Method for evaluating pain

FIELD: medicine, medicinal psychology.

SUBSTANCE: one should test a patient by seven scales: frequency, duration, intensity, sensor perception of pain, emotional attitude towards pain, neurotization level, adaptation capacity level to evaluate the results obtained by the scales mentioned from 0 to 6 points. Moreover, the scales for sensor perception and emotional attitude, the levels of neurotization and adaptation capacity should be evaluated in accordance to the Tables given in description. Additionally, one should, compare the degree of psychogenic constituent of pain according to chromatic choice made by a patient depending upon, at least, three choices of pain intensity: "pain during testing", "no pain", "severe pain" in accordance to the Tables given in description. Then, according to the results of testing one should evaluate the degree of patient's pain feelings both quantitatively and qualitatively. Moreover, by the scale of frequency the appearance of pain should be evaluated from "pain appeared once during several days or rarely" to "constant pain". By the scale of duration pain should be evaluated from "momentary pain" to "constant pain". By the scale of intensity the pain should be evaluated from "very weak pain" to "unbearable pain". By the scale of neurotization level one should take into account basic behavioral factors, such as anxiety, emotional lability, aggression, depression, psychogenia, hypochondria. The present innovation enables to increase significance in evaluating pain achieved due to broadened verbal description of patient's pain feelings.

EFFECT: higher accuracy of evaluation.

5 cl, 4 dwg, 2 ex, 17 tbl

 

The present invention relates to medicine, medical psychology and can be used for differentiated evaluation of the patient with psychological counseling research purposes. The application of the method of verbal-projective pain scores are shown for the rapid assessment of pain of various Genesis for the purpose of differential diagnosis and clarification of medical diagnosis, in order to select individual technique and tactics pain therapy, for the purpose of developing individual schemes acupuncture analgesia and therapeutic reflex effects, and to assess the dynamics of the treatment, therapeutic effectiveness of drugs.

The measurement of pain is a complex set of problems. On the individual perception of pain is influenced by demographic factors, gender, age, ethnic characteristics, as well as the emotional and physical condition of the patient. In addition, the pain is closely associated with social and psychological factors. Difficulties that may arise for patients in the description of your condition, complicate the diagnosis, especially if the pain are psychogenic in nature. These patients are exposed to numerous additional therapeutic and diagnostic research. The lack of clear criteria pain and methods of measurement bluedot to frequent diagnostic, expert and ethical errors.

For qualitative and quantitative assessment of pain increasingly widely used psychological methods, taking into account the factor of subjective self-assessment of pain by the patient, as well as analysis of doctor of behavioral and affective components of pain.

These methods involve self-esteem patients pain intensity on a 5-point rating scale, where 1 - mild, mild pain, and 5 is unbearable pain. Another way to assess the intensity of pain is the method the visual analogue scale on which, for example, in a section of straight length of 10 cm at the extremes of "no pain" to "pain very strong" patient notes pain intensity (Korolenko ZP, S. Pavlenko Objectification of pain and its assessment. //The journal "Pain and its treatment", 1995, No. 2, p.7-9).

The closest in technical essence of the present invention is a method of pain assessment using Mac-Gilowska pain questionnaire (ibid.). The questionnaire is filled in patients with doctor and reflects the feelings of the patient at the moment. The questionnaire consists of 102 words determinants of pain descriptors. All the descriptors are divided into four classes:

1. Class of sensory descriptions of pain in temporal and spatial terms, terms of pressure, temperature and other

2. Class affective (emotional) description the pain in terms of voltage, fear, autonomic manifestations.

3. Class assessment definitions of pain, which reflects the subjective assessment of the experience of pain.

4. A variety of descriptions of pain.

These classes are divided into 20 subclasses consisting of words similar in meaning, but differ in the intensity of the transmitted them pain or nuances, especially important for the patient.

Every word of the descriptor is assigned a numeric value corresponding to its place in the subclass, and their sum is the index type of pain. The questionnaire contains a General assessment of pain intensity at the time of the study, which is defined as a number from 0 to 5, associated with the following words: 0 - no pain, 1 - mild, mild pain, 2 - discomfort, 3 - annoying pain, 4 - terrible, terrible pain, 5 - intolerable, unbearable pain.

Despite the fact that the processing of the scales of sensory and emotional-affective reflections pain is computed metric, it does not reflect the specifics of the pain syndrome in a patient and does not correspond to the severity of the condition. So, for example, three selected characteristics of pain: indifferent, namespacea and inconsequential give the same values as the three definitions, such as terrifying, torturing, terrible. This is due to the fact that the scoring scale is only based on the amount of co is the R words, i.e. without taking into account their semantic significance. Used the questionnaire does not take into account differences in the subjective assessment of pain men and women. This method of assessment does not contain a map of the pain that reflect topico and migration of pain on the body. Furthermore, the method does not allow to assess changes in patient behavior and the degree of dependence of the pain from factors in the external environment.

The present invention is the task of developing a method for the assessment of pain, providing qualitative and quantitative assessment of patients with various forms of pain syndrome due to the expansion of verbal descriptions of pain, reflecting a conscious level of perception of pain, and the simultaneous use of non-verbal symbol, color, associative choice which reflects the subconscious level of perception of pain.

The problem is solved in that in the method of assessment of pain by testing:

the patient indicates the body area of the pain, which define the area affected by the pain that allows you to define meaningful for diagnosis topico pain and the extent of its spread;

- said at least one characteristic that is specified in the verbal rating scale, which determines the frequency of pain;

selects at least the bottom of the definitions of the duration of episodes of pain, specified in the verbal rating scale;

selects at least one of the definitions of pain intensity (conscious component of pain perception) and at least two colors, one of which is a color preference, and the other color rejection, verbal-color rating scale, intensity of pain, based on a preliminary identification of color preference/rejection depending on pain intensity and form of pain syndrome for different groups of patients (associative color choice reflects the attitude to pain associated with subconscious level of perception of pain);

- gives a positive or negative response to each of the statements included in the scale of neurotic and taking into account the key behavioural factors, a change which reflects the patient's pain, and PI, determining the degree of sincerity of the patient;

selects at least one of the factors in each of the scales modalities, revealing the environmental factors causing or intensifying pain;

- test questionnaires to assess sensory perception and emotional relationship to pain contain, respectively, 46 and 25-word descriptors, each of which has obtained in the course of our research their weight coefficient of intensive the STI pain points reflecting the semantic significance of the descriptor and sex differences in the perception of pain;

- on scales produce a count of the number of points and the test results are qualitative and quantitative integrated assessment of pain.

In the proposed method, the pain is understood as a complex multi-layered phenomenon, affecting different levels of mental reflection: perceptual, emotional, cognitive, behavioral. The complex process of sensation, perception and experience of pain is considered included in the context of other mental formations and forms of activity of the subject. In the process of ontogenesis man learns developed culture forms of manifestation and perception of physicality, including disease, so psychosomatic phenomena can be understood and treated as a complex sign-mediated functional mental education. Color has a specific meaning for a person, both biological and social, and the color value remains stable enough that we can consider it as a code carrier relations of the subject to the object. This position is reflected in the phenomena of preference and rejection colors depending on the intensity of pain, similarity of color choice for neurogenic somatogennye pain syndrome, acute is hepatogenous pain in children healthy subjects and color perversions for psychogenic pain syndrome.

In the method according to the invention for the first time to assess pain, the authors apply:

- identified semantic color categorization intercepting pain in humans, presented in the form of scales of preference/rejection colors, depending on the pain intensity and form of pain syndrome;

set the similarity of the patterns of preference/rejection colors depending on the intensity of pain in patients with neurogenic, somatogennye pain syndromes in children with acute non-pathogenic pain and healthy people, presents with pain of high intensity black and grey, when the average pain intensity of brown and red, in the absence of pain - yellow and green colors;

- identified the phenomenon of color perversion identified in patients with psychogenic pain syndrome when choosing colors, depending on the intensity of pain. Color preferences in this group presented with pain and high intensity yellow, purple, red, in the absence of pain - gray and green colors.

- identified sex differences in the perception of pain in men and women: (a) self-assessment intercepting sensations of pain, (b) self-assessment emotional relationship to pain, in) quantitative selection de is scriptorem when describing pain, g) manifestations angry reactions depending on the form of pain.

