Behavioral assessment of head and neck cancer pain.

Behavioral evaluations of pain were carried out on a sample of 30 head and neck cancer patients before, at the midpoint, and at the end of their treatment. Observations of patients' behavior as they carried out functional activities revealed that patients tended to display their pain primarily through facial expression and to a lesser extent through guarded movement. During the period of treatment there were significant increases in the number of simple daily activities that increased pain, in the time spent sitting each day, and in the number of patients using narcotics. There was also a strong tendency for patients to lose weight and to use a greater number of pain relieving methods. A behavioral dysfunction index based on scores on each of the behavioral measures was clearly related to pain ratings. Measures of pain taken before treatment were highly predictive of behavioral dysfunction index scores recorded at the completion of cancer treatments.