TY - JOUR
T1 - Moving beyond pain scores
T2 - Multidimensional pain assessment is essential for adequate pain management after surgery
AU - van Boekel, Regina L M
AU - Vissers, Kris C P
AU - van der Sande, Rob
AU - Bronkhorst, Ewald
AU - Lerou, Jos G C
AU - Steegers, Monique A H
PY - 2017
Y1 - 2017
N2 - BACKGROUND: Clinical experience teaches us that patients are willing to accept postoperative pain, despite high pain intensity scores. Nevertheless, relationships between pain scores and other methods of pain assessment, e.g. acceptability of pain or its interference with physical functioning, are not fully established. Our aims were to examine these relationships.METHODS: A cross-sectional study was conducted on patients who underwent major surgery between January 2008 and August 2013. Using logistic regression, we quantified the relationships between movement-evoked pain scores on the numerical rating scale (NRS-MEP) and three dichotomous dependent variables: patient's opinion on acceptability of pain (PO: acceptable or unacceptable pain); nurses' observation of patient's performance of necessary activities to expedite recovery (NO: good or bad performance); a compound measure judging the presence of the clinically desirable situation of acceptable pain associated with good patients' performance (PONO: present or not). Using Receiver Operating Characteristics (ROC) analysis, NRS cut-off points were determined such that they best discriminate between patients having one versus the other outcome for PO, NO and PONO.RESULTS: 15,394 assessments were obtained in 9,082 patients in the first three postoperative days. Nine percent of the patients had unacceptable pain while having an NRS-MEP of 0-4. An estimated 47% (95%CI = 45%-49%) of patients with an NRS-MEP of 7 described their pain as acceptable on day one. Moreover, 33% (31%-35%) performed all required physical activities, and 22% (21%-24%) combined acceptable pain with appropriate movement. NRS cut-off points for PO, NO and PONO were five, four and four, respectively, but had insufficient discriminatory power.CONCLUSIONS: Our results suggest pain management should be guided by the many dimensions of the patient's pain experience, not solely by NRS cut-off points. Future research should evaluate the impact of such multidimensional pain assessment on patients' functional outcome.
AB - BACKGROUND: Clinical experience teaches us that patients are willing to accept postoperative pain, despite high pain intensity scores. Nevertheless, relationships between pain scores and other methods of pain assessment, e.g. acceptability of pain or its interference with physical functioning, are not fully established. Our aims were to examine these relationships.METHODS: A cross-sectional study was conducted on patients who underwent major surgery between January 2008 and August 2013. Using logistic regression, we quantified the relationships between movement-evoked pain scores on the numerical rating scale (NRS-MEP) and three dichotomous dependent variables: patient's opinion on acceptability of pain (PO: acceptable or unacceptable pain); nurses' observation of patient's performance of necessary activities to expedite recovery (NO: good or bad performance); a compound measure judging the presence of the clinically desirable situation of acceptable pain associated with good patients' performance (PONO: present or not). Using Receiver Operating Characteristics (ROC) analysis, NRS cut-off points were determined such that they best discriminate between patients having one versus the other outcome for PO, NO and PONO.RESULTS: 15,394 assessments were obtained in 9,082 patients in the first three postoperative days. Nine percent of the patients had unacceptable pain while having an NRS-MEP of 0-4. An estimated 47% (95%CI = 45%-49%) of patients with an NRS-MEP of 7 described their pain as acceptable on day one. Moreover, 33% (31%-35%) performed all required physical activities, and 22% (21%-24%) combined acceptable pain with appropriate movement. NRS cut-off points for PO, NO and PONO were five, four and four, respectively, but had insufficient discriminatory power.CONCLUSIONS: Our results suggest pain management should be guided by the many dimensions of the patient's pain experience, not solely by NRS cut-off points. Future research should evaluate the impact of such multidimensional pain assessment on patients' functional outcome.
KW - Adult
KW - Aged
KW - Cross-Sectional Studies
KW - Female
KW - Humans
KW - Male
KW - Middle Aged
KW - Pain Management
KW - Pain Measurement
KW - Pain, Postoperative/diagnosis
KW - ROC Curve
KW - Surveys and Questionnaires
U2 - https://doi.org/10.1371/journal.pone.0177345
DO - https://doi.org/10.1371/journal.pone.0177345
M3 - Article
C2 - 28489926
SN - 1932-6203
VL - 12
SP - e0177345
JO - PLOS ONE
JF - PLOS ONE
IS - 5
ER -