Quantifying the Unquantifiable: The Measurement and Meanings of Chronic Pain

Chronic pain is an extremely common, costly, and consequential health problem--and one that defies easy quantification. How do (or could) health researchers define and measure this invisible, subjective, and temporally complex phenomenon? This dissertation addresses this question in three empirical chapters, each using different data sources and methods. The first empirical chapter, based on close analysis of 79 medical studies of low back pain (LBP) and 20 interviews with international pain experts, documents the diversity of pain measures used in contemporary LBP research, and seeks to understand why these measures are poorly standardized. Findings reveal several factors undermining standardization, including the locality and multiplicity of the concepts of "validity" and "comparability," as well as the loose networks of the LBP research community. In addition, some pain researchers, responding to the considerable challenges of treating pain intensity , redefine their work around other, putatively more treatable domains, such as disability or social participation. The diversity of measures of low back pain is thus attributable less to pain's epistemological fragility than to its therapeutic intractability. The next chapter uses 11-country data from the World Health Organization and the Health and Retirement Study (HRS) to test whether a recently developed survey method, anchoring vignettes, can improve intergroup comparability of self-ratings of pain. Results show that, except in rare circumstances, existing anchoring vignettes substantially violate critical measurement assumptions, and thus should not be used. The final empirical chapter highlights the dimension of time in its measurement of chronic pain, using 7 waves of biennial HRS data to identify patterns and socioeconomic disparities in long-term pain trajectories. Latent growth curve models reveal striking disparities in pain experiences by sex, education, wealth, and survival status, but a surprising lack of expected disparities by age and race-ethnicity. These findings do not appear to be artifacts of group differences in reporting styles (though they do appear to result partially from mortality selection). Overall, this dissertation integrates sociological theories, advanced statistical methods, and empirical data to explore the measurement of chronic pain, with a goal of enhancing future research on this important area of health research.

Copyright - Copyright ProQuest, UMI Dissertations Publishing 2013 Last updated - 2013-09-13 First page - n/a

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