RU2251388C1 - Method for evaluating pain - Google Patents

Abstract

FIELD: medicine, medicinal psychology.

SUBSTANCE: one should test a patient by seven scales: frequency, duration, intensity, sensor perception of pain, emotional attitude towards pain, neurotization level, adaptation capacity level to evaluate the results obtained by the scales mentioned from 0 to 6 points. Moreover, the scales for sensor perception and emotional attitude, the levels of neurotization and adaptation capacity should be evaluated in accordance to the Tables given in description. Additionally, one should, compare the degree of psychogenic constituent of pain according to chromatic choice made by a patient depending upon, at least, three choices of pain intensity: "pain during testing", "no pain", "severe pain" in accordance to the Tables given in description. Then, according to the results of testing one should evaluate the degree of patient's pain feelings both quantitatively and qualitatively. Moreover, by the scale of frequency the appearance of pain should be evaluated from "pain appeared once during several days or rarely" to "constant pain". By the scale of duration pain should be evaluated from "momentary pain" to "constant pain". By the scale of intensity the pain should be evaluated from "very weak pain" to "unbearable pain". By the scale of neurotization level one should take into account basic behavioral factors, such as anxiety, emotional lability, aggression, depression, psychogenia, hypochondria. The present innovation enables to increase significance in evaluating pain achieved due to broadened verbal description of patient's pain feelings.

EFFECT: higher accuracy of evaluation.

5 cl, 4 dwg, 2 ex, 17 tbl

Description

The present invention relates to medicine, medical psychology and can be used for differentiated assessment of the patient's condition during psychological counseling for research purposes. The use of the method of verbal-projective pain assessment is shown for the rapid assessment of pain of various origins for the purpose of differential diagnosis and clarification of the medical diagnosis, for the individual selection of the method and tactics of analgesic therapy, with the aim of drawing up individual acupuncture analgesia and therapeutic reflex treatment regimens, as well as for assessing the dynamics of treatment, the effectiveness of drugs.

Measuring pain is a complex set of problems. The individual perception of pain is influenced by demographic factors, gender, age, ethnic characteristics, as well as the emotional and physical condition of the patient. In addition, the occurrence of pain is closely related to social and psychological factors. Difficulties encountered by patients in describing their condition complicate the diagnosis, especially if the pain is psychogenic. These patients undergo numerous additional diagnostic and treatment studies. The lack of clear criteria for pain and methods for measuring pain lead to frequent diagnostic, expert and deontological errors.

For a qualitative and quantitative assessment of pain, psychological methods are increasingly used that take into account the patient’s subjective self-assessment of pain, as well as the doctor’s analysis of the behavioral and affective components of pain.

Such methods include self-assessment of pain intensity for patients on a 5-point rating scale, where 1 point is mild, weak pain, and 5 points is unbearable pain. Another way to assess the intensity of pain is the method of visual analogue scale, according to which, for example, on a segment of a straight length of 10 cm with the extreme values “no pain” - “pain is very strong”, the patient notes the intensity of the pain (Korolenko Ts. P., Pavlenko S.S. Objectivization of pain and its assessment. // Journal "Pain and its treatment", 1995, No. 2, pp. 7-9).

Closest to the technical nature of the present invention is a method for assessing pain using the McGill pain questionnaire (ibid.). The questionnaire is filled in by the patient along with the doctor and reflects the feelings and feelings of the patient at the moment. The questionnaire consists of 102 words - determinants of pain - descriptors. All descriptors are divided into four classes:

1. The class of sensory descriptions of pain in temporal and spatial terms, in terms of pressure, temperature, etc.

2. A class of affective (emotional) descriptions of pain in terms of tension, fear, vegetative manifestations.

3. A class of evaluative definitions of pain reflecting the subjective assessment of the pain experienced

4. A class of diverse descriptions of pain.

These classes are divided into 20 subclasses, consisting of words similar in meaning, but differing in the intensity of the pain they transmit or the nuances that are especially important for the patient.

Each descriptor word is assigned a numerical value corresponding to its place in the subclass, and their sum is an index such as pain. The questionnaire also contains a general assessment of the pain intensity at the time of the study, which is defined as a number from 0 to 5, associated with the following words: 0 - no pain, 1 - soft, mild pain, 2 - discomfort, 3 - annoying pain, 4 - terrible , terrible pain, 5 - intolerable, unbearable pain.

Despite the fact that when processing scales of sensory and emotional affective reflection of pain, a quantitative indicator is calculated, it does not reflect the specificity of the pain syndrome in the patient and does not correspond to the severity of the condition. So, for example, the three selected characteristics of pain: indifferent, disturbing and inconsequential give the same meanings as the choice of three definitions, such as frightening, tormenting, terrible. This is due to the fact that scoring on the scale is based only on the number of selected words, i.e. without taking into account their semantic significance. The questionnaire used does not take into account differences in the subjective assessment of pain by men and women. This assessment method does not contain a map of pain localization, which allows reflecting the topic and migration of pain on the human body. In addition, the method does not allow to assess changes in patient behavior and the degree of dependence of the occurrence of pain on environmental factors.

The present invention is based on the task of developing a method for assessing pain, providing a qualitative and quantitative assessment of the condition of patients with various forms of pain by expanding the verbal description of pain, reflecting a conscious level of pain perception, and at the same time using a non-verbal color symbol, the associative choice of which reflects the subconscious level of pain perception.

The problem is solved in that in the method of assessing pain by testing:

- the patient points to the body the localization zone of pain, which determines the area affected by the pain, which allows you to determine the topic of pain that is significant for the diagnosis and the degree of its spread;

- notes at least one characteristic, which is indicated in a verbal rating scale that determines the frequency of pain;

- selects at least one of the definitions of the duration of pain attacks indicated on the verbal rating scale;

- selects at least one of the definitions of pain intensity (the conscious component of pain perception) and at least two colors, one of which is the color of preference, and the other is the color of rejection, from the verbal-color rating scale of pain intensity compiled on the basis of preliminary identify colors of preference / rejection depending on the intensity of pain and the form of pain for different groups of patients (associative color choice reflects the attitude to pain associated with a subconscious Vnem perception of pain);

- gives a positive or negative answer to each of the statements included in the neurotization scale and taking into account the main behavioral factors, the change of which is associated with the presence of a pain syndrome in the patient, and in the lie scale that determine the degree of patient sincerity;

- selects at least one of the factors in each of the scales of modalities that identify environmental factors that provoke or intensify pain;

- at the same time, test questionnaires for assessing sensory perception and emotional attitude to pain contain respectively 46 and 25 descriptor words, each of which has a weight coefficient of pain sensation obtained in our studies, which reflects the semantic significance of the descriptor and gender differences in pain perception ;

- on a scale, the number of points is calculated and, based on the results of testing, they present a quantitative and qualitative integral assessment of pain.

In the proposed method, pain is understood as a complex multi-level phenomenon affecting various levels of mental reflection: perceptual, emotional; cognitive, behavioral. The complex process of sensation, perception and experience of pain is considered to be included in the context of other mental formations and forms of activity of the subject. In the process of ontogenesis, a person assimilates the forms of manifestation and perception of corporeality, including illnesses, developed by culture, that is why psychosomatic phenomena can be understood and considered as complex sign-mediated mental functional formations. Color has a certain meaning for a person, both biological and social, and the meaning of color remains quite stable, which allows us to consider it as a carrier of the code of the relationship of the subject to the object. This situation is reflected in the phenomena of preference and color rejection depending on the intensity of pain, the similarity of the color choice for neurogenic somatogenic pain syndrome, for acute non-pathogenic pain in children, healthy subjects and color perversion for psychogenic pain syndrome.

