Patient perception of pain versus observed pain behavior during a standardized electrodiagnostic test

Abstract

Introduction: Clinicians often assume that observations of pain behavior are adequate for assessment of patient pain perception during procedures. This has not been tested during a standardized electrodiagnostic experience. Methods: During a prospective trial including extensive, standardized electrodiagnostic testing on persons with lumbar stenosis, vascular claudication, and asymptomatic volunteers, the subjects and an observer rated levels of pain. Results: In 60 subjects, observers significantly under-rated pain (Visual Analog Scale 3.17 ± 2.23 vs. 4.38 ± 2.01, t=-4.577, df=59, P<0.001). Perceived pain during testing related to bodily pain as measured by the visual analog, McGill, Pain Disability, and Quebec scales, but not age, duration of symptoms, Tampa kinesiphobia, Center for Epidemiological Studies Depression scale, or SF-36 health quality of life. Conclusions: Persons with worse pain syndromes may perceive more pain during testing than others. Clinicians and researchers should understand that patients may have more pain than they recognize.