On the basis of color phenomena similarities and perversion, as well as gender differences in pain perception, identified by the study, the authors first developed a comprehensive rapid method for evaluation of pain using color and verbal scales, which allows a high degree of probability to identify patients with pain psychogenic nature; for the first time to consider sex differences in the perception of pain; to quantify (in points/percentages) intensity components of the pain syndrome in 7 scales, covering different levels of experiences pain man:

- nociception - scale localization of pain, 1-I scale the frequency of pain, 2-I scale the duration of pain, 3rd verbal-color scale of pain intensity;

- pain - 4th scale sensory perception of pain;

- the experience of pain - 5th scale emotional relationship to pain;

- pain behavior - 6th scale neurotic and 0 PI;

- level of adaptability - 7-I scale modalities, revealing the dependence of the intensity of pain from the time of day, and climatic conditions, from the position of the body, diet, stress factors;

- after testing, it seems integral assessment of pain.

The proposed method of pain assessment differs significantly from the known is the shaft of methods for the assessment of pain, as for the first time reflects the peculiarities of the perception of pain by a person at different levels of the psyche - of nociception (pain sensitivity), perceptions, emotions, behavior, adaptability; for the first time allows you to spend subjective descriptions of pain taking into account differences in pain perception men and women, as well as to systematize the factors scales in accordance with the concepts of multidimensional manifestation of pain and quantified in points/percentage intensity of all components of the pain syndrome in 7 scales. For the first time simultaneously with the verbal description of pain in the generated use non - verbal symbol, color, and also obtained by the authors of the diagnostic criteria for the selection or rejection of colors, depending on the strength of pain and forms of pain. For the first time on the basis of these criteria created color scale pain for pain syndromes of different pathogenese and developed verbal-color scale to assess pain intensity, to allow differential rapid diagnostics for toiletries pain syndrome to psychogenic pain.

Thus, use of the method of pain assessment allows the physician already in the early stages of diagnosis with a high degree of probability to identify pain psychogenic nature, get celostnu the evaluation taking into account sex differences in severity components of pain at different levels of perception of pain man what is important when choosing a method and tactics pain therapy.

Further, the invention is illustrated with specific examples of its implementation and the accompanying drawings, on which:

figure 1 depicts the scheme of a person (rear view) showing the area of the pain;

figure 2 - profile of pain the patient Liter;

figure 3 - dynamic model - interest total pain;

figure 4 - profile of pain in neurologic patients before and after a course of dynamic electroneurostimulation.

The way pain scores according to the invention is as follows.

Before testing the patient explain the importance of research. The choice of definitions of pain is performed sequentially from one scale to another. Before working with each scale to the patient or test subject is required to explain its content and only after it will become evident that the patient understood everything correctly, start testing.

Nociception. Map of the pain. The scale is a diagram of a human body from different angles (front, back and side) and you can specify it on the area of the pain and determine the area affected by pain; indicate point of pain radiation to other parts of the body; in dynamics to determine the change of the area of the body associated with pain, as well as the detection of the th topico migration of pain.

Calculation of results. To determine the area of pain is the full count square units included in the painful area, then counting partial square units, this number is divided by 2, the result of the sum: S pain = Σni + Σkj/2, where Σni is the sum of the total square units Σkj/2 is the sum of the partial square units (figure 1).

Figure 1 shows an example view of the patient's pain L.: the figure is shaded in on the man's silhouette area of pain; the area of pain: 1 Quad + 5/2 Quad = 3,5 square units

Nociception. 1. The frequency scale of pain, which allows to assess the frequency of pain, to reflect the dynamics of its changes.

Measuring the basis of the scale is the verbal rating scale, allowing to assess the frequency of pain from the pain occurs every few days” to “constant pain”.

The patient selects and marks the characteristics that most corresponds to the frequency of onset of pain. If he has difficulty selection, then selects those descriptions of pain, which is most similar to the frequency of pain from him, or selects multiple indicators frequency of pain.

Table 1
Verbal rating scale, which determines the frequency of pain
Nociception. 1 ø the Ala
 The frequency of painPoints
1.0The pain is absent0
1.1Once in a few days or less1
1.2Almost every day2
1.3Daily3
1.4Almost hourly4
1.5The pain is almost constant5*
1.6Constant6
The asterisk (*) denotes the selected patients definition.

Calculation of results. The rate of pain is the number of points specified in the column opposite the frequency of pain selected patients.

Frequency = Σmj/n, where Σmj is the sum of the scores of evaluators selected definition, n is the number of selected definitions. In the proposed example, the patient L.: Frequency = 5 points. The test results on the frequency scale (1) the appearance of pain attacks presented in figure 2

Figure 2 presents the profile of pain patient L. axis of abscisses specified: 0 - PI; 1 - scale frequency of pain; 2 - scale duration of pain; 3 - scale intensity of pain; 4 - scale sensory perception of pain; 5 - scale affective-emotional the CSO relationship to pain; 6 - scale neurotic; 7 - scale modalities; amounts. The show is an integrative indicator of pain. On the y - axis, the average pain scores.

Nociception 2. Scale duration of pain in the dynamics allows us to determine the change in the duration of episodes of pain in the patient. Measuring the basis of the scale is the verbal rating scale, allowing to determine the duration of pain “pain is fleeting” to “constant pain”.

The patient chooses the definition of duration of pain, which is most relevant to his senses. If he has difficulty selection, then selects those determine the duration of pain attacks, which is closest to his sensations or more suitable definition.

Table 2
Verbal rating scale, which determines the duration of the bouts of pain.
Nociception. 2 Scale
 The duration of attacks of painPoints
2.0The pain is absent0
2.1Pain passing1
2.2Pain short2
2.3The pain lasts for minutes3*
.4 The pain lasts for hours4*
2.5The pain lasts for days5
2.6The pain is constant6
The asterisk (*) denotes the selected patients L. definition.

Calculation of results. An indicator of the duration of pain is the number of points specified in the column opposite the selected patients duration of pain attacks.

Duration = Σmj/n, where Σ - the sum of the scores of evaluators selected definition, n is the number of selected definitions.

In the proposed example, the patient L. duration of pain is (3+4)/2 = 3.5 (figure 2).

Nociception. 3. Verbal-color numeric pain intensity scale allows you to determine dynamics of the intensity of pain in the patient; to detect with high probability, using the color rapid diagnosis of psychogenic pain of the character.

Measuring the basis of the scale is the verbal rating scale, allowing to assess the intensity of pain from the pain very weak” to “unbearable pain”, as well as associative selection preference/rejection colors depending on the intensity. Qualitative analysis when comparing the color of the election of the patient with the color sliders allows to determine with high probability the presence of psychogenic pred is pozicii in pain pathology, to describe his behavioral pattern (table. 3, 6,17).

Presents verbal-color scale was developed by the authors on the basis of the results of the investigation of the perception of color by the person depending on his experiences of pain.

Results were examined in 5 groups: 4 groups of patients with various forms of pain syndrome and a control group (healthy volunteers).

The 1st group consisted of patients with neurogenic pain syndrome, 30 patients (14 women, 16 men) aged 18 to 70 years. Neurogenic pain were studied on the model of phantom pain syndrome - 27 patients (11 women, 16 men) and facial neuralgia of the trigeminal nerve is 3 people (women).

The development of neurogenic pain syndromes currently associated with morphological and functional changes in the injured peripheral nerve and Central nervous system.

The 2nd group consisted of patients with somatogennye pain syndrome 34 students (18 women and 16 men) aged 18 to 65 years. Somatogennye pain syndrome was presented: postoperative pain is 3 people (1 woman, 2 men); abdominalgia - 3 people (1 woman, 2 men); articular pain - 5 people (3 women, 2 men); myalgia - 5 people (1 woman, 4 men); vertebrogenic pain -7 people (3 women, 4 men); cephalgia - 11 people (9 women, 2 men).

Pain syndromes resulting from activation of nociceptive receptors with trauma, inflammation, ischemia, stretch fabrics, refer to somatogennye pain syndromes.

The 3rd group consisted of patients with psychogenic pain syndrome - 18 people (9 women, 9 men) aged 18 to 60 years. Psychogenic pain syndrome was presented conversion and depressive disorders identified in the framework of cephalgy (stress headaches), abdominalgia, myalgias, vertebrogenic pain. All patients in this group have gone through a large number and variety of medical examinations, which have not been identified any significant physiological disorders which can cause constant pain.

In the 4th group consisted of children with acute pain. This group was studied on the model of the complex course of treatment method Iasconsole after the procedure, therapeutic injections (injecting one metameric pharmacotherapy) examined 20 children (9 girls, 11 boys) aged from 3 to 10 years with various forms of cerebral palsy and good intelligence.

The control group consisted of 64 (34 women, 30 men) aged 17-65 years, not experiencing pain at the time of the survey and without chronic diseases. In the study to the control group proceeded from every healthy person in one way or another has a certain painful experience, which can be regarded as a collapsed form of pain perception, meant personal and community experiences.

Results were examined 166 adults and children (75 women and 9 girls, 71 men and 11 boys).