In the method according to the invention for the first time to assess pain, the authors apply:

- the identified semantic color categorization of intraceptive pain in humans, presented in the form of color preference / rejection scales, depending on the intensity of the pain and the form of the pain syndrome;

- the established similarity of color preference / rejection patterns depending on the intensity of pain in patients with neurogenic, somatogenic pain syndromes, in children with acute non-pathogenic pain and healthy people, presented with high intensity pains - black and gray, with moderate pain - brown and red, in the absence of pain - yellow and green colors;

- the revealed phenomenon of color perversion, revealed in patients with psychogenic pain syndrome when choosing a color depending on the intensity of pain. Color preferences in this group are presented for pains of high and medium intensity - yellow, purple, red, in the absence of pain - gray, green colors.

- identified gender differences in pain perception in men and women: a) self-assessment of the intraceptive sensations of pain, b) self-esteem of the emotional attitude to pain, c) the quantitative choice of descriptors in describing pain, d) manifestations of angry reactions depending on the form of the pain syndrome.

Based on the color phenomena of similarity and perversion, as well as gender differences in the perception of pain identified during the study, the authors first developed a comprehensive express method for assessing pain using color and verbal scales, which makes it possible to identify patients with pain of a psychogenic nature with a high degree of probability; first take into account gender differences in pain perception; quantify (in points / percent) the severity of the components of the pain syndrome according to 7 scales, covering various levels of pain experience by a person:

- nociception — pain localization scale, 1st scale of pain frequency, 2nd scale of pain duration, 3rd verbal color scale of pain intensity;

- pain sensation - 4th scale of sensory perception of pain;

- pain experience - 5th scale of emotional attitude to pain;

- pain behavior - 6th scale of neurotization and 0 scale of lies;

- adaptability level - the 7th scale of modalities, revealing the dependence of the severity of pain on the time of day, climatic conditions, body position, nutritional conditions, stress factors;

- Based on the test results, an integrated assessment of pain is presented.

The proposed method for assessing pain is significantly different from the known methods for assessing pain, since for the first time it simultaneously reflects the characteristics of the perception of pain by a person at different levels of the psyche - nociception (pain sensitivity), perception, emotions, behavior, adaptability; for the first time, it allows for a subjective description of pain with allowance for differences in the perception of pain by men and women, as well as its systematization according to factors-scales in accordance with the ideas about the multidimensional manifestation of pain and quantitatively evaluate in points / percent the severity of all components of the pain syndrome on 7 scales. For the first time, along with a verbal description of pain in the created method, a non-verbal symbol is used - color, as well as diagnostic criteria obtained by the authors for choosing or rejecting color, depending on the strength of the pain and the form of the pain syndrome. For the first time, based on these criteria, pain color scales were created for pain syndromes of various pathogenesis, and a verbal color scale was developed to assess pain intensity, which allows differential express diagnostics to determine whether the pain syndrome belongs to psychogenic pains.

Thus, the use of the method of pain assessment allows the doctor already at the first stages of diagnosis with a high degree of probability to identify pain of a psychogenic nature, to obtain a holistic assessment taking into account gender differences in the severity of the components of the pain syndrome at different levels of pain perception by a person, which is important when choosing a method tactics of pain therapy.

In the future, the invention is illustrated by specific examples of its implementation and the accompanying drawings, in which:

figure 1 depicts a diagram of a person (rear view) indicating the area of localization of pain;

figure 2 is a pain profile of a patient L.;

figure 3 - dynamic model is the percentage of total pain;

4 is a profile of pain in neurological patients before and after a course of dynamic electroneurostimulation.

The method for assessing pain according to the invention is as follows.

Before starting testing, the patient is explained the importance of the study. The choice of definitions of pain is carried out sequentially from one scale to another. Before starting work with each scale, the patient or subject is explained its contents and only after it becomes obvious that the patient understood everything correctly, they begin testing.

Nociception. Map of localization of pain. The scale is a diagram of the human body in various angles (front, back and side) and allows you to specify on it the area of localization of pain and determine the area affected by pain; indicate the point of irradiation of pain in other parts of the body; in dynamics to determine the change in body area associated with pain, as well as identify the topic of migration of pain.

Counting the results. To determine the area of pain, a total square meter is calculated. units included in the pain area, then the calculation of incomplete square. units, this number is divided by 2, as a result, the sum is calculated: S pain = Σni + Σkj / 2, where Σni is the sum of total square meters. units, Σkj / 2 - the sum of incomplete sq. units (figure 1).

Figure 1 shows an example of a representation of the pain sensations of the patient L.: a figure shaded on the silhouette of a person is a pain zone; area of pain: 1 square unit + 5/2 sq. = 3.5 sq. units

Nociception. 1. The scale of the frequency of pain, which allows you to assess the frequency of occurrence of pain, reflect the dynamics of its changes.

The measuring basis of the scale is the verbal rating scale, which allows to evaluate the frequency of pain from “pain appears every few days” to “pain is constant”.

The patient selects and notes those characteristics that are most consistent with the frequency of pain. If he finds it difficult to choose, then he selects those descriptions of pain that are most similar to the frequency of pain in him, or selects several indicators of the frequency of pain.

Table 1 Verbal Rating Scale for Pain Frequency Nociception. 1 scale Frequency of pain Points 1.0 No pain 0 1.1 Once every few days or less 1 1.2 Almost daily 2 1.3 Daily 3 1.4 Almost hourly 4 1.5 The pain is almost constant 5* 1.6 Constant 6 An asterisk (*) indicates the patient’s definition.

Counting the results. An indicator of the frequency of occurrence of pain is the number of points indicated in the graph opposite the frequency of occurrence of pain chosen by the patient.

Frequency = Σmj / n, where Σmj is the sum of points evaluating the selected definitions, n is the number of selected definitions. In the proposed example, the patient L.: Frequency = 5 points. The test results on a frequency scale (1) of the appearance of pain attacks are presented in figure 2

Figure 2 presents the pain profile of patient L. On the axis of the abscissa are indicated: 0 - lie scale; 1 - a scale for the frequency of pain; 2 - pain duration scale; 3 - scale of intensity of pain; 4 - scale of sensory perception of pain; 5 - scale affective-emotional attitude to pain; 6 - a scale of neurotization; 7 - scale of modalities; sums. The show is an integrative indicator of pain. The y-axis is the average pain score.

Nociception 2. The scale of the duration of pain in dynamics allows you to determine the change in the duration of pain attacks in the patient. The measuring basis of the scale is the verbal rating scale, which allows to determine the duration of pain from “fleeting pain” to “constant pain”.

The patient chooses the definition of the duration of pain that is most consistent with his sensations. If he is at a loss in choosing, then he chooses those definitions of the duration of pain attacks that are closest to his sensations or several suitable definitions.

table 2 Verbal-rating scale that determines the duration of pain attacks. Nociception. 2 Scale Duration of pain attacks Points 2.0 No pain 0 2.1 The pain is fleeting 1 2.2 The pain is short 2 2.3 The pain lasts a minute 3 * 2.4 The pain lasts for hours 4* 2.5 The pain lasts for days 5 2.6 Constant pain 6 An asterisk (*) indicates the definitions selected by patient L.

Counting the results. An indicator of the duration of pain is the number of points indicated in the graph opposite to the duration of pain attacks chosen by the patient.

