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

Credit: Unsplash

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.


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.

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:

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.

the sting Milestone

Featured Stings

Can we feed everyone without unleashing disaster? Read on

These campaigners want to give a quarter of the UK back to nature

How to build a more resilient and inclusive global system

Stopping antimicrobial resistance would cost just USD 2 per person a year

How can coronavirus lockdowns end safely and effectively? – WHO briefing

These 5 industries can drive digital financial inclusion

Can we balance conservation and development? Science says yes

Tartu Call for a Healthy Lifestyle shows concrete results for EU citizens

UN chief calls for ‘solidarity, compassion and action’ on World Refugee Day

Digital business is Europe’s best hope to get back to growth

How Bangladesh’s leaders should respond to the economic threats of COVID-19

Will CETA be implemented after eight long years or it will be vetoed by the EU citizen?

Mobile health: The future of global healthcare

Brexit: European Commission publishes Communication on preparing for the UK’s withdrawal from the EU

Instability in Africa’s Sahel, spreading outwards, Security Council told

London to say hello or goodbye to Brussels this week

Pesticides: MEPs propose blueprint to improve EU approval procedure

EU shapes its ambitious strategy on India

Climate change update: consistent global actions urgently needed as we are running out of time

Why are so few women buying into Bitcoin?

The West is struggling to hit its climate targets. What would the developing world do differently?

3 ways to stop COVID-19 from drying up start-up talent pools

Want a more inclusive society? Start with mobility

As Yemen relief operations face funding gap, timing of surge in violence ‘couldn’t be worse’

A European student just sets the question of the day: What kind of education policies are missing in Europe?

From diamonds to recycling: how blockchain can drive responsible and ethical businesses

Despite falling attacks, ISIL terrorists remain ‘global threat’: UN report

European Union policy for improving drought preparedness and mitigation

Parliament adopts new rules for short-stay visas

‘Passport to dignity’ that schools represent may expire fast, without emergency funding warns UN Palestine refugee agency

Precision medicine should be accessible to all

We have to fight for a fairer tech industry for women

Madrid is banning high-polluting vehicles from the city centre

Tuesday’s Daily Brief: Disability inclusion, minimum wage, and LGBTI rights in Botswana

The untold story of who caused and who pays for the economic crisis

“Will TTIP solve the massive EU-US unemployment? Absolutely not!” A revealing Sting Exclusive with Tim Bennett from the Transatlantic Business Council

The financial future of Eurozone on the agenda of Friday’s ECOFIN council

Sign language protects ‘linguistic identity and cultural diversity’ of all users, says UN chief

Here are 4 tips for governing by design in the Fourth Industrial Revolution

Italian voters put again the European Peoples in the Brussels picture

Menu for change: why we have to go towards a Common Food Policy

Aid convoy for north-east Syria postponed over security concerns – UN relief chief

The European Sting at the Retail Forum for Sustainability live from Barcelona

Human Rights Council election: 5 things you need to know about it

Meet the man who drove from the Netherlands to Australia without visiting a gas station

Is there a way out of the next financial crisis? Can more printed money or austerity save us all?

How India’s government can build better contracts with blockchain

How to unleash the potential of regions like São Paulo

How bad could British healthcare get for its citizens abroad post-Brexit?

A Sting Exclusive: “The Digital Economy and Industry are no longer opposing terms”, Commissioner Oettinger underlines live from European Business Summit 2015

Going climate-neutral: expert-group recommendations to help energy-intensive industries contribute to the EU’s 2050 target

COVID-19: MEPs want safe vaccines, full transparency and liability for companies

How do we make artificial intelligence more humane?

Drone regulation is necessary to democratize the sky for humanity

EU-China: Council authorises signature of the agreement on geographical indications

5 shocking facts about inequality, according to Oxfam’s latest report

Sri Lankan authorities must work ‘vigorously’ to ease simmering ethno-religious tensions, urges UN rights expert

It’s time to build a responsible media supply chain

The ECB still protects the banks at the expense of the EU taxpayers

Commission considers anti-dumping duty on Chinese solar glass imports

Explained, the economic ties between Europe and Asia

EU budget deal struck with Parliament negotiators

Myanmar willing to repatriate ‘verified returnees’ from Bangladesh

From farms to supermarkets: MEPs approve new EU rules against unfair trading

More Stings?


Speak your Mind Here

Fill in your details below or click an icon to log in: Logo

You are commenting using your account. Log Out /  Change )

Google photo

You are commenting using your Google account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s