For research was developed verbal-color method of pain assessment based on established authors pain questionnaire, to allow the evaluation of pain on five factors - scales, the method of scaling (visual-digital scale) and cocoercivity experiment according to the method of the color choice of eight colors Luscher test. The research procedure consisted of selecting a patient (subject) descriptors describing sensory (e.g., “pulling”, “oppressive” and so on) and emotional (e.g., “annoying”, “painful” and so on) characters pain, their evaluation according to the visual numeric scale (from 0 “no pain” to 6 points - “unbearable pain”) depending on the intensity of experienced pain, two color choices - preference and rejection colors depending on the intensity of pain. And were also used methods of psychological diagnostics - lüscher test, MMPI, the scale of reactive and personal anxiety of Spilberger Hanina, questionnaire anger of Spilberger.

When aggregating Dan who's applied methods of mathematical statistics - descriptive statistics, statistics Pearson, Wilcoxon, Kendal, Spearman, method crosstabulation for the analysis of contingency tables.

The study was conducted at the outpatient database of the Institute of reflexology Federal scientific clinico-experimental centre of traditional diagnostic methods and treatment Ministry of health of Russia; the Federal centre of expertise and rehabilitation of disabled persons (Central research Institute of prosthetics and protestosterone) M3 RF 3rd orthopaedic Department; Scientific and therapeutic centre for the prevention and treatment of neuropsychiatric disability (NTC STUMPS under the guidance of Professor, MD Iasconsole).

The study of pain using a verbal-color method in each of the five groups have provided data on the frequency of selection of colors, depending on the intensity of pain: in group 1 patients with neurogenic pain syndrome color preferences amounted to 412 elections, color rejection - 512 elections; in group 2 patients with somatogennye pain color preferences amounted to 583 selection, color rejection - 617 elections; in 3 patients with psychogenic pain syndrome color preferences amounted to 390 elections, color rejection - 376 elections; 4 children with acute non-pathogenic pain color preferences amounted to 173 selection, color rejection, 254; in the control g is the group of color preference was - 507 elections, color rejection - 556 elections.

When describing the state of “no pain” patients with neurogenic, somatogennye pain syndromes, children with acute pain and healthy individuals, preference is given to yellow (47,9-55,8%) and green (33-25%) colors. Patients with psychogenic pain no pain “stained”, mostly in grey (43%), to a lesser extent in the green (17,8%), purple (15,4%) color. Preference grey in the absence of pain patients with psychogenic pain is associated with anxiety States, depression (atherogenetic), emotional lability (irritability), whereas others characteristic the need for action, emotional involvement, optimism.

The pain is “very weak,” pain “weak” in groups with neurogenic, somatogennye pain syndromes, in the group with acute non-pathogenic pain in children are semantically similar, with the preferred colors for neurogenic pain and acute pain in children is purple (respectively 32,4% and 30.4%)in the group with a somatogennye pain syndrome are preferred grey (50% - 26%), green (15%-17%) and yellow (15.4%), in patients with pain of psychogenic origin color preferences associated with pain “very weak” and “weak” are different to “very weak” pain is preferable green (41,2%), grey (23,5%) and red (176%) color; for “weak” pain - red (22%), yellow (17,1%) color for the control group is also characterized by the difference in the color of choice for pain “fleeting” - yellow (30%), green (24,2%), purple (21.2%) of colors for pain “weak” brown (27,5%), purple (20.3%) and grey (20,3%) color.

Any discrepancies in the color perception of pain in patients with neurogenic pain and patients with pain somatogennye Genesis reflect significant differences in their pain behavioral pattern. Thus, in patients with phantom pain “weak” pain” provocative behavior, emotional lability, irritability, emotional tension, patients with somatic pain - behavior is Stanichno attempt to protect yourself from unnecessary stimuli, to create a zone of maximum comfort. For children with acute non-pathogenic pain also inherent irritability, moodiness. For patients with psychogenic pain in this case characterized by difficulties in communication, protective tendencies. Healthy people “very weak” pain is perceived as a prosperous condition and is equivalent to the condition “no pain”; the pain ' weak ' cause discomfort, mild irritability. It is notable that in the group of patients with psychogenic pain syndrome “very weak pain” and “pain is not” too (as in group ZV the world of subjects) “are painted in the same color, ie is such a pain not change their usual behavior.

For pain “medium strength” for all groups characterized by similar color pattern - gray, brown, red/purple: for patients with pain of neurogenic origin preferred color black (19%), brown (19%) and purple (17,2%); for patients with somatogennye pain typical choice of accommodation - gray (27,4%), brown (22,6%) and red (19,8%) flowers; for children with acute pain - gray (25,5%), red (25,5) and brown (20%) color; healthy people - gray (23,4%), brown (18,8%) and purple (15.6 per cent) colors except the color of choice in patients with psychogenic pain is their preferred, as in the case of pain “weak”, red (42,5%) and yellow (16.1%) in color. Thus, pain is “average power” for all groups except patients with psychogenic pain causes stress, fatigue, malaise, loss of usual life stereotype, anxiety. For patients with psychogenic pain intensifies previous behavioral tendency of stress, manifested by marked emotional instability; there is a sense of their situation as victims, its share of the blame is shifted on the other, shows the desire to dominate.

Pain “strong” in the group of patients with neurogenic pain provokes a preference for red (38,1%), gray (17,5%) C is billing purposes, in patients with somatogennye pain - gray (27,4%), brown (23,8%), red (17,6%) flowers, children with acute non-pathogenic pain prefer black (51.6 per cent) color, control group - red (26,8%), black (22,3%), gray (17.9 per cent)and in the group with psychogenic pain color choice is still yellow (25,6%), red (23,1%), purple (24,4%). Pain “strong” provokes aggression, irritability, feelings of powerlessness, emotional stress, the appearance of psychosomatic tendencies in the behavior of patients with phantom pain in patients with somatic pain increases depressive component in behavior that increases irritable weakness, pronounced physiological discomfort, anxiety; for children with acute pain characterized by fear, for the control group - the emergence of aggression, anxiety, fear. For patients with psychogenic pain characteristic of former behavioral trends - inconsistency, arbitrariness, authoritarianism, demanding of others, the displacement of the true causes of the conflict, the tendency to see themselves as victims, transferring the blame on others.

When “very strong” pain for patients with neurogenic pain syndrome is characterized by a preference for black (35,4%), gray (28,1%) and red (22,9%) flowers, in the group with somatogennye pain black (41,5%) gray (22.5%) and red (17,6%); children running the Roy pain revealed preference of black (50%), in the control group - black (50%) and red (29.6 per cent) colors, which is characterized by stress, tension, possible aggressive reactions, passive resistance. In patients with psychogenic pain syndrome colour and behavioral patterns do not change: color choice yellow (32,9%), red (21,9%) and purple (17,8%), characteristic features of the behavior is inconsistent, self-will, authoritarianism, demanding of others, the displacement of the true causes of the conflict, the tendency to see themselves as victims, transferring the blame on others.

The pain is unbearable increases tend to prefer the black color for all groups: neurogenic pain - black (64,4%) and grey (29,7%) color; somatogennye pain - black color (74,7%), acute pain in children - black color (51,6%); control group - black (49,3%) and red (23,9%) color. The pain is unbearable” provokes fear, anxiety, depression, attempt to protect itself from external stimuli, a high degree of asthenia (black, gray), search and need for protection.

For patients with psychogenic pain syndrome colour and behavioral patterns do not significantly change increases the tendency of preferences yellow (40,4%), red (21,3%) and purple (23,4%) of colors, enhanced previous behavioral trends. Thus we can conclude that pain for patients that gr is PPI closely connected with the compensation was inadequate attention to them, care problems, etc. and no pain with fear losing attention, a sense of abandonment, disappointment and depression, which is known to be characteristic of the disease psychogenic origin.

The purpose of the comparative analysis of the results of elections color preference and rejection in each group were summed and normalized by the number of patients in the group. To determine the validity of the similarities/differences of color patterns depending on the shape of the pain syndrome calculations of correlation coefficients between samples (groups) - defined coefficients concordancia (t) Kendal and rank correlation (r) coefficient, making it possible to identify the authenticity of the similarities/differences between the color of elections depending on the form of pain syndrome or absence of pain. Revealed significant similarity elections color preference/rejection colors, depending on the strength pain between groups of patients with neurogenic pain syndrome, somatogennye pain syndrome with acute non-pathogenic pain in children and the control group. For each of these groups with a small amount of variation in choice of color is characterized by the following General preferences: “the pain is severe, unbearable pain” black, “the pain of the average force”, “strong pain” - grey red, brown color, if color choice re the supply, that is equivalent to the definition of “no pain”, yellow and green.