Duration = Σmj / n, where Σ is the sum of the points that evaluate the selected definitions, n is the number of selected definitions.

In the proposed example, the patient L. the duration of pain is (3 + 4) / 2 = 3.5 points (figure 2).

Nociception. 3. The verbal-color scale of pain intensity allows you to determine the dynamics of pain intensity in a patient; identify with a high degree of probability using color rapid diagnosis of pain of a psychogenic nature.

The measuring basis of the scale is the verbal rating scale, which allows evaluating the intensity of pain from “pain is very weak” to “pain is unbearable”, as well as the associative choice of color preference / rejection depending on the intensity. A qualitative analysis when comparing the patient’s color choices with color scales makes it possible to determine with a high degree of probability the presence of psychogenic predisposition in pain pathology, and to describe its behavioral pattern (table. 3, 6,17).

The presented verbal color scale was developed by the authors on the basis of the results of a study of the characteristics of color perception by a person depending on the pain they experience.

A total of 5 groups were examined: 4 groups of patients with various forms of pain and a control group (practically healthy people).

The 1st group consisted of patients with neurogenic pain syndrome - 30 people (14 women, 16 men) aged 18 to 70 years. Neurogenic pains were studied on a model of phantom pain syndrome - 27 patients (11 women, 16 men) and facial trigeminal neuralgia - 3 people (women).

The development of neurogenic pain syndromes is currently associated with morphofunctional changes in both the peripheral injured nerve and the central nervous system.

The 2nd group consisted of patients with somatogenic pain syndrome - 34 people (18 women, 16 men) aged 18 to 65 years. Somatogenic pain syndrome was presented: postoperative pain - 3 people (1 woman, 2 men); abdominal malignancies - 3 people (1 woman, 2 men); joint pain - 5 people (3 women, 2 men); myalgia - 5 people (1 woman, 4 men); vertebral pain - 7 people (3 women, 4 men); cephalalgia - 11 people (9 women, 2 men).

Pain syndromes arising from the activation of nociceptive receptors in trauma, inflammation, ischemia, tissue stretching, are classified as somatogenic pain syndromes.

The 3rd group consisted of patients with psychogenic pain syndrome - 18 people (9 women, 9 men) aged 18 to 60 years. Psychogenic pain syndrome was represented by conversion and depressive disorders identified in the framework of cephalgia (tension headaches), abdominal pain, myalgia, vertebrogenic pain. All patients in this group went through a large number of a wide variety of medical examinations, as a result of which no significant physiological abnormalities were found that could cause constant pain.

The 4th group included children with acute pain. This group was investigated on the model of complex course treatment according to the method of I.A.Skvortsov after the procedure of therapeutic chipping (injection metamer pharmacotherapy) - 20 children (9 girls, 11 boys) aged 3 to 10 years with various forms of cerebral palsy and intact intelligence were examined.

The control group consisted of 64 people (34 women, 30 men) aged 17-65 years, not experiencing pain at the time of the survey and without chronic diseases. In the study of the control group, it was assumed that each practically healthy person to one extent or another has a certain pain experience, which can be considered as a minimized form of pain perception, signified by personal and social experience.

A total of 166 adults and children were examined (75 women and 9 girls, 71 men and 11 boys).

For research, a verbal-color method for assessing pain was developed, based on a pain questionnaire created by the authors, which allows pain assessment to be performed on five factors - scales, the scaling method (visual-digital scale) and a color-associative experiment using the color selection method of eight colors of the Lusher test. The study procedure consisted of the selection by the patient (subject) of descriptors describing the sensory (for example, “pulling”, “pressing”, etc.) and emotional (eg, “annoying”, “painful”, etc.) pain characters, their ratings on a visual-digital scale (from 0 - “no pain” to 6 points - “unbearable pain”) depending on the intensity of the pain experienced, two color choices - preference and color rejection depending on the intensity of the pain. Also, methods of psychological diagnostics were used - the Luscher test, MMPI, the Spilberger-Khanin reactive and personal anxiety scale, and the Spilberger anger manifestation questionnaire.

For statistical data processing, methods of mathematical statistics were used - descriptive statistics, statistics of Pearson, Wilcoxon, Kendal, Spearman, and crosstabilization method for analysis of contingency tables.

The study was conducted on the outpatient basis of the Institute of reflexology at the Federal Scientific Clinical and Experimental Center for Traditional Diagnostic and Treatment Methods of the Russian Ministry of Health; at the Federal Center for Expertise and Rehabilitation of Persons with Disabilities (Central Research Institute of Prosthetics and Prosthetics) M3 of the Russian Federation, in the 3rd orthopedic department; in the Scientific and therapeutic center for the prevention and treatment of neuropsychiatric disability (STC PNI under the supervision of a professor, MD I.A.Skvortsov).

In the study of pain using the verbal color method in each of the five groups, data were obtained on the frequency of color choice depending on the intensity of pain: in 1 group of patients with neurogenic pain syndrome, the color preferences were 412 choices, the rejection colors were 512 choices; in the 2nd group of patients with somatogenic pain syndrome, color preferences were - 583 choices, colors of rejection - 617 choices; in the 3rd group of patients with psychogenic pain syndrome, color preferences were 390 choices, rejection colors were 376 choices; in the 4th group of children with acute non-pathogenic pain, the preference colors were 173 choices, the rejection colors 254 choices; in the control group, the colors of preference were - 507 elections, the colors of rejection - 556 elections.

When describing the “no pain” state, patients with neurogenic, somatogenic pain syndromes, children with acute pain, and healthy people gave preference to yellow (47.9-55.8%) and green (33-25%) colors. Patients with psychogenic pain syndrome “stained” the absence of pain, mainly in gray (43%), to a lesser extent - in green (17.8%), purple (15.4%). The preference for gray in the absence of pain by patients with psychogenic pain syndrome is associated with states of anxiety, depression (fencing off), emotional lability (irritability), while the rest are characterized by a need for action, emotional involvement, optimism.

The pain is “very weak”, the pain is “weak” in groups with neurogenic, somatogenic pain syndromes, in the group with acute non-pathogenic pain in children are semantically similar, while the preferred colors for neurogenic pains and acute pain in children are purple (32, respectively 4% and 30.4%), in the group with somatogenic pain, gray (50% - 26%), green (15% -17%) and yellow (15.4%) are preferred, in patients with pain of psychogenic origin color preferences, pain-related “very weak” and “weak” are different, for “about Shade mild "pain preferred green (41,2%), gray (23.5%) and red (17.6%) of the color; for “mild” pain - red (22%), yellow (17.1%) colors, for the control group the difference in color choice for “fleeting” pain is also characteristic - yellow (30%), green (24.2%), violet (21.2%) colors, for pain “weak” - brown (27.5%), violet (20.3%) and gray (20.3%) colors.

The revealed discrepancies in the color perception of pain in patients with neurogenic pain and patients with pain of somatogenic origin reflect significant differences in their painful behavioral pattern. So, in patients with phantom pains “weak” pains provoke emotional lability, irritability, emotional stress in behavior, and in patients with somatic pain - behavior takes on a stench attempt to protect oneself from unnecessary irritants and create a zone of greatest comfort for oneself. For children with acute non-pathogenic pain, irritability and moodiness are also inherent. For patients with psychogenic pains in this case, difficulties in communication, protective tendencies are characteristic. In healthy people, “very weak” pain is perceived as a healthy condition and equates to a “no pain” state; “weak” pain causes discomfort, slight irritability. It is noteworthy that in the group of patients with psychogenic pain syndrome “very weak pain” and “no pain”, too (as in the group of healthy subjects) are “painted” in the same colors, i.e. such pain does not change their usual behavior.

