title: Patient perception of pain versus observed pain behavior during a standardized electrodiagnostic test.
abstract: BACKGROUND
  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.
authors.affiliation: Department of Physical Medicine and Rehabilitation, The University of Michigan, 325 E. Eisenhower, Ann Arbor, Michigan, 48108, USA.
authors.forename: Josh
authors.initials: J
authors.lastname: Verson
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Haig
authors.forename: Danielle
authors.initials: D
authors.lastname: Sandella
authors.forename: Karen S J
authors.initials: KS
authors.lastname: Yamakawa
authors.forename: Zachary
authors.initials: Z
authors.lastname: London
authors.forename: Christy
authors.initials: C
authors.lastname: Tomkins-Lane
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D058443:Catastrophization / Q000175:diagnosis / Q000523:psychology*; D004576:Electromyography / Q000379:methods* / Q000592:standards*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000175:diagnosis* / Q000523:psychology*; D010147:Pain Measurement; D058748:Pain Perception / Q000502:physiology*; D011446:Prospective Studies; D011788:Quality of Life
keywords: back pain; electrodiagnosis; electromyography; experimental pain; pain