To Measure the Invisible: Why Is it So Difficult to Standardize Measures of Pain?

• In Event: 346 - Regular Session. Sociology of Science 1

Abstract

Chronic pain is a pervasive affliction with substantial personal and economic costs. Though increasingly recognized as a public health problem, its study is stymied, in part, by the lack of standard measures of pain (IOM 2011:140). This paper examines how low back pain (LBP) researchers measure pain, with a focus on why pain measures are (from some perspectives) highly unstandardized. How do norms of scientific justification, organizational recommendations, professional networks and identity, and pain’s epistemological fragility interact to shape pain measurement and standardization? The study is based on 79 medical studies of LBP (published 1999-2008) and interviews with 20 pain experts, including 15 with authors of the reviewed studies.

Multiple factors are found to undermine standardization of pain measures. The characteristics most often cited as desirable in pain measures--validity and comparability--do not guarantee movement toward standardization: validity is gauged differently in different contexts of study design, language, etc., while the meaning of “comparability” depends on local notions of reference groups. Organizational attempts to promote standardization are impeded by the weak cohesion of the (highly international and interdisciplinary) LBP research community.

Moreover, pain researchers do not agree on the fundamental question of what constitutes a “pain measure”. In particular, due to the difficulty of treating pain intensity, some pain experts re-focus their work on putatively more treatable domains, such as pain-related disability. Standardization of pain measures is thus undermined by pain’s therapeutic characteristics more than its epistemological ones. Implications for theories of science and standardization are discussed.

Author

• Hanna Grol-Prokopczyk, State University of New York-Buffalo