For “moderate strength” pains, a similar color pattern is characteristic for all groups - gray, brown, red / violet: for patients with pain of neurogenic origin, colors gray (19%), brown (19%) and violet (17.2%) are preferred; patients with somatogenic pains are characterized by a choice of gray (27.4%), brown (22.6%) and red (19.8%) colors; for children with acute pain - gray (25.5%), red (25.5) and brown (20%) colors; for healthy people - gray (23.4%), brown (18.8%) and violet (15.6%) colors with the exception of the color choice of patients with psychogenic pains - they are preferable, as in the case of “weak” pain , red (42.5%) and yellow (16.1%) colors. Thus, the pain of “medium strength” for all groups except for patients with psychogenic pain causes a state of tension, fatigue, poor health, loss of the usual life stereotype, and anxiety. For patients with psychogenic pain, the previous behavioral tendency intensifies - stress, manifested by severe emotional instability; there is a feeling of their position as a victim, their share of guilt is passed on to others, the desire for dominance is manifested.

Pain “severe” in the group of patients with neurogenic pains provokes a preference for red (38.1%), gray (17.5%), in patients with somatogenic pain gray (27.4%), brown (23.8%) , red (17.6%) colors, children with acute non-pathogenic pain prefer black (51.6%), the control group - red (26.8%), black (22.3%), gray (17.9 %), and in the group with psychogenic pains the color choice remains the same - yellow (25.6%), red (23.1%), purple (24.4%). “Strong” pain provokes aggressiveness, irritability, a feeling of powerlessness, emotional stress, the appearance of psychosomatic tendencies in the behavior of patients with phantom pains, in patients with somatic pains, the depressive component in behavior intensifies, irritable weakness increases, pronounced physiological discomfort, anxiety; fear is characteristic of children with acute pain; the appearance of aggressiveness, anxiety, and fear is characteristic of the control group. Patients with psychogenic pain are characterized by previous behavioral tendencies - inconsistency, self-will, authoritarianism, exactingness to others, crowding out the true causes of the conflict, a tendency to see oneself as a victim, transferring guilt to others.

With “very severe” pain, patients with a neurogenic pain syndrome are characterized by a preference for black (35.4%), gray (28.1%) and red (22.9%) colors, in the group with somatogenic black pain (41.5 %) gray (22.5%) and red (17.6%); black children (50%) were identified for children with acute pain, black (50%) and red (29.6%) colors in the control group, which is characterized by a state of stress, tension, possible aggressive reactions, and passive resistance. In patients with psychogenic pain syndrome, the color and behavioral patterns do not change: the color choice is yellow (32.9%), red (21.9%) and purple (17.8%), the characteristic features of behavior are inconsistency, self-will, authoritarianism, exactingness to others, crowding out the true causes of the conflict, a tendency to see oneself as a victim, transferring guilt to others.

“Unbearable” pain reinforces the tendency to prefer black for all groups: neurogenic pains - black (64.4%) and gray (29.7%); somatogenic pains - black (74.7%), acute pain in children - black (51.6%); the control group was black (49.3%) and red (23.9%). Pain “unbearable” provokes fear, anxiety, depression, an attempt to protect oneself from external stimuli, a high degree of asthenia (black, gray), the search and the need for protection.

For patients with psychogenic pain syndrome, the color and behavioral patterns do not change significantly - the preference for yellow (40.4%), red (21.3%) and violet (23.4%) colors increases, and previous behavioral trends intensify. Thus, we can conclude that pain for patients of this group is closely related to compensating for insufficient attention to them, avoiding solving problems, etc., and the absence of pain is associated with fear of loss of attention, feelings of abandonment, disappointment and depression, which, like It is known to be characteristic of diseases of psychogenic origin.

For the purpose of comparative analysis, the results of color choices of preference and rejection for each of the groups were summed up and normalized to the number of patients in the group. To determine the reliability of similarities / differences in color patterns depending on the form of the pain syndrome, correlation coefficients between samples (groups) were calculated - coefficients of concordance (t) of Kendal and rank correlation (r) of Spearman were determined, which allowed to determine the reliability of similarities / differences between color selections depending from a form of pain or lack of pain. There was a significant similarity between the color choices of color preference / rejection depending on the strength of pain between groups of patients with neurogenic pain syndrome, somatogenic pain syndrome, acute non-pathogenic pain in children and the control group. The following main preferences are characteristic for each of these groups with a small fraction of variations in the choice of color: “pain is very strong”, “pain is unbearable” - black, “pain of medium strength”, “pain is strong” - gray red, brown, in case the color choice of rejection, which is equivalent to the definition of “no pain,” is yellow and green.

According to the statistics of Kendel and Spearman, a negative correlation was revealed in the choice of color between groups of patients with neurogenic, somatogenic, acute non-pathogenic pains (in children), a control group, and a group of patients with pains of psychogenic origin.

In the associative color choice, when assessing the intensity of pain for patients with psychogenic pain syndrome, color perversions are characteristic: “pain is severe”, “pain is very strong” and “pain is unbearable” they “color” yellow, red, “medium-strength pain” - yellow , red, “no pain” - gray (Table 3).

Within each group, significant differences in color preference were revealed depending on the intensity of pain, which allowed us to determine the color scales of pain intensity for the neurogenic, somatogenic and psychogenic forms of the pain syndrome, for acute non-pathogenic pain in children and healthy people.

The revealed phenomena of similarity in color choices in patients with neurogenic, somatogenic pain syndromes, in children with acute pain and healthy subjects, and differences in color choices in patients with psychogenic pain syndrome were used to develop a verbal color scale for this method of pain assessment.

For testing on this scale, a color line is used that contains eight color mini-cards corresponding to the colors of the Lusher test: 1 - blue, 2 - green, 3 - red, 4 - yellow, 5 - purple, 6 - brown, 7 - black, 0 (8) - gray (Table 4). If it is not possible to execute research protocols in color format, standard cards of the 8-color Luscher test are used. When conducting color express diagnostics, each patient should have at least three choices: the first choice is the association of color with the pain that the patient is experiencing at the time of testing; the second choice is the association of color with the state when “there is no pain”; the third choice is the association of color with the most severe pain, i.e. with pain “unbearable” or “very strong”.

The patient chooses the definition of the intensity (strength) of pain that most accurately characterizes them. If he is at a loss in choosing, he selects those definitions that are closest to his feelings or selects several definitions. According to the color scale, the patient selects the color with which his pain sensation is associated (color of preference), indicates the color with which he relates the absence of pain (“no pain”), and selects the color with which the pain is associated with him “unbearable (it’s not possible to be stronger maybe) ”or“ very strong ”.

After that, the patient enters the selected color names (color numbers) in the protocol columns.

Counting the results. An indicator of the intensity of pain is the number of points indicated in the graph, opposite to determining the strength of pain chosen by the patient.

Intensity = Σmj / n, where: Σmj is the sum of points evaluating the selected definitions, n is the number of selected definitions.

In example 1, in patient L., the intensity of pain And = (1 + 2) /2=1.5 points (figure 2).

The color choice of patient L. is presented in table 5. After comparing this choice with the color scales in table 4, it can be concluded that somatogenesis of pain in patient L. can be concluded, comparing these data with a subjective description of pain allows you to clarify the diagnosis and determine the choice of therapy.