According to the statistics of Kendal and Spearman revealed a negative correlation in the choice of color between groups of patients with neurogenic, somatogennye, acute non-pathogenic pain (in children), the control group and the group of patients with pain of psychogenic origin.

In associative color selection and assessment of pain intensity for patients with psychogenic pain syndrome characterized by color perversion: “strong pain”, “pain is severe and unbearable pain” they “paint” in yellow, red color, “the pain of the average force” - yellow, red, “no pain” - gray (table 3).

Within each group revealed significant differences in preference of colors, depending on the intensity of pain, which allowed to determine the color scale intensity of pain for neurogenic, somatogennye and psychogenic forms of pain, acute non-pathogenic pain in children and healthy people.

Discovered the phenomena of color similarity elections in patients with neurogenic, somatogennye pain syndromes in children with acute pain and healthy subjects and color differences elections in patients with psychogenic pain syndrome were used in the development of verbal-color scale, this method of pain assessment.

Businessmen who of testing on this scale using color range, containing eight color mini-cards matching the colors of the Luscher test: 1 - blue, 2 - green, 3 - red, 4 - yellow, 5 - purple, 6 - brown 7 - black, 0 (8) grey (table 4). If you cannot perform research protocols in the color format use standard card 8 color Luscher test. When conducting color rapid diagnosis of each patient must be at least three choices: first choice - the Association of color with the pain experienced by the patient at the time of testing; second choice - color Association with the state, when “no pain”; the third choice - the Association of colors with the most severe pain, i.e. pain “unbearable” or “very strong”.

The patient chooses the definition of intensity (strength) of pain, which most accurately characterizes them. If he has difficulty selection, then selects those definitions that are closest to his feelings or selects multiple definitions. On the color scale, the patient chooses a color, which is associated with his pain (color preference), specifies the color with which he relates the absence of pain (“no pain”), and sets the color associated pain is unbearable (stronger)” or “very strong”.

Then, the selected names of colors (number of colors) patient records in the fields of the Protocol.

Calculation of results. The intensity of pain is the number of points specified in the column opposite the strength pain selected patients.

Intensity = Σmj/n, where: Σmj is the sum of the scores of evaluators selected definition, n is the number of selected definitions.

In example 1 the patient L. the intensity of pain And=(1+2)/2=1.5 Bal (figure 2).

The color choice of the patient L is presented in table 5. After comparing this selection with the color sliders in table 4 we can conclude somatogennye the Genesis of pain in a patient L., comparison of these data with subjective pain description allows you to specify the diagnosis and to determine the choice of therapy.

Table 5
Example 1. The color choice of the patient L.
 The intensity of painThe choice of color preferencesThe choice of color rejectionRapid diagnosis
0Pain noYellow The patient P. somatogennye pain causes Stanichno attempt to protect yourself from unnecessary irritants (to create a zone of maximum comfort) and may be associated with involuntary restriction of professional activity and lignosulfonate.
1The pain is very weakGrey, greenGreen, yellow 
2Pain weakGrey, greenGreen, yellow 
3The pain of the average force   
4The pain is strong   
5The pain is very strong   
6The pain was intolerableBlackYellow 

Comparison of choice of the patient M, shown in example 2 (see table 6) with the scales in table 3, allows to make an assumption about the psychogenic origin of his pain.

Table 6
Example 2. The color choice of the patient M
 The intensity of painThe choice of color preferencesThe choice of color rejectionRapid diagnosis
0Pain noBlue, gray The patient M. the pain of psychogenic nature, being what can be done for him unconscious form of psychological protection and avoids adverse social conditions or relationships.
1The pain is very weak   
2Pain weakRedGrey 
3The pain of the average forceRed, yellowGrey purple 
4The pain is strong   
5The pain is very strong   
6The pain was intolerableYellowGrey 

The appearance in the color selection preferences for pain of high intensity (“unbearable” or “very strong”) red, yellow and purple color may indicate psychosomatically pain to the patient. If further testing of the patient revealed high scores on a scale of neurotic (see below) and/or scale for assessing emotional relationship to pain, this fact increases the probability of psychogenic origin of pain in a given patient.

In the study using verbal-color method revealed significant gender differences in perception and emotional relationships to Bo the and in patients with neurogenic, somatogennye, psychogenic pain syndromes, in healthy individuals and were obtained weighting coefficients for each descriptor, depending on its semantic significance separately for men and women (table 7, 8, 9). In addition, in the course of the study were collected new definitions (descriptors)used by patients to characterize pain. This allowed to extend the dictionary description traceptive feelings on a scale of sensory perception of pain to 46 descriptors (table 8), on the scale of emotional relationship to pain - up to 25 descriptors (table).

To summarize the results of the summation indices of self-esteem men and women perception of pain and emotional relationship to pain - groups of patients with neurogenic, somatogennye, psychogenic pain syndromes and the control group. Comparative statistical analysis assessment of pain (statistics Pearson) revealed no significant difference in pain perception men and women on a scale of sensory experiences and on the scale of emotional relationship to pain.

On a scale of sensory perception of pain difference is that men are more likely to experience minor pain (21,2%) and average intensity (22,6%)women, respectively (15,7%) and (19,6%). Women are more likely to experience and emotional experience more “severe” pain felt is placed - 18.3%in men “strong” pain be 8,73%. On the scale of emotional relationship to the pain expressed emotional reactions to the pain “very weak” presents more common in males than females, whereas pain “medium strength” men and women evoke similar emotional manifestations.

In addition to differences in the self-assessment of pain in each group of patients was identified differences in intercepting dictionaries men and women when describing their pain, as well as the difference in the number of selected descriptors on the scale of sensory perception and emotional-affective relationship to pain. And found that women compared with men choosing a greater number of handles on both scales (table 7). Thus, the obtained results confirm the difference in pain perception in men and women.

Table 7
The average quantitative selection of descriptors in patients with neurogenic, somatogennye, psychogenic pain syndromes
№ p/pGroupThe scale of the sensory perception of painScale emotional. relationship to pain
  Husband.Wives.Husband. Wives.
1Neurogenic pain syndrome6,47,84,15
2Somatogennye pain6,17,3a 4.95,3
3Psychogenic pain syndrome10,414,69,610,8
4Average total7,68,86,27,1

Comparative quantitative and statistical analysis of pain showed a significant difference in pain perception men and women as on the scale of sensory experience (Chi-square = 79,9, importance = 0, degree of freedom = 6, p≤0.01), and on the scale of emotional-affective relationship to pain (Chi-square = 13,6, significance = 0,0343, degree of freedom = 6, p<0,05).

These facts allow us to conclude that meaningful indicators of differences in pain perception men and women are differences in self-esteem experienced intercepting sensations and intensity of the emotional-affective relationship to pain that reflect the received semantic weights of the descriptors; as well as a quantitative indicator of the choice of descriptors describing the pain and the attitude towards it.

the results have been applied in the development of the sensory perception and scales emotional relationship to pain.

Nociception. 4. The scale of the sensory perception of pain allows you to carry out a qualitative and quantitative analysis of the sensory components of pain, to clarify the degree of pathological changes associated with disease. The scale contains 46 descriptors describing pain; when calculating quantitative indicators on a scale take into account weighting factors that reflect the semantic significance of the descriptors depending on sex differences in pain perception, and particularly quantitative selection of descriptors taking into account gender differences in the perception of pain (table 7, 8).

The patient chooses words that describe his pain. If pain has a complex quality, it selects a corresponding word characteristics. If the patient has difficulty choice, he chooses words that describe the pain that most closely fit his pain, i.e. several characteristics.

Calculation of results. The test results on a scale of sensory perception of pain are calculated according to the formula:

, K=n/ncf

where n is the number of selected descriptors, Σnkthe total points of all the selected descriptors, the correction factor that takes into account the number selected, and ncf- the average total amounts of the frame selection handles, equal value for men - 7, 6, for women was 8.8 (table 7, 8).

In the proposed example, the scoring is selected keys for men (table 8):

With= (2,5+2,6+2,5+3,9)/4 + 4/7,6=2,75+0,52=3,27 score (figure 2).

