Critical Thinking

Can we truly “study” pain? An informal analysis of qualititative data

I recently conducted an informal cross-sectional study over at SomaSimple.com, to gather an idea of the individualized experience of others when watching the video below.

The responses from the participants varied and here is a summary of responses, to the following statement: This is a test. I want you to sit through this 2 minute video and then describe  what you feel. I then want you to reflect on the experience and describe why you felt this way.

After a day or so, I gathered the responses and attempted to analyze them (n=15):

After careful analysis, I suspected there were two classifications of individuals :

No response (or down-regulated response):
4 participants

Positive Response:

Participant 5: Social factors influenced her response and caused her to feel “on-guard”

Participant 6: Able to experience a quality of pain (through visualization and memory).  The participant recognized the quality was different than the actual experience.

Participant 7: No pain BUT did exhibit  altered action programming (he curled in ball and grabbed his hand)

Participant 8:  No pain but did have a sympathetic Response + altered action programming

Participant 9:  No pain but the sound caused altered action programming

Participant 10:  Didn’t need to watch the video; the words simply created fear  avoidance behavior

Participant 11: Sympathetic Response

Participant 12: The participant had altered action programming

Participant 13: Sympathetic Response (felt queasy)

Participant 14: Fear-avoidance (refusal to watch video)

Participant 15: Laughed. 

(To read the individual responses, click on the link above).

So when analyzing the above data, how do we make sense of it and what does it mean to us clinically?   Again, these responses were simply from watching a video. There was no immediate or direct (real?) threat involved. But in over half of the participants, their brain responded in a very real way (by causing a variation of physiological actions).

I wanted to quote one of the participants descriptions of why they believe they did not experience a response:

As a child, I grew up amongst a large community of Micronesians (indigenous people of the Far NW Pacific) and accepted their culture as markedly different from the one I was getting used to – ours.  If someone hurt himself, quite significantly, those around him would laugh out loud and almost roll on the ground with laughter. The kids laughed, the wives and girlfriends too. He ended  up laughing as well, through gritted teeth. Then later I found myself wondering why our culture was so damn serious about pain and hurt which was not life-threatening. I still wonder. Five of my cousins grew up in the  Solomons (NW Pacific) amongst a different culture – warmongering Melanesians who  were ex-cannibals but the approach to discomfort and pain was the same.  When  the two of the five cousins started skin diving to get pearls, they often  developed the bends. They were attached to a rope and breathing tube to the  boat. They hung onto the rope until they could slowly surface. Once all was  normalised, their father told them to go down again…and again.  A little bit of history which may explain why a paper cut seems trivial to me. However I  do understand why it isn’t to others – I think. Blame the culture??

When considering the study of pain, I am not truly convinced RCTs can account for group differences.  Sure, you can randomize a study by assigning patients to groups with methods to assure equal probability of allocation, and then analyze for group homogeneity, but isnt this truly limited by the variables analyzed.   In research, do we truly account for individualized experiences that influence responses to our experiences, as in the story above?

Moving forward, I am not convinced that more RCTs hold the answer.  I suspect we need to conduct qualitative studies, and learn about the individualized responses we receive.

How did you experience the video above?  How would you have answered this question?  What does this mean for us clinically?

- Joe B

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2 replies »

  1. I agree, I feel “objectifying” pain by asking a number 1-10 has given us a false sense of security in research. It also sets us up to make faulty assumptions regarding cause and effect relationships with interventions. Asking a pt about pain at one small point in time can’t capture the essence of the pain experience. However it is hard to publish data without significant p-values supporting or refuting interventions.

    • Thanks for the reply, Josh! I am 100% in agreement with you—And this seems to be an underdiscussed issue with the translation of pain research into practice. We see individuals give a large scale of responses when asked to describe their experience clinically—and we are learning so much about the completely individualized nature of pain. But is any research assessing “pain”, truly translational into practice when we put limits on the description of experience? Sure it helps you get published—but isn’t this an issue then with how we approach research?

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