Table 5 Example 1. Color selection of patient L. Pain intensity Color preference selection Cure Color Choice Express diagnosis 0 No pain Yellow Patient P.'s somatogenic pain causes a stenic attempt to protect himself from unnecessary irritants (to create a zone of greatest comfort for himself) and may be associated with a forced restriction of professional activity and personal activity. 1 The pain is very mild Gray green Green yellow 2 The pain is mild Gray green Green yellow 3 Moderate pain 4 Severe pain 5 The pain is very severe 6 Unbearable pain The black Yellow

Comparison of the choice of patient M, presented in example 2 (see table 6) with the scales in table 3, allows us to make an assumption about the psychogenic origin of his pains.

Table 6 Example 2. Color selection of patient M. Pain intensity Color preference selection Cure Color Choice Express diagnosis 0 No pain Blue gray Patient M. has pain of a psychogenic nature, which may be an unconscious form of psychological protection for him and avoids adverse social conditions or relationships. 1 The pain is very mild 2 The pain is mild Red Gray 3 Moderate pain Red Yellow Gray purple 4 Severe pain 5 The pain is very severe 6 Unbearable pain Yellow Gray

The appearance in the color choice of preference for pains of high intensity ("unbearable" or "very strong") red, yellow and purple colors may indicate a psychosomatization of pain in the patient. If, during further testing, the patient reveals high rates on the neurotic scale (see below) and / or on the scale for assessing emotional attitude to pain, then this fact increases the likelihood of psychogenic origin of pain in this patient.

As a result of the study, using the verbal-color method, significant gender differences in perception and emotional attitude to pain were revealed in patients with neurogenic, somatogenic, psychogenic pain syndromes in healthy subjects, and weights were obtained for each descriptor depending on its semantic significance separately for men and women (tab. 7, 8, 9). In addition, the study compiled new definitions (descriptors) used by patients to characterize pain. This made it possible to expand and supplement the dictionary of descriptions of itraceptive sensations on the scale of sensory perception of pain up to 46 descriptors (Table 8), on the scale of emotional attitude to pain - up to 25 descriptors (Table 9).

To summarize the results, a summation of the self-esteem indicators of men and women for the perception of pain and emotional attitude to pain was carried out for groups of patients with neurogenic, somatogenic, psychogenic pain syndromes and the control group. A comparative statistical analysis of pain assessment (Pearson statistics) revealed a significant difference in the perception of pain by men and women on the scale of sensory sensations and on the scale of emotional attitude to pain.

According to the scale of sensory perception of pain, the difference lies in the fact that men are more likely to experience pain of low (21.2%) and medium intensity (22.6%), women, respectively (15.7%) and (19.6%). Women are more likely to experience and more emotionally experience more “strong” pain - 18.3%, in men “strong” pains make up - 8.73%. According to the scale of emotional attitude to pain, pronounced emotional reactions to pain “very weak” are presented more often in men than in women, while pains of “medium strength” in men and women cause similar emotional manifestations.

In addition to differences in the self-assessment of pain, in each group of patients, a difference was found in the intraceptive dictionaries of men and women when describing their pain, as well as a difference in the number of selected descriptors on the scales of sensory perception and emotional-affective attitude to pain. Moreover, it was found that women compared with men choose a larger number of descriptors on both scales (Table 7). Thus, the results confirm the difference in the perception of pain by men and women.

Table 7 Average indicators of the quantitative selection of descriptors in patients with neurogenic, somatogenic, psychogenic pain syndromes No. p / p Group Pain Sensory Scale The scale is emotional. relationship to pain Husband. Wives Husband. Wives 1 Neurogenic pain syndrome 6.4 7.8 4.1 5 2 Somatogenic pain syndrome 6.1 7.3 4.9 5.3 3 Psychogenic pain syndrome 10,4 14.6 9.6 10.8 4 Average total 7.6 8.8 6.2 7.1

A comparative quantitative and statistical analysis of pain sensations showed a significant difference in the perception of pain by men and women both on the scale of sensory sensations (Chi-square = 79.9, significance = 0, degree of freedom = 6, p≤0.01), and on the scale of emotional affective attitude to pain (Chi-square = 13.6, significance = 0.0343, degree of freedom = 6, p <0.05).

The established facts allow us to conclude that significant indicators of differences in the perception of pain by men and women are the differences in the self-esteem of the experienced intraceptive sensations and the severity of the emotional-affective attitude to pain, which reflect the obtained semantic weighting coefficients of the descriptors; as well as a quantitative indicator of the selection of descriptors describing pain and its relation to it.

The results found their application in the development of a scale of sensory perception and a scale of emotional attitude to pain.

Nociception. 4. The scale of sensory perception of pain allows a qualitative and quantitative analysis of the sensory components of pain, to clarify the degree of pathological changes associated with the disease. The scale contains 46 descriptors describing pain; when calculating quantitative indicators on a scale, weight coefficients are taken into account, which reflect the semantic significance of descriptors depending on gender differences in pain perception, and features of quantitative selection of descriptors taking into account gender differences in pain perception (Tables 7, 8).

The patient chooses the words that characterize his pain. If pain has a complex quality, then he selects several corresponding characteristic words. If the patient is at a loss in choosing, then he selects the words describing the pain that are closest to his pain sensations, i.e. several characteristics.

Counting the results. Test results on a scale of sensory perception of pain are calculated by the formula:

, К=n/n_ср

, K = n / n _cf

where n is the number of selected descriptors, Σn _k is the total score of all selected descriptors, K is a correction coefficient that takes into account the number of selected, and n _cp is the average total indicator of the quantitative choice of descriptors, equal to 7.6 for men, 8 for women, 8 (Tables 7, 8).

In the proposed example, when calculating points, keys for men are selected (Table 8):

C = (2.5 + 2.6 + 2.5 + 3.9) / 4 + 4 / 7.6 = 2.75 + 0.52 = 3.27 points (FIG. 2).

Table 8 Pain descriptors No.
p / p Pain Wives (score) Husband. (score) No.
p / p Pain Wives (score) Husband. (score) 4.0 No pain 0 0 4.23 Tearing apart 5,0 4.8 4.1 Crushing 2.9 2.5 * 4.24 Tearing 5,0 4.8 4.2 Gardening 2,5 1.7 4.25 Cutting 4,5 3.8 4.3 Gnawing 3,1 2.9 4.26 Chopping 4.2 3,5 4.4 Bursting 4.0 2.7 4.27 Ticky 4.1 3.6 4.5 Breaking 3.9 3,1 4.28 Sawing 4.0 3.2 4.6 Tightening 3,1 2.6 * 4.29 Plucking 3,5 3 4.7 Compressive 3.3 2.7 4.30 Biting 3,7 3.2 4.8 Shackling 3,7 2.7 4.31 Shooting 4.3 3,5 4.9 Scraping 2,5 1.9 4.32 Scorching 4,5 4.0 4.10 Yelling 2,3 1.8 4.33 Burning 4.7 4.1 4.11 Scratching 2.2 1.4 4.34 Creeping 4.1 3.2 4.12 Shearing 2,5 1.7 4.35 Migratory 2,8 3,5 4.13 Pulling 2.7 2.5 * 4.36 Paroxysmal 4,5 4.4 4.14 Jerking 3.6 3.3 4.37 Surface 4.7 2.0 4.15 Aching 3.4 3.0 4.38 Deep 4.1 4.1 4.16 Throbbing 3,1 3.4 4.39 Waved 2,8 2,8 4.17 Drilling 3.8 3.9 * 4.40 Striking 4,5 5.5 4.18 Boring 3.6 3,5 4.41 Monotonous 4.4 6.0 4.19 Stitching 3,5 3,5 4.42 Dumb 4.9 6.0 4.20 Tingling 5.3 4.7 4.43 Twisting 4,5 4,5 4.21 Dagger 4.9 4.1 4.44 Numbing 5,0 5 4.22 Piercing 4.9 4.8 4.45 Shy 2.9 4.0 4.46 Itchy 2.7 6.0 An asterisk (*) indicates the descriptors selected by the patient that describe his pain.