Table 8
Descriptors of pain
No.

p/p
PainWives. (point)Husband. (point)No.

p/p
PainWives. (point)Husband. (point)
4.0Pain no004.23Tearing5,04,8
4.1Pressing2,92,5*4.24Tearing5,04,8
4.2Sore2,51,74.25Cutting4,5the 3.8
4.3Gnawing3,12,94.26Hacking4,23,5
4.4Arching4,02,74.27Whipping4,13,6
4.5Lomas the I a 3.93,14.28Sawing4,03,2
4.6Garter3,12,6*4.29Plucking3,53
4.7Compression3,32,74.30Biting3,73,2
4.8Chilling3,72,74.31Shooting4,33,5
4.9Scraping2,51,94.32Burning4,54,0
4.10Blade scraping2,31,84.33Burningthe 4.74,1
4.11Scratching2,21,44.34Mozgawa4,13,2
4.12Cuts2,51,74.35Migratory2,83,5
4.13Pulling2,72,5*4.36Paroxysmal4,54,4
4.14/td> Jerking3,63,34.37Surfacethe 4.72,0
4.15Aching3,43,04.38Depth4,14,1
4.16Throbbing3,13,44.39Wavy2,82,8
4.17Drillthe 3.83,9*4.40Batter4,55,5
4.18Pierced3,63,54.41Monotone4,46,0
4.19Stabbing3,53,54.42Stupida 4.96,0
4.20Tingling5,3the 4.74.43Microcephala4,54,5
4.21Daggera 4.94,14.44Nemausa5,05
4.22Piercinga 4.94,84.45Freezing2,9
    4.46Itchy2,76,0
The asterisk (*) denotes the selected patients descriptors describing his pain.

The experience of pain. 5. Scale emotional relationship to pain allows to quantitatively and qualitatively assess the dynamics of subjective attitude towards pain. The scale contains 25 descriptors, reflecting the inclusion of the emotional sphere of the patient's internal picture of the experience of pain. When calculating the quantitative indicator singularities of sex differences in the relationship to pain (table).

The patient selects a definition that reflects his attitude to pain. If he has difficulty selection, then selects those definitions that is closest to its state, i.e. selects several characteristics.

Table 9
Descriptors reflecting the emotional attitude to pain
N

p/p
Attitudes to painWives. (point)Husband. (point)N

p/p
Attitudes to painWives. (point)Husband. (point)
5.0pain no 05.13scary4,14,2
5.1indifferent1,31,85.14tormented5,14,6
5,2irrelevant3,22,15.15torturing5,04,1
5.3namespacea1,02,75.16exhaustinga 4.9a 4.9
5.4distractions3,13,3*5.17exasperating5,14,1
5.5preventing3,13,5*5.18awesome5,5a 4.9
5.6disturbingthe 3.83,4*5.19painful5,25,5
5.7annoying4,2the 3.85.20itazawa5,34,5
5.8boring4,53,75.21ismailiya4,65,2
5.9annoying3,63,75.22terrible5,66,6
5.10oppressive4,43,65.23terrible5,94,5
5.11blah4,14,05.24serious5,36,0
5.12painful4,54,65.25the uncertainty. fear6,06,0
The asterisk (*) denotes the selected patients definition that defines the relationship to pain.

Calculation of results. Calculation of test results on the scale of emotional-affective pain perception is carried out by the formula:

K=n/ncf

where n is the number of selected descriptors, Σnkthe total points of all the selected descriptors, the correction factor that takes into account the number of selected descriptors, and ncf- the average total quantitative selection of descriptors, equal value for men and 6.2, for women and 7.1 (see table 7).

In the following example:

In the proposed example, the scoring is selected keys for men (that is L.9):

E= (3,3+3,5+3,4)/3 + 3/6,2 =3,4+0,48=3,88 ball. (figure 2).

Note: when testing on scales №№1-5 on letterhead points are not followed, because it is the key for specialists.

To develop a scale reflecting the level of change in the behavior of patients with various forms of pain syndrome and children with acute pain, a study was conducted of emotional States, behavioral and personality characteristics using test Mini-Mult, Luscher test, questionnaire of self-esteem anxiety of Spilberger Hanina, questionnaire self-assessment of severity of angry reactions of Spilberger.

It is known that acute pain is usually given the value of the warning signal. As a result of its exposure to experience various emotional, motivational changes, which are of a temporary nature (to eliminate the damaging factor or tissue healing). The results of the study using Luscher test in children indicate that acute pain is really a short-term negative emotional States, such as irritability, aggressiveness, fear, high anxiety levels, however, these changes are not sustained after treatment significant positive changes in the emotional state of children. These changes in status are reflected in C is etova choice in children depending on the intensity they experienced pain (table 7).

It was found that for patients with neurogenic and somatogennye pain syndromes are common in varying degrees of severity traits emotional lability, demonstrative, aggressiveness, anxiety, decreased mood. For these patients the pain (illness) is pregnacny or conflicting meaning, it finds its confirmation in the appropriate colour elections acute pain are preferred black, gray and red colors. Such a patient is not always able to maintain control over their behavior and emotions. Often there are failures, guilt, shame, decreased self-esteem with access to a depressive state.

In patients with psychogenic pain syndrome observed avoidance of solving problems such as “illness”, the displacement of conflicts, outwardly blaming behavior - in this case, the pain provides certain advantages, allows you to get more attention, reduces the requirements to the person from others, that carries a positive meaning. The disease in this case allows you to get some benefits, but forced to withdraw from others, such as getting the attention of others in exchange for the restriction of freedom. Thus, the combination of conflict and positive meanings in relation to pain (disease) in these patients find their confirmation in Izotova choice what is expressed in the host preference of yellow, purple, red.

In addition, it was found that in the groups of patients with neurogenic and somatogennye pain syndromes for men characterized by the pronounced manifestation of angry reactions and a reduced level of self-control, whereas in the group of patients with psychogenic pain syndrome, on the contrary, women find high levels of anger and low self-control. A similar difference in the manifestation of angry reactions can be explained by the fact that for women with psychogenic pain is more characteristic of outwardly blaming behavior with the displacement of the true causes of conflict and the transfer of guilt to the environment.

The patient's response to pain is associated with the formation of “internal picture of the disease and includes emotional, motivational, behavioral tumors that are often unproductive in nature and hamper treatment of the disease. Analysis of internal picture of the disease, its components must be taken into account by the physician in the diagnosis and therapy appointment.

To assess the severity of behavioral changes designed rating scale level of neurotic.

Pain behavior. 6. The scale of neurotic allows to estimate the level of neurotic and degree of involvement of behavioral whom is onenew in the severity of pain in the patient. When diagnosing level of neurotic take into account the basic behavioral factors which change is closely linked with the presence of pain in humans: anxiety, emotional lability, aggression, depression, autonomic manifestations, hypochondria. The basis for selection of the questions were is MMPI questionnaire, questionnaire of spielberger (anger).

The patient meets with all shown in table 10 claims. If the assertion is suitable to him, he makes a mark in the column “YES”if the statement is wrong for him - in the column “NO”

Table 10
The questions assess the level of neurotic.
 QuestionsAnswers
 1. AnxietyYesNo
6.1I have a restless and broken sleep, often disturbing dreams. *
6.2I often worry too much over little things.* 
6.3Sometimes, for no particular reason I feel a sense of anxiety or fear. *
 2. Emotional Labi is inost   
6.4Often my mood can change depending on a serious reason or without it. *
6.5I often feel a “lump in the throat” in situations that concern me. *
6.6It's hard for me to concentrate while performing some task (work). *
 3. Aggression  
6.7When I get mad, I say nasty things.* 
6.8I'm pretty easily irritated.* 
6.9Sometimes I have trouble controlling my anger. *
 4. Depression  
6.10I often for no particular reason there is a feeling of neglect and fatigue. *
6.11Lately, I feel worse than ever. *
6.12I wanted to be (such) as happy as katsarova people.  *
 5. Autonomic manifestations *
6.13Often in different parts of my body I feel burning, tingling, a feeling of pins and needles, numbness. *
6.14Sometimes I tremble or feel lightheaded. *
6.15I sometimes have bouts of nausea and vomiting. *
 6. Hypochondria *
6.16Most of the time I feel General weakness.  
6.17I often have the feeling as if I had done /had done something bad or wrong.  
6.18I rarely filled with/ full of energy.* 

The calculation results according to the scale of neurotic. To determine the level of neurotic count the number of positive responses, and then the sum is divided by 3, where n is the number of “Yes”answers, then the level of neurotic = (Σn)/ 3. The larger the result, the higher the level of neurotic.

Low neurotitan and - 1-2 points; the average level of neurotic - 2-4; high level of neurotic - 4-6 points.

In the above example, the patient L. after calculating the level of neurotic equal to 4/3=1.33 inch TFT touch the ball (figure 2).

High levels of neurotic indicates severe emotional excitability, resulting such negative conditions such as anxiety, fear, tension, anxiety, irritability. High levels of neurotic may indicate a hypochondriac fixation on somatic sensations, the difficulties of social adaptation associated with social shyness, insecurity, confusion, dependency, lack of initiative. High levels of neurotic, as a rule, significantly reduces the effectiveness of any therapy. In this connection it is necessary to take into account this fact and included in the algorithm of treatment interventions aimed at normalization of the emotional state of the patient.

