1. Working Paper No.3 Add.4 11 November 2005 STATISTICAL COMMISSION andSTATISTICAL OFFICE OF THE UN ECONOMIC COMMISSION FOREUROPEAN COMMUNITIES EUROPE (EUROSTAT) CONFERENCE OF EUROPEAN WORLD HEALTH STATISTICIANS ORGANIZATION (WHO) Joint UNECE/WHO/Eurostat Meeting on the Measurement of Health Status (Budapest, Hungary, 14-16 November 2005) Session 3 – Invited paper Pain and Discomfort Jennifer Madans National Center for Health Statistics, U.S.A

2. Pain Concept: “Pain is an unpleasant sensation that can range from mild, localized discomfort to agony. Pain has both physical and emotional components. The physical part of pain results from nerve stimulation. Pain may be contained to a discrete area, as in an injury, or it can be more diffuse, as in disorders like fibromyalgia. Pain is mediated by specific nerve fibers that carry the pain impulses to the brain where their conscious appreciation may be modified by many factors." Cannot be measured directly, but it is the subjective experience of pain that determines the consequences for the person and for society

3. Pain (cont.) Components:  Intensity Pain vs. Discomfort (separate concepts or on a continuum)  Location  Frequency/Constancy Attribution:  Multiple causes; not always known Impact:  Does severity need to be measured through impact

4. Proposed items for measuring pain and discomfort PAIN – Have you had any pain during the past……(days/weeks/months) (all types of pain).  Yes (if yes proceed to question FREQ_PAIN)   No FREQ_PAIN – Thinking about the past…(days/weeks/months): How often did you have pain?  All the time (non-stop)  Daily (with pauses)  Several days per week, but not every day  One of two times per week  Several times per month  Once a month  Less frequent

5. MED_PAIN – Have you used any medication to try to ease (the) pain during this period?  No  Daily  Now and again INTENS_PAIN – Thinking about the last time you had pain: On a scale from 1-100 how intense was the pain: 0 is no pain and 100 is the worst pain imaginable. Proposed items for measuring pain and discomfort (cont.) 100 worst pain imaginable No pain 0

6. Pain: Characteristics of Proposed Questions Filter Question:  Used Assistive Devices:  Information obtained on use of pain meds  Questions on frequency and intensity do not specify whether pain meds are used Recall period/chronicity  Intent is to limit to chronic or recurrent pain but not specified or defined  Recall period is used but length of period not yet specified for ever having pain and frequency of pain  Most recent episode for intensity of pain Response categories:  Frequency: Labeled categories – ‘all the time’ to ‘less frequent’  Intensity: Scale from 1 to 100 Severity:  Measured for frequency and intensity