How to describe chronic pain beyond numbers? A Brazilian measuring instrument

This article was exclusively written for The European Sting by Ms. Kamila Blaka, a fourth-year medical student from Santa Catarina Federal University (UFSC) in Florianópolis, Brazil and Ms. Nubia Gabrieli Kukla, a degree in Computer Information Systems at Iguaçu Valley University Center, in União da Vitória, Brazil. They are affiliated to the International Federation of Medical Students Associations (IFMSA), cordial partner of The Sting. The opinions expressed in this piece belong strictly to the writers and do not necessarily reflect IFMSA’s view on the topic, nor The European Sting’s one.

The pain, beyond a neurological process involving sensory neurons, is an individual emotional experience, according to the International Association for the Study of Pain. There are several types of pain, from acute to chronic, with particular characteristics between patients –  The duration, location, intensity, signs, and symptoms list shouldn’t be exhaustive.  Furthermore, social factors like culture, emotions, psychiatric previous conditions make the “painful journey” absolutely subjective, and all this clinical scene requires a multidisciplinary team for an assessment and management. Chronic pain can deteriorate the life activities and affects between 30% and 50% of the world population, mostly female, according to Souza et al. (2018).

 The diagnosis is based on the clinical analysis in addition to the patient reports. The Visual Analogue Scale (VAS) is widely used for pain measurement, where the patient attributes a number for his pain – 0 for “no pain” to 10 for “the worst pain for me”. Our question is: if the pain is a personal experience, solely a number can tell us what the patient really expresses?

 This question conduced to us for a previous case report, in 2018, at the Acupuncture Ambulatory  (University Hospital – UFSC). 38 years-old male diagnosed with neuropathic pain after bilateral inguinal herniorrhaphy for 3 years and refractory to pharmacology treatment. He had an important emotional factor (catastrophism symptoms) and allodynia. Our objective was to demonstrate acupuncture treatment effects. We used a European tool that mixed the VAS and colorful body diagrams (Symptom Drawing – SD), who allowed the patient to “showed” his pain and his improvement more precisely than VAS single used. Our paper was well-received on the V International CMAESP Acupuncture Congress, XXII Brazilian CMBA Acupuncture Congress, V Filasma Southern Region Congress, and IV CMBA Congress of Pain, in 2018, received an award for the innovation and relevance. 

 For a chronic pain patient, signs and symptoms can vary along the days and sometimes is hard to describe precisely. Keeping a “diary” can help the patient and the medical doctor on follow-up. At that time, there wasn’t a tool like that in the Portuguese language. Thus, Nubia Gabrieli Kukla, a computer programmer, developed the Mensurador, a Web Application (WA) in Portuguese, with a minimalist design, simple and intuitive interface, using the VAS and SD. The main idea is optimizing the communication between patients and health teams. The WA doesn’t make diagnostics – this is the physician’s role – but calculate the result after a period of time (weekly or monthly). Kukla developed this tool for her undergraduate final project, obtaining the maximum score.

 The humanization of health care should be based on better communication. Understanding the pain through the neurology is essential, also go beyond and listen who searches for help for his individual journey. Maybe numbers are not so precise as the person wants to say and what medical teams really need to know, so our role is to find ways to get this conversation better.

References

Blaka, K. Moré AOO; Lee RBY; Uda A; Min LS. Como evidenciar os efeitos da dor neuropática? Relato da utilização da ferramenta de Symptom Drawing. V Congresso Internacional de Acupuntura do CMAESP, XXIII Congresso Brasileiro de Acupuntura do CMBA, V Congresso Regional Sul da FILASMA e IV Seminário de Dor do CMBA. (Apresentação de Trabalho/Comunicação). São Paulo, 2018.

International Association for the Study of Pain. IASP Terminology. https://www.iasp-pain.org/Education/Content.aspx?ItemNumber=1698

Jang A, MacLean DL, Heer J. 2014. BodyDiagrams: improving communication of pain symptoms through drawing. In Proceedings of the SIGCHI Conference on Human Factors in Computing Systems (CHI ’14). Association for Computing Machinery, New York, NY, USA, 1153–1162. DOI:https://doi.org/10.1145/2556288.2557223

Kukla N.B. Desenvolvimento de um sistema de apoio para mensuração de dor em pacientes com diagnóstico de dores neuropáticas através da escala visual analógica e a ferramenta symptom drawing.Iguaçu Valley University Center, União da Vitória, Brazil, 2019

Souza, J. B. de, Grossmann, E., Perissinotti, D. M. N., Oliveira Junior, J. O. de, Fonseca, P. R. B. da, & Posso, I. de P. (2017). Prevalence of Chronic Pain, Treatments, Perception, and Interference on Life Activities: Brazilian Population-Based Survey. Pain Research and Management, 2017, 1–9.

About the authors

About Kamila Blaka: 26 years-old, a fourth-year medical student from Santa Catarina Federal University (UFSC) in Florianópolis, Brazil. President at the Neurology and Neurosurgery Academic League (LANNc) and Internship Director of the Acupuncture Academic League (LiAAc). Scholarship at PET Interprofessional Education (Tutorial Education Program). Student Member in Intern Medicine Department at UFSC. Neurosciences enthusiast, with a special interest in the neuropsychiatric interfaces of chronic pain.

About Nubia Gabrieli Kukla: 25 years-old, a degree in Computer Information Systems at Iguaçu Valley University Center, in União da Vitória, Brazil. She had been working as a Content Analyst since 2016 at Girafa Interactive Communication, by Verde Vale Communication Group. Web design achiever at Ativa! Digital Communication and PoupeUP Startup. Front-end development enthusiast, php solutions also, as Mensurador tool, major research object in the undergraduate final project.

Both believe in technology as an instrument of the improvement and the change of society and health care, without borders between the people and the knowledge.

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