The low level of neurotic indicative of emotional stability, positive background emotions (calmness, optimism), social boldness, which is a favorable background for conducting pain therapy.

For more information on the scale of the neurotic may be derived by analysis of the answers selected by main factors: anxiety, emotional is labilnosti, aggression, depression, autonomic manifestations, hypochondria; that will help when you need to find methods for further in-depth psychological examination of the patient.

Pain behavior. 0. The PI allows to determine the degree of sincerity of the responses of the patient. The basis for selection is the PI test is MMPI and designed questions that determine the coincidence of some of the responses on scales multidimensional verbal-color test. The important thing is that all of the statements on a scale of lies are in the same list together with the statements on a scale of assessing the level of neurotic. Approval on both scales is presented to the patient without necessarily appropriate headings and in random order.

Table 11
Issues of scale lie
  YESNO
0.1The last time I had the pain appears more than once in a few days. *
0.2In recent times I have been suffering from prolonged pain attacks.* 
0.3Lately I sometimes unbearably strong attacks bol is.  *
0.4Sometimes, I can gossip* 
0.5Sometimes I want to swear.* 
0.6Not all of my friends I like. *

The counting results for the PI. To determine the results on the scale lies calculate the total number of positive responses: question # 1 - answer receives 1 point, if the detected mismatch response when compared to the response on a scale of nociception 1 (frequency of pain); question # 2 answer receives 1 point, if the detected mismatch response when compared to the response on a scale of nociception 2 (duration of pain - pain lasting for hours, days, permanent); question # 3 answer receives 1 point, if the detected mismatch response when compared to the response on a scale of nociception 3 (the power of the pain is strong, very strong, unbearable); 4-6 - a “No” answer receives 1 point. Higher scores on the scale lies, the less accurate the test.

Calculation of test results patient L.

Question No. 1 is estimated at 0 points, because the same response on the frequency scale of pain. The response of the patient L. on a scale of 1 - “constant Pain”. Question No. 2 is estimated at 0 is allow, since the same answer on a scale of duration of pain. The response of the patient L scale 2 - “the Pain lasts for hours”. Question No. 3 is estimated at 0 points, because the same response verbal-color scale of pain intensity. The response of the patient Liter scale 3 - “the Pain of the average force (see table 1, 3, 4). Counting on questions 4-6 revealed one “No” answer 6 question. Thus, the sum of responses on the scale lie the patient L = 1 point. High scores on this scale may indicate insincerity answers or that the patient misunderstood the instructions of the test. This is the signal for re-testing. Thus, the data of this scale required for qualitative analysis in the calculation of the average and integral indicators of pain are ignored.

The level of adaptability

Adaptability - the next level comprehensive analysis of the perception of pain. This level is associated with the development of the scale of modalities, which allow to assess the degree of dependence and the severity of pain from external environmental factors. During the examination, each patient was to describe the factors causing him pain. The obtained data were analyzed and presented in a scale modalities.

Table 12
.1. The factor “Time-sleep” determines the dependence of the appearance or intensification of pain from the time of day.
Time of dayWatch
Night123456
Morning7*8*9*10*11*12*
Day131415*16*17*18*
Evening192021222324
Insomnia 

The patient indicates, noting the cross, in which the clock appears or increases the pain.

Table 13
7.2. Factor the Weather determines the dependence of the appearance or intensification of pain from weather conditions.
WeatherColdCoolHeatHot
Sunny    
Mostly cloudy    
Dry    
Wet    
Windy    
Rain    
Snow    
Change of weather    
More 

The patient tells you what weather appears or increases the pain.

Table 14
7.3. The factor of “Posture-movement determines the occurrence or increased pain from your body posture or movement.
 PeaceMovement
PoseLyingWalkingNot depends
 Sitting*RockingMore
 Bent overTouch 
 One hundred is Pressure 
Changing the position Standing up 
  The sitting down 

Table 15.
Factors determining the occurrence or increased pain depending on food intake, General condition and exposure to harmful conditions.
7.4. The factor “Famine food”7.5. The factor of “General state”7.6. Harmful factors
1Hunger 1Fatigue 1Noise
2Spicy foods 2Exercise 2Light
3Acidic foods 3The emotional load 3Smell
4Sweet food 4Stress 4Pitching
5ologna food  5Overheating 5Vibration
6Hot food 6Cooling 6More
7Alcohol 7More 7 
8Smoking 8  8 
9More 9  9 

Calculation of results. The resulting score modalities is calculated as follows: if the patient notes (points) factor one or more items that may cause soreness, it receives 1 point. Finally sums up the scores of all the factors noted by the patient, as the factors causing (increasing) his pain. Qualitative analysis of selected terms within each factor will allow the physician to obtain additional information about the patient's condition.

Patient L. indicated only one factor (Time-to-sleep”associated it with pain, appropriate estwenno total score on this scale modalities equal to 1 (figure 2).

After testing it, the results can be presented in tabular form and in the form of charts, showing the intensity and the ratio of all components of pain on different levels of mental pain perception by humans (figure 3).

Figure 3. presents a dynamic model of the percent total pain, reflecting the experience of pain a person on different mental levels.

Calculation of results. Interest total pain (figure 3).

The test contains 7 scales, in each of which the test result is the minimum of zero, equal to the maximum 6 points total on all scales most pain can be appreciated = 7 scales × 6 ball. = 42 points. This number is taken as 100%, respectively, each scale maximum is estimated at (100/6)%. The calculation of the percentage of the test for each level (scale) is carried out according to the formula (Σ level.)/42 × 100, where Σ level. - total points level (scale).

An example of the calculation and presentation of the percentage of total pain patient L.:

The level of nociception Σ level= (5+3,5+1)/ 42 × 100 = 22.6%.

The level of pain Σ level. the felt. = 3/43 × 100 = 7%.

The level of experience of pain Σ level. having survived. = 2.5/42 × 100 = 5.9%.

The level of pain behavior Σ level. the behaviour. = 1.3/42 × 100 = 3%.

At Owen adaptability Σ level. adaptability. = 2/42 × 100 = 4.8%.

Interest total = 22.7% + 7% + 5.9% + 3% + 4.9% = 43.5%, or

Interest total index = (5+3.5+1+3+2.5+1.3+2)/42 × 100 = 43.5%.

When conducting a rapid assessment of pain syndrome is not compulsory testing the patient for all scales at once. At the discretion of the physician (investigator) may be incomplete testing of the patient depending on the diagnosis and direction of therapy, but it can be no less than 3 scales and mandatory testing are scales (1-3) level of nociception (frequency, duration, intensity of pain, color scale).

Conclusions on the test results of the patient L (table 16)

Testing reliably. The patient somatogennye pain syndrome. Pain localized in the region T10 - S1. The pain is almost constant, weak, oppressive nature. Increases in the mornings and afternoons in the sitting position. Pain triggers irritable emotional state. Pain causes involuntary restriction of professional and personal activity. Identified high emotional stability is a favorable background for conducting pain therapy. Note: depending on the depth of analysis of the test results allow us to make an extended report on the state of the patient.

To confirm adequates and results test conditions patients proposed method of pain assessment, a survey was conducted of a group of neurological patients with vertebrogenic pain - 21 patients (12 women, 9 men) before and after the course of electroreflectance method of percutaneous dynamic electroneurostimulation (DENS).

To evaluate the dynamics of the patient during therapy conducted a comprehensive study group of patients with the use of this method of evaluation, ultrasound dopplerography (USDG) and variation cardiointervals (ASD), and also assessed the level of constant potential brain (SCP).

Psychological testing was carried out using the computer version of this method of pain assessment, which is an important part of psychodiagnostic module hardware-software complex of the Cabinet of analgesic therapy.

The results of testing patients before and after a course of DANCE therapy revealed significant positive trend in terms of the reduction of indicators for all components of pain, except for the indicator of adaptability scale modalities. The most pronounced effect was observed in reducing the frequency, duration and intensity of pain, i.e. components that are associated with nociception. After treatment in patients identified as improved emotional state, which was reflected in the decrease in the level of neurotic and affective relationship to pain (figure 4).

Figure 4 represent the go dynamics of the patient before and after a course of DENS-therapy. Axis of abscisses specified: 0 - PI; 1 - scale frequency of pain; 2 - scale duration of pain; 3 - scale intensity of pain; 4 - scale sensory perception of pain; 5 - scale affective-emotional relationship to pain; 6 - scale neurotic; 7 - scale modalities; amounts. The show is an integrative indicator of pain. On the y - axis, the average pain scores.

