-affective diverse Descoiptoes
spilled radiant piercing spilling		twisting constraining pulling squeezing tearing			cool, cold, icy				pain-interference pain-annoyance pain-suffering pain-torment pain-torture

In the final version, it contains 102 words - pain descriptors, distributed into three groups. The first group is associated with the nature of the sensations, the second with the intensity and the third with the duration of pain. The expressions included in the first group are combined into four main classes and distributed into 20 subclasses (the principle of semantic meaning).

In each subclass, descriptors are arranged in increasing intensity. The patient is asked to describe the pain by selecting one or another descriptor from any of 20 subscales, but only one from each subscale. Data processing comes down to obtaining two main indicators: the number of selected words and the pain rank index.

The total number of selected descriptors is the first indicator - the index of the number of selected words. The pain rank index is the sum of the ranks of the descriptors. Rank is the ordinal number of the descriptor in a given subscale from top to bottom.

The most important thing is that each type of pain is characterized by a certain set of sensory descriptors, which makes it possible to differentiate the organic nature of the pain. At the same time, descriptors of affective characteristics more fully illustrate the psychological state of patients.

The results of a survey of patients showed that in emotionally labile individuals with more pronounced symptoms of depression and anxiety, all indicators in the affective class were higher than in those examined with a normal psyche; in women it is higher than in men, in patients with chronic pain it is higher than with acute pain. Computer processing of data obtained as a result of testing makes it possible to make an accurate diagnosis in 77% of cases. However, after adding additional information in the form of determining the location of pain and the gender of the patients, the accuracy of the diagnosis increases to 100%.

Assessment of pain intensity

There are several methods for assessing the intensity of pain, presented in table. 4.

Table 4. Methods for grading pain intensity

Way	Gradations of pain	When to use
Five-digit general scale	0 = no pain 1 = weak (slightly) 2 = moderate (painful) 3 = severe (very painful) 4 = unbearable (cannot be tolerated)	During assessment (examination) under normal conditions
Verbal quantitative scale	0................... 5................. 10 no pain unbearable (What number corresponds to your pain?)	During assessment (examination) under normal conditions
Visual analogue scale (10 cm line, sliding ruler)	1...................1 no pain unbearable (Mark on the line how severe your pain is)	During assessment (examination) under normal conditions Can be used in children over 6 years of age
Behavioral and psychological parameters (indirect signs of pain; should be taken into account with caution as they are not specific)		When assessing unconscious, autistic, critically ill patients
Assessment of the patient's vital functions by a doctor	Can the patient independently perform basic functions (for example, voluntary deep breathing, coughing, active joint movements, walking) Yes/No	Correlate with subjective assessments obtained from the patient himself. Should be used in all categories of patients

The intensity and severity of pain is determined using one of the available standardized scales that can facilitate the assessment of the sensations described by the patient and determine the effect of the treatment (Fig. 2).

Rice. 2. Simple, 10-point and analog pain intensity scales

The severity of pain is also assessed by its impact on the patient's consciousness, habits and daily life activities, including sleep, appetite, nutrition (eating), mobility, career and sexual activity.

The prevalence of pain is assessed by the presence of redness, swelling, increased skin temperature or vice versa, cooling of the skin, as well as changes in function (skin sensitivity and mobility). To assess the extent of pain, conventional examination methods are used, such as visual inspection, palpation, percussion, auscultation, sensometry, dolorimetry, reflexometry, passive and active joint movement, etc. It is necessary to ask the patient to demonstrate movements or positions that increase or decrease pain.

During the examination, it is necessary to clarify the duration of the pain, its constancy or frequency, occurrence at a certain time of the day, year, connection with food intake, etc.

It is also necessary to ask the patient about the presence of symptoms accompanying pain, such as dizziness, increased sensitivity to light, disorientation in space and time, fainting, nausea, profuse sweating, paleness or flushing, incontinence, weakness, weight loss, swelling, redness or fever . It is also necessary to determine the presence of comorbidities or other health problems that may alter the patient's experience of pain.

Since pain is a subjective phenomenon, upon examination by a doctor, objective signs can be identified, such as an increase or decrease in cardiac activity, blood pressure and/or respiration, changes in pupil size, reflexes, impairment of certain types of sensitivity, biochemical changes in the blood, endocrine changes, electrophysiological indicators or a change in the state of consciousness, the presence of a state of passion. Their presence may be important in assessing pain, but their absence may not indicate the absence of pain.

We should not forget about instrumental diagnostic methods that allow us to clarify the cause and localization of pain (ultrasound, CT, MRI, X-ray studies, rheovasography, electromyography, electroencephalography, etc.)

It should be remembered that pain itself may be the primary barrier to pain assessment, creating such discomfort for the patient that he is unable to concentrate and answer questions. Other barriers may be embarrassment, the physical and emotional state of the patient, time, cultural, linguistic or tribal characteristics.

G.I. Lysenko, V.I. Tkachenko