Experiencing pain. 5. The scale of the emotional attitude to pain allows you to quantitatively and qualitatively assess the dynamics of the subjective attitude to pain. The scale contains 25 descriptors that reflect the involvement of the patient’s emotional sphere in the internal picture of pain experience. When calculating the quantitative indicator, the features of gender differences in relation to pain are taken into account (Table 9).

The patient chooses definitions that reflect his attitude to pain. If he finds it difficult to choose, then he chooses those definitions that are closest to his condition, i.e. selects several characteristics.

Table 9 Emotional pain descriptors N
p / p Attitude to pain Wives (score) Husband. (score) N
p / p Attitude to pain Wives (score) Husband. (score) 5.0 no pain 0 0 5.13 frightening 4.1 4.2 5.1 indifferent 1.3 1.8 5.14 tormenting 5.1 4.6 5.2 inconsequential 3.2 2.1 5.15 tormenting 5,0 4.1 5.3 troubling 1,0 2.7 5.16 exhausting 4.9 4.9 5.4 distracting 3,1 3.3 * 5.17 harassing 5.1 4.1 5.5 interfering 3,1 3.5 * 5.18 awesome 5.5 4.9 5.6 harassing 3.8 3.4 * 5.19 painful 5.2 5.5 5.7 annoying 4.2 3.8 5.20 torturing 5.3 4,5 5.8 bored 4,5 3,7 5.21 exhausting 4.6 5.2 5.9 annoying 3.6 3,7 5.22 scary 5,6 6.6 5.10 depressing 4.4 3.6 5.23 creepy 5.9 4,5 5.11 disgusted 4.1 4.0 5.24 heavy 5.3 6.0 5.12 painful 4,5 4.6 5.25 undefined fear 6.0 6.0 An asterisk (*) indicates the patient’s definition of pain.

Counting the results. The calculation of test results on a scale of emotional-affective perception of pain is carried out according to the formula:

К=n/n_ср

K = n / n _cf

where n is the number of selected descriptors, Σn _k is the total score of all selected descriptors, K is a correction coefficient that takes into account the number of selected descriptors, and n _cp is the average total quantitative choice of descriptors, equal to 6.2 for men and 7 for women , 1 (see table 7).

In the proposed example:

In the proposed example, when calculating points, keys for men are selected (Table 9):

E = (3.3 + 3.5 + 3.4) / 3 + 3 / 6.2 = 3.4 + 0.48 = 3.88 points. (figure 2).

Note: during testing on scales No. 1-5, points are not put on the forms, because these are keys for specialists.

To develop a scale that reflects the level of changes in the behavior of patients with various forms of pain and children with acute pain, we conducted an investigation of emotional states, behavioral and personality characteristics using the Mini-Mult test, the Luscher test, the Spilberger-Hanin anxiety self-assessment questionnaire, and the self-assessment questionnaire the severity of angry Spielberger reactions.

It is known that acute pain is usually given the value of a warning signal. As a result of its impact, various emotional, motivational changes occur that are temporary in nature (until the elimination of the damaging factor or tissue healing). The results of the study using the Luscher test in children indicate that acute pain really causes short-term negative emotional states, such as irritability, aggressiveness, fear, a high level of anxiety, but these changes are not sustained, after the end of treatment there is a significant positive dynamics in the emotional state of children. These changes in the state are reflected in the color choice in children, depending on the intensity of the pain they experience (Table 7).

It was found that for patients with neurogenic and somatogenic pain syndromes, the severity of emotional lability, demonstrativity, aggressiveness, anxiety, and a reduced mood background are characteristic of varying degrees of severity. For such patients, pain (illness) has an obstructive or conflicting meaning, this is confirmed by the corresponding color choices - in case of severe pain, black, gray and red colors are preferred. Such a patient does not always manage to maintain control over his behavior and emotions. Often there are disruptions, guilt, shame, a decrease in self-esteem with the release into a depressed state.

In patients with psychogenic pain syndrome, there is an avoidance of solving problems such as “getting into a disease”, crowding out conflicts, apparently blaming behavior - in this case, pain provides certain advantages, allows you to get more attention, reduces the requirements for people from others, which has a positive meaning . In this case, the disease allows one to obtain certain advantages, but forces one to abandon the others, for example, receiving the attention of others in exchange for restricting freedom. Thus, the combination of conflicting and positive meanings in relation to pain (illness) in these patients is also confirmed in their color choice, which is expressed in the leading preference for yellow, purple, red colors.

In addition, it was found that in groups of patients with neurogenic and somatogenic pain syndromes for men, a pronounced manifestation of angry reactions and a reduced level of self-control are characteristic, while in a group of patients with psychogenic pain syndrome, on the contrary, women show a high level of manifestation of anger and a low level self-control. Such a difference in the manifestation of angry reactions can be explained by the fact that women with psychogenic pain syndrome are more likely to have externally accusing behavior with crowding out the true causes of the conflict and transferring guilt to the environment.

The patient’s response to pain is associated with the formation of an “internal picture of the disease” and includes emotional, motivational, behavioral neoplasms, which are often unproductive and interfere with the treatment of the disease. The analysis of the “internal picture of the disease”, its components must be taken into account by the doctor when making a diagnosis and prescribing therapy.

In order to assess the severity of behavioral changes, a scale for assessing the level of neurotization was developed.

Painful behavior. 6. The neurotic scale allows you to assess the level of neurotic and the degree of involvement of behavioral components in the severity of pain in the patient. When diagnosing the level of neurotization, the main behavioral factors are taken into account, the change of which is closely related to the presence of a pain syndrome in a person: anxiety, emotional lability, aggression, depression, autonomic manifestations, hypochondria. The basis for the selection of questions was the MMPI questionnaire, the Spielberger questionnaire (anger).

The patient gets acquainted with all the statements given in table 10. If the statement fits him, then he makes a mark in the column “YES”, if the statement is wrong for him - in the column “NO”

Table 10 Issues of assessing the level of neurotization. Questions The answers 1. Anxiety Yes No 6.1 I have a restless and intermittent sleep, often disturbing dreams. * 6.2 I often worry too much about minor things. * 6.3 Sometimes, for no particular reason, I feel a sense of anxiety or fear. * 2. Emotional lability 6.4 Often my mood can change depending on a serious reason or without it. * 6.5 I often feel a “lump in my throat” in situations that excite me. * 6.6 It’s hard for me to concentrate when doing any task (work). * 3. Aggression 6.7 When I get angry, I say unpleasant things. * 6.8 I'm pretty annoyed easily. * 6.9 Sometimes I have difficulty controlling my anger. * 4. Depression 6.10 Often, for no particular reason, I have a feeling of indifference and fatigue. * 6.11 I’ve been feeling worse lately than ever. * 6.12 I would like to be as happy as other people seem. * 5. Vegetative manifestations * 6.13 Often in various parts of my body I feel a burning sensation, tingling sensation, goosebumps, numbness. * 6.14 Sometimes I tremble or feel a chill. * 6.15 I have bouts of nausea and vomiting. * 6. Hypochondria * 6.16 Most of the time I feel general weakness. 6.17 I often feel as if I did / did something wrong or wrong. 6.18 I am rarely full / full of energy. *

Calculation of results on a neurotic scale. To determine the level of neurotization, the number of positive answers is calculated, and then the resulting amount is divided by 3, where n is the number of answers “Yes”, then the level of neurotization = (Σn) / 3. The higher the result, the higher the level of neurotization.