Tested resulted in the first stages of the studies identified in this group of patients 5 people who have “very strong” pain was associated with yellow and red flowers (table 17).

Data mapping elections color with the color scale multidimensional verbal-color pain test allows to make an assumption about the psychogenic origin of pain in these patients. Additional psychological testing using the questionnaire anxiety of Spilberger Hanina and MMPI test confirmed the presence of these patients such personal characteristics as a high level of personal anxiety, emotional lability (patient N., the patient F.), stress (patient G), (patient L), high rigidity (patient x). The obtained results confirm the assumption about the psychogenic nature of pain in these patients.

Table 17
Color choice neurological patients with psychogenic predispozitie pain syndrome
 The intensity of painThe selected color
  Patient N.Patient X.The patient WasThe patient F.Patient L.
0Pain noBlue, gray.Grey, green.Grey, green, yellow.Green, grey, blue.Green, gray,
1The pain is very weak     
2Pain weak  The violet.  
3The pain of the average forceThe violet., red.Red, violet.The violet., red. Red
4The pain is strong     
5The pain is very strong  Yellow, red.Yellow, red.  
6The pain was intolerableThe violet., red.Yellow, Red.Yellow, red.Yellow, red.Red, yellow.

Improvements in the condition of the patients on the background of a course of DENS therapy is also confirmed by clinical and functional examinations. Thus, significant positive changes in the state of patients on treatment, based on the results of the assessment of pain using the established method for the assessment of pain, confirmed by clinical observations and objective functional studies.

The study made it possible to conclude that the developed method for evaluation of pain, both qualitatively and quantitatively, objectively reflects the severity of pain, the dynamics of States of patients and can be used in the clinic for pain.

Based on the results of the research developed a method of rapid assessment of pain, which allows the physician, psychologist already in the early stages of diagnosis with a high degree of probability to identify patients with pain of psychogenic origin, to evaluate with regard to sex differences, the severity of components of pain, which becomes very important when choosing a method and tactics pain t is rapii.

Using this method of pain assessment is possible with a high degree of accuracy to assess the dynamics of the components of pain, the influence of various factors on different levels of experiences pain man, allowing it to be used in diagnostic and therapeutic physician practice any profession, psychotherapy and psycho-work with patients with various forms of pain, and also as a tool for studying pain in scientific research.

Established method of assessing pain is significantly different from the known methods of assessment of pain by the fact that for the first time in the assessment of pain is used developed verbal-color, allowing a high degree of probability to identify pain psychogenic nature, to spend the description of pain taking into account differences in pain perception men and women, to systematize pain factors-scales in accordance with the concepts of multidimensional manifestation of pain and quantify (in points/percentage intensity of all components of the pain syndrome in 7 scales. After testing, it seems integral assessment of pain. The method contains a map of the pain that is designed for visual detection of zones and areas of pain on the body. The test results represent Vlada in the paper and graphic variations (figure 2, 3).

1. Method of assessment of pain, characterized by the fact that the patient is tested on seven scales: frequency, duration, intensity, sensory perception of pain, emotional attitude to pain, levels of neurotic, level of adaptability, and evaluate the results on these scales from 0 to 6 points, with sensory perception and emotional relationships, levels of neurotic and adaptive estimate in accordance with tables 7-10, 12-15, contained in the description, and additionally assess the severity of psychogenic component of pain on the color chosen by the patient depending on at least three elections intensity of his pain: “pain on the time of testing”, “no pain”, “pain strong” in accordance with described in tables 3, 4, then according to the test results assess the severity of the patient's pain qualitatively and quantitatively.

2. The method according to claim 1, characterized in that the frequency scale to assess pain from the pain appears once every few days or less” to “constant pain”.

3. The method according to any one of claims 1 and 2, characterized in that on the scale of the duration of pain assess from the fleeting pain” to “pain constant”.

4. The method according to claim 1, characterized in that on a scale of intensity pain assessed from the pain very weak” to “pain Nevin the independent”.

5. The method according to claim 1, characterized in that the level of neurotic take into account the basic behavioral factors - anxiety, emotional lability, aggression, depression, psychogene, dejected.

6. The method according to claim 1, characterized in that as environmental factors, precipitating or aggravating the pain, the level of adaptability choose the factors “time-dream”, “weather”, “posture-movement”, “famine food”, “overall status”, “hazards”.



 

Same patents:

FIELD: medicine, pediatrics.

SUBSTANCE: the present method deals with predicting deviations in psychic disorders in small children to detect initial manifestations of psychic disorders in children aged 1 mo - 3 yr. A child undergoes diagnostic tests to study 5 spheres of psychic activity: sensorics including the studying of vision, hearing, reflector tactile sensitivity and individual tactile sensitivity; emotions; the sphere of gnosis including the studying of attention, expressive and impressive speech, peculiarities of one's thinking; in behavioral sphere one should evaluate biological behavior that includes alimentary behavior and one's skills to be neat, and, also, social behavior that includes the development of "mother-child" system and communication with alien people, moreover, for every age period there are 20 test questions and each task is evaluated by 5 points, then one should determine the coefficient of psychic development (CPD) by the following formula: CPD = Σ (+ n), where Σ (+ n) - the sum of points for all fulfilled age tasks and at CPD being equal to 90 - 110 points one should detect normal psychic development, at CPD being equal to 80 - 89 and 111 points and higher the risk for the development of nervous-psychic pathology is detected and at CPD being equal to 79 points and less one should state nervous-psychic development as affected.

EFFECT: higher quality of diagnostics.

4 ex

FIELD: medicine, neurology.

SUBSTANCE: by the table of quantitative evaluation of affected praxysis and gnosis as the value of cerebral corical disorders and degree of dementia manifestation level one should calculate in points these disorders. Moreover, if total value is above 24 points one should diagnose no disorders, if 20-23 points - light disorders, if 10-19 points - moderate disorders, and if below 9 points - pronounced functional disorders are stated upon.

EFFECT: higher accuracy of diagnostics.

1 ex, 1 tbl

FIELD: medicine.

SUBSTANCE: method involves determining prognostic parameter values like those of lung ventilation function after spoken rational and irrational test texts. Three values are calculated from the obtained data using linear classification functions. They are compared and functional cerebral asymmetry pattern is to be predicted from their values.

EFFECT: high accuracy and reliability of prognosis.

FIELD: medicine.

SUBSTANCE: method involves forming signals as tests requiring solution. The tests are shown with frequency changed proportionally to the frequency they are solved. The number of tests is set to be the same in the cases of recovered and tired state. General amount of time spent for finding solution for given number of tests and the number of tests having right solutions are determined in each state. Mental fatigue degree is evaluated from relative change of mean time needed for finding the right test solution using a relationship like (Tm.r- Tm.t)100%/Tm.t, where Tm.t = Tsum.t/Kr.t, Tm.r = Tsum.r/Kr.r, Tm.t is the time spent for finding the right answer in tired state, Tm.r is the time spent for finding the right answer in recovery state, Tsum.t is the total time spent to solve given number of tests in tired state, Tsum.r is the total time spent to solve given number of tests in recovered state, Kr.t is the number of right answers to the tests in tired state, Kr.r is the number of right answers to the tests in recovered state.

EFFECT: reliable estimation of fatigue degree.

The invention relates to the field of urology and psychiatry and can be used in the treatment of patients undergoing surgery for benign prostatic hyperplasia

The invention relates to medicine, namely to occupational health

The invention relates to psychophysiology and can be used in professional psychological evaluation of operators in various areas of work, as well as in the field of medical psychology and psychiatry to evaluate the emotional stability of patients

The invention relates to medicine, namely psychiatry and psychology, and may find application in psycho and expert surveys of different groups of people
The invention relates to diagnostics of psychophysiological opportunities for students and can be used to identify the individual psycho-physiological abilities of students, as well as for scientific research
The invention relates to the psychology of individual differences, and in particular to methods of determining the individual characteristics of a person with subsequent correction of his mental and physical state, and can be used in psychological counseling, selection, career guidance, the formation of groups in different spheres of activity

FIELD: medicine.

SUBSTANCE: method involves forming signals as tests requiring solution. The tests are shown with frequency changed proportionally to the frequency they are solved. The number of tests is set to be the same in the cases of recovered and tired state. General amount of time spent for finding solution for given number of tests and the number of tests having right solutions are determined in each state. Mental fatigue degree is evaluated from relative change of mean time needed for finding the right test solution using a relationship like (Tm.r- Tm.t)100%/Tm.t, where Tm.t = Tsum.t/Kr.t, Tm.r = Tsum.r/Kr.r, Tm.t is the time spent for finding the right answer in tired state, Tm.r is the time spent for finding the right answer in recovery state, Tsum.t is the total time spent to solve given number of tests in tired state, Tsum.r is the total time spent to solve given number of tests in recovered state, Kr.t is the number of right answers to the tests in tired state, Kr.r is the number of right answers to the tests in recovered state.

EFFECT: reliable estimation of fatigue degree.

FIELD: medicine.

SUBSTANCE: method involves determining prognostic parameter values like those of lung ventilation function after spoken rational and irrational test texts. Three values are calculated from the obtained data using linear classification functions. They are compared and functional cerebral asymmetry pattern is to be predicted from their values.

EFFECT: high accuracy and reliability of prognosis.

FIELD: medicine, neurology.

SUBSTANCE: by the table of quantitative evaluation of affected praxysis and gnosis as the value of cerebral corical disorders and degree of dementia manifestation level one should calculate in points these disorders. Moreover, if total value is above 24 points one should diagnose no disorders, if 20-23 points - light disorders, if 10-19 points - moderate disorders, and if below 9 points - pronounced functional disorders are stated upon.

EFFECT: higher accuracy of diagnostics.

1 ex, 1 tbl

FIELD: medicine, pediatrics.

SUBSTANCE: the present method deals with predicting deviations in psychic disorders in small children to detect initial manifestations of psychic disorders in children aged 1 mo - 3 yr. A child undergoes diagnostic tests to study 5 spheres of psychic activity: sensorics including the studying of vision, hearing, reflector tactile sensitivity and individual tactile sensitivity; emotions; the sphere of gnosis including the studying of attention, expressive and impressive speech, peculiarities of one's thinking; in behavioral sphere one should evaluate biological behavior that includes alimentary behavior and one's skills to be neat, and, also, social behavior that includes the development of "mother-child" system and communication with alien people, moreover, for every age period there are 20 test questions and each task is evaluated by 5 points, then one should determine the coefficient of psychic development (CPD) by the following formula: CPD = Σ (+ n), where Σ (+ n) - the sum of points for all fulfilled age tasks and at CPD being equal to 90 - 110 points one should detect normal psychic development, at CPD being equal to 80 - 89 and 111 points and higher the risk for the development of nervous-psychic pathology is detected and at CPD being equal to 79 points and less one should state nervous-psychic development as affected.

EFFECT: higher quality of diagnostics.

4 ex

FIELD: medicine, medicinal psychology.

SUBSTANCE: one should test a patient by seven scales: frequency, duration, intensity, sensor perception of pain, emotional attitude towards pain, neurotization level, adaptation capacity level to evaluate the results obtained by the scales mentioned from 0 to 6 points. Moreover, the scales for sensor perception and emotional attitude, the levels of neurotization and adaptation capacity should be evaluated in accordance to the Tables given in description. Additionally, one should, compare the degree of psychogenic constituent of pain according to chromatic choice made by a patient depending upon, at least, three choices of pain intensity: "pain during testing", "no pain", "severe pain" in accordance to the Tables given in description. Then, according to the results of testing one should evaluate the degree of patient's pain feelings both quantitatively and qualitatively. Moreover, by the scale of frequency the appearance of pain should be evaluated from "pain appeared once during several days or rarely" to "constant pain". By the scale of duration pain should be evaluated from "momentary pain" to "constant pain". By the scale of intensity the pain should be evaluated from "very weak pain" to "unbearable pain". By the scale of neurotization level one should take into account basic behavioral factors, such as anxiety, emotional lability, aggression, depression, psychogenia, hypochondria. The present innovation enables to increase significance in evaluating pain achieved due to broadened verbal description of patient's pain feelings.

EFFECT: higher accuracy of evaluation.

5 cl, 4 dwg, 2 ex, 17 tbl

FIELD: medicine, psychotherapy.

SUBSTANCE: the method deals with correcting neurological and psychopathological disorders with anxiety-phobic symptomatics due to individual trainings. The method includes evaluation of body reaction to stimulating signals, seances of individual training performed due to the impact of two quasiantipodal stimulating signals of similar physical modality applied in time of sporadic character, and as a signal one should present biological feedback for the altered value of physiological parameter adequately reflecting body reaction to the impact of stimulating signal. At the first stage of training it is necessary to achieve body adaptation to the impact of quasiantipodal stimulating signals, at the second stage it is necessary to obtain conditional reflex for one out of stimulating signals, for this purpose one should accompany this stimulating signal with discomfort impact, during the third stage, finally, due to volitional efforts one should suppress body reaction to stimulating signal. The devise suggested contains successively connected a transformer of physiological parameter into electric signal and a bioamplifier, an analysis and control block with a connected block to present the signals of biological feedback, a block for presenting discomfort impact, an indication block and that of forming and presenting quasiantipodal stimulating signals. The innovation enables to have skills to control one's emotions, decrease sensitivity threshold to environmental impacts and learn to how behave during stress situations.

EFFECT: higher efficiency of training.

15 cl, 8 dwg

FIELD: medicine.

SUBSTANCE: method involves measuring patient weight, recording age and sex of the patient. The patient is positioned in front of computer display unit. The data are inputted into the computer comprising software containing a program for estimating organism organs and systems condition. The following organs are detected. Lung, spleen, heart, kidneys, liver are proved for having deviations from norm with negative sign towards hypofunction or with positive sign towards hyperfunction. The data are displayed with the program on the screen as a table with reference and current values being shown in relative units with plus or minus sign. Canal states are estimated from detected organs being under maximum stress on the basis of infogram: lung canal P, spleen - canal RP, heart - canal C, kidneys - canal R, liver - canal F. When estimating organ state with deviation having plus sign, that means hyperfunction, canal state is estimated as having energy excess. When organ state deviation has plus sign, that means hyperfunction, canal state is estimated as having lack of energy. Eye diseases are diagnosed from state of organs and canals of P, RP, C, R and F. Hyperfunction in organ and excess in canal being available, initial ophthalmic disease stage is diagnosed. Hypofunction in organ and deficit in canal being available, chronic ophthalmic disease stage is diagnosed.

EFFECT: wide range of functional applications.

3 cl, 7 tbl

FIELD: medicine.

SUBSTANCE: method involves carrying out situation, planning, self-control and correction analysis. Volitional effort is included into functional self-organization process structure components. Functional self-organization process structure components characterize the following individual human specific characteristics: 1) goal-setting as taking and retaining aims; 2) situation analysis as revealing and analyzing circumstances essential from the point of view of achieving the set goal; 3) planning as scheduling private activity; 4) volitional effort as changing private activity sense; 5) self-control as controlling and estimating private actions; 6) correction as adjusting private goals, situation analysis, plan of actions, private activity sense, estimation criteria and self-control forms. Human self-organization process structure diagnosis is set after relaxation training aimed at relieving emotional effort and overfatigue. The relaxation training is exercised in coachman position with calming musical accompaniment and comprises the following stages: 1) respiratory exercises (inspiration duration is equal to expiration one, breath is hold between the inspiration and expiration for a time twice as short as inspiration time) 4 min long; 2) relaxation exercises (invoking heaviness and warmth sensation) of head, arms, legs and body -8 min long; 3) rest in maximum relaxation state - 4 min long.

EFFECT: high accuracy of diagnosis.

3 cl, 1 tbl

FIELD: medicine.

SUBSTANCE: method involves showing sequence of two luminous pulses of 10 ms duration separated by 150 ms long pause. The pulses are repeated in constant 1.5 s long interval. Pause duration between two luminous pulses is reduced at the first measurement stage at constant speed of 20ms/s until a testee fixes fusion of two luminous pulses into single one in subjective assessment mode. Pause duration between two luminous pulses is increased at the second measurement stage with given constant step of 0.4 ms until the testee identifies the moment of subjective perception of two luminous pulses separation. Pause duration is reduced in discrete mode with given constant 0.1 ms long step at the third measurement stage until the testee identifies the moment of subjective perception of two luminous pulses fusion into single one. Human vision system persistence time is determined to be equal to pause duration between two luminous pulses when subjective fusion into single pulse takes place at the third measurement stage.

EFFECT: high accuracy in determining human vision system persistence time.

3 dwg

FIELD: medicine.

SUBSTANCE: method involves asking patient to tell or write down 5-7 novels. Rhetorical structure representations of the novels are built. Rhetorical structure mean depth being greater than 8, branching index being greater than 88 and occurrence of relations like sequence and consequence being less than 8, cognitive source relation being greater than 5, opposition relation being greater than 2 per 100 discourse units, neurotic disorder is to be diagnosed.

EFFECT: high accuracy of the method.

2 dwg, 1 tbl

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