Low level of neurotization - 1-2 points; the average level of neurotization is 2-4 points; high level of neurotization - 4-6 points.

In the above example, in patient L., after calculations, the level of neurotization is 4/3 = 1.33 points (figure 2).

A high level of neurotization indicates a pronounced emotional excitability, as a result of which negative states such as anxiety, fear, tension, anxiety, irritability appear. A high level of neurotization may indicate hypochondriacal fixation on somatic sensations, the difficulties of social adaptation associated with social timidity, uncertainty, confusion, dependence, lack of initiative. A high level of neurotization, as a rule, significantly reduces the effectiveness of any therapy. In this regard, it is necessary to take this fact into account and include measures aimed at normalizing the patient’s emotional state in the therapy algorithm.

A low level of neurotization indicates emotional stability, a positive background of feelings (calm, optimism), social courage, which is a favorable background for pain therapy.

Additional information on the neurotic scale can be obtained by analyzing the selected answers for the main factors: anxiety, emotional lability, aggression, depression, autonomic manifestations, hypochondria; which will help, if necessary, select methods for further in-depth psychological examination of the patient.

Painful behavior. 0. The lie scale allows you to determine the degree of sincerity of the patient's responses. The basis for the selection of questions is the lie scale of the MMPI test, as well as engineered questions that determine the coincidence of some answers on the scales of a multidimensional verbal-color test. It is important that all statements on a lie scale are presented in one list together with statements on a scale for assessing the level of neuroticism. Statements on both scales are presented to the patient without any relevant headings and in random order.

Table 11 Lie Scale Questions YES NOT 0.1 Recently, I have pain more often than once every few days. * 0.2 Recently, sometimes I have been tormented by prolonged pain attacks. * 0.3 Recently, I have had unbearable severe bouts of pain. * 0.4 Sometimes i can gossip * 0.5 Sometimes I want to swear. * 0.6 Not all my friends I like. *

Counting results on a lie scale. To determine the results on a lie scale, the total number of positive answers is calculated: on question No. 1 - the answer is evaluated at 1 point if a mismatch of the answer is revealed when compared with the answer on the nociception scale 1 (frequency of pain); on question No. 2, the answer is estimated at 1 point if a mismatch of the answer is detected when compared with the answer on the nociception scale 2 (pain duration - pain lasts for hours, days, constant); on question No. 3, the answer is assessed at 1 point if a mismatch of the answer is revealed when compared with the answer on the nociception scale 3 (the strength of pain is strong, very strong, unbearable); on questions 4-6 - the answer “No” is estimated at 1 point. The higher the lie score, the less reliable the test.

Calculation of test results of patient L.

Question No. 1 is rated at 0 points, as it coincides with the answer on the pain frequency scale. Patient L.'s response on a scale of 1 is “Constant pain.” Question No. 2 is rated at 0 points, as it coincides with the answer on the pain duration scale. Patient L.'s response on a scale of 2 - “Pain lasts for hours.” Question No. 3 is rated at 0 points, as it coincides with the answer on the verbal-color scale of pain intensity. Patient L.'s response on a scale of 3 is “Medium Strength Pain” (see Tables 1, 3, 4). Counting on questions 4-6 revealed one answer “No” on question 6. Thus, the sum of the answers on a lie scale in patient L. = 1 point. High rates on this scale may indicate insincerity of responses or that the patient misunderstood the test instructions. This is a signal for re-testing. Thus, the data of this scale are necessary for a qualitative analysis and are not taken into account when calculating the average and integral indicators of pain.

Adaptability level

Adaptability is the next level of a comprehensive analysis of pain perception. This level is associated with the development of a scale of modalities that allow us to assess the degree of dependence and severity of pain from external environmental factors. During the examination, each patient had to describe the factors that provoke pain in him. The data obtained were systematized and presented on the scale of modalities.

Table 12 7.1. The factor “Time-sleep” determines the dependence of the appearance or intensification of pain on the time of day. Times of Day Clock Night 1 2 3 4 5 6 Morning 7 * 8* 9* 10* eleven* 12* Day thirteen 14 fifteen* 16* 17 * 18* Evening 19 twenty 21 22 23 24 Insomnia

The patient indicates, marking at what time the pain appears or intensifies.

Table 13 7.2. The “Weather” factor determines the dependence of the appearance or intensification of pain on weather conditions. Weather Cold Cool Heat Hot Sunny Mainly cloudy Dry Wet Windy Rain Snow Change of weather Other

The patient indicates in what weather the pain appears or intensifies.

Table 14 7.3. The “Pose-movement” factor determines the occurrence or intensification of pain from a body posture or movement. Peace Traffic Pose Lying down Walking Does not depend Sitting * Wiggle Other Bending over Touch Standing Pressure Change of position Rising Sitting down

Table 15. Factors determining the occurrence or intensification of pain depending on the meal, general condition and exposure to harmful conditions. 7.4. Factor “Hunger-food” 7.5. Factor “General condition” 7.6. Harmful factors 1 Hunger 1 General fatigue 1 Noise 2 Spicy food 2 Exercise stress 2 Shine 3 Sour food 3 Emotional load 3 Smell 4 Sweet food 4 Stress 4 Pitching 5 Cold food 5 Overheat 5 Vibration 6 Hot food 6 Cooling 6 Other 7 Alcohol 7 Other 7 8 Smoking 8 8 nine Other nine nine

Counting the results. The resulting score on the scale of modalities is calculated as follows: if the patient notes (indicates) in the factor one or more points that can provoke painful sensations, this is estimated at 1 point. The points are finally summed up for all the factors that the patient noted, as factors that provoke (aggravate) his pain. A qualitative analysis of the selected conditions within each factor will allow the doctor to obtain additional information about the patient's condition.

Patient L. indicated only one factor “Time-sleep” associated with the occurrence of pain, respectively, the total score on this scale of modalities is 1 (figure 2).

At the end of testing, its results can be presented in tabular form and in the form of diagrams that clearly reflect the severity and ratio of all components of pain at various levels of mental perception of pain by a person (figure 3).

In figure 3. a dynamic model is presented - a percentage total pain indicator, reflecting the experience of pain by a person at various mental levels.

Counting the results. The percentage of total pain (figure 3).

The test contains 7 scales, in each of which the test result is minimally zero, maximum 6 points, so for all scales the maximum pain can be evaluated = 7 scales × 6 points. = 42 points. This number is taken as 100%, respectively, each scale is maximally estimated at (100/6)%. The calculation of the percentage test result for each level (scale) is carried out according to the formula (Σ level.) / 42 × 100, where Σ level. - the amount of points by level (scale).

An example of calculating and presenting a percentage of the total pain indicator of a patient L.:

The level of nociception Σ level = (5 + 3.5 + 1) / 42 × 100 = 22.6%.

The level of pain sensation is Σ level. sensation. = 3/43 × 100 = 7%.

The level of pain experience is Σ level. outlived. = 2.5 / 42 × 100 = 5.9%.

The level of pain behavior is Σ level. behavior = 1.3 / 42 × 100 = 3%.

Adaptability level Σ level. adaptive. = 2/42 × 100 = 4.8%.

Percentage total = 22.7% + 7% + 5.9% + 3% + 4.9% = 43.5% or

The percentage total indicator = (5 + 3.5 + 1 + 3 + 2.5 + 1.3 + 2) / 42 × 100 = 43.5%.

When conducting an express assessment of pain, it is not necessary to test the patient on all scales at once. At the discretion of the doctor (researcher), patient testing may be incomplete depending on the diagnosis and the direction of the prescribed therapy, however, it can be at least 3 scales and scales (1-3) of the nociception level (frequency, duration, pain intensity, color) are mandatory when testing scale).

Conclusions on the results of testing patient L. (table 16)

Testing is reliable. The patient has somatogenic pain syndrome. The pain is localized in the region of T10 - S1. The pain is almost constant, weak, pressing character. Strengthens in the morning and afternoon in a sitting position. Pain provokes an irritable emotional state. Pain causes a forced restriction of professional and personal activity. Identified high emotional stability is a favorable background for pain therapy. Note: depending on the depth of analysis, the test results allow you to make an extended conclusion about the patient's condition.

In order to confirm the adequacy of the results of testing the conditions of patients with the proposed method for assessing pain, we examined a group of neurological patients with vertebrogenic pains - 21 patients (12 women, 9 men) before and after a course of electroreflexotherapy using percutaneous dynamic electroneurostimulation (DENS).

To objectify the dynamics of the state of patients during therapy, a comprehensive study of a group of patients was carried out using the created evaluation method, ultrasound dopplerography (Doppler ultrasound) and variational cardiointervalometry (WKIM), as well as an assessment of the level of constant brain potential (SCP).

Psychological testing was carried out using a computer version of this method of pain assessment, which is an important component of the psychodiagnostic module of the hardware-software complex of the office of pain therapy.

According to the results of testing patients before and after the course of DENS therapy, a reliable positive dynamics was revealed, expressed in a decrease in indicators for all components of the pain syndrome, with the exception of the adaptability indicator on the modality scale. The most pronounced effect was observed in a decrease in the frequency, duration and intensity of pain, i.e. components associated with nociception. After a course of treatment, patients also showed an improvement in their emotional state, which was manifested in a decrease in the level of neuroticism and an affective relationship to pain (Fig. 4).

Figure 4 presents the dynamics of the condition of patients before and after the course of DENS-therapy. The abscissa indicates: 0 - the scale of lies; 1 - a scale for the frequency of pain; 2 - pain duration scale; 3 - scale of intensity of pain; 4 - scale of sensory perception of pain; 5 - scale affective-emotional attitude to pain; 6 - a scale of neurotization; 7 - scale of modalities; sums. The show is an integrative indicator of pain. The y-axis is the average pain score.

The testing carried out at the first stages of the study revealed 5 patients in this group of patients whose “very strong” pain was associated with yellow and red colors (Table 17).

A comparison of these color choices with the color scale of the multivariate verbal-color pain test allows us to make an assumption about the psychogenic origin of pain in these patients. Additional psychological testing using the Spilberger-Hanin anxiety questionnaire and the MMPI test confirmed the presence of such personality characteristics in these patients as a high level of personal anxiety, emotional lability (patient N., patient F.), stress (patient G.), (patient L. .), high rigidity (patient X.). The results confirm the assumption of the psychogenic nature of pain in these patients.

Table 17 Color selection of neurological patients with psychogenic predisposition of pain Pain intensity Selected color Patient N. Patient X. Patient G. Patient F. Patient L. 0 No pain Blue, gray. Gray, green. Gray, green, yellow. Green, gray, blue. Green gray 1 The pain is very mild 2 The pain is mild Violet. 3 Moderate pain Violet., Red. Red, violet. Violet., Red. Red 4 Severe pain 5 The pain is very severe Yellow Red. Yellow Red. 6 Unbearable pain Violet., Red. Yellow Red. Yellow Red. Yellow Red. Red Yellow.

Improvements in the condition of patients on the background of the course DENS therapy are also confirmed by the data of clinical and functional examinations. Thus, the reliable positive dynamics of the patient's condition during treatment, obtained from the results of pain assessment using the created pain assessment method, is confirmed by clinical observations and objective functional studies.

The study made it possible to conclude that the developed method for assessing pain both qualitatively and quantitatively objectively reflects the severity of pain, the dynamics of patients' conditions and can be used in the clinic of pain syndromes.

Based on the results of the studies, a method for rapid pain assessment was developed, which allows the doctor, psychologist, at the first stages of diagnosis, with a high degree of probability to identify patients with pain of psychogenic origin, to evaluate the degree of severity of pain components taking into account gender differences, which is important when choosing method and tactics of analgesic therapy.

Using this method of pain assessment, it is possible to assess with a high degree of reliability the dynamics of the components of the pain syndrome, the influence of various factors on different levels of pain experience by a person, which allows it to be used in the diagnostic and medical practice of a doctor of any specialty, in psychotherapeutic and psychocorrection work with patients with various forms of pain, as well as a tool for studying pain in scientific research.

The created method for assessing pain significantly differs from the known methods for assessing pain in that for the first time in evaluating pain, the developed verbal color is used, which makes it possible to identify pains of a psychogenic nature with a high degree of probability, describe pain sensation taking into account differences in the perception of pain by men and women, systematize pain sensation according to factors-scales in accordance with the ideas about the multidimensional manifestation of pain and quantitatively evaluate (in points / percent the severity of all components of pain syndrome of 7 scales. As a result of the test appears integral assessment of pain. The method comprises the map location of pain intended for visual detection zone and the areas of localization of pain to the human body. The test results are presented graphically in blank and embodiments (Figures 2, 3).

Claims (6)

1. A method for assessing pain, characterized in that the patient is tested on seven scales: frequency, duration, intensity, sensory perception of pain, emotional attitude to pain, level of neurotization, level of adaptability, and evaluate the results on the listed scales from 0 to 6 points, at the same time, the scales of sensory perception and emotional attitude, levels of neurotization and adaptability are evaluated in accordance with tables 7-10, 12-15 in the description, and the severity of the psychogenic component of pain is additionally evaluated about the patient’s color choice, depending on at least three choices of the intensity of his pain: “pain at the time of testing”, “no pain”, “severe pain” in accordance with tables 3 and 4 described in the description, after which the severity is evaluated according to the results of testing pain sensations of the patient qualitatively and quantitatively. 2. The method according to claim 1, characterized in that on a scale of the frequency of occurrence of pain, evaluate from “pain appears once every few days or less” to “constant pain”. 3. The method according to any one of claims 1 and 2, characterized in that on a scale of duration the pain is evaluated from “fleeting pain” to “constant pain”. 4. The method according to claim 1, characterized in that on an intensity scale the pain is evaluated from “pain is very weak” to “pain is unbearable”. 5. The method according to claim 1, characterized in that on a scale of the level of neurotization take into account the main behavioral factors - anxiety, emotional lability, aggression, depression, psychogeny, hypochondria. 6. The method according to claim 1, characterized in that as factors of the environment that provoke or enhance pain, in the scale of the level of adaptability factors are selected “time-sleep”, “weather”, “pose-movement”, “hunger-food ”,“ General condition ”,“ harmful factors ”.

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