An Objective Pain Score for Chronic Pain Clinic Patients.

Agnes K Pace,John Donovan,Sonia J Vaida,Jill M Eckert,Melanio Bruceta,Giustino Varrassi

doi:10.1155/2021/6695741

Abstract

Objectives Although numerous studies have looked at the numeric rating scale (NRS) in chronic pain patients and several studies have evaluated objective pain scales, no known studies have assessed an objective pain scale for use in the evaluation of adult chronic pain patients in the outpatient setting. Subjective scales require patients to convert a subjective feeling into a quantitative number. Meanwhile, objective pain scales utilize, for the most part, the patient's behavioral component as observed by the provider in addition to the patient's subjective perception of pain. This study aims to examine the reliability and validity of an objective Chronic Pain Behavioral Pain Scale for Adults (CBPS) as compared to the traditional NRS. Methods In this cross-sectional study, patients were assessed before and after an interventional pain procedure by a researcher and a nurse using the CBPS and the NRS. Interrater reliability, concurrent validity, and construct validity were analyzed. Results Interrater reliability revealed a fair-good agreement between the nurse's and researcher's CBPS scores, weighted kappa values of 0.59 and 0.65, preprocedure and postprocedure, respectively. Concurrent validity showed low positive correlation for the preprocedure measurements, 0.34 (95% CI 0.16–0.50) and 0.47 (95% CI 0.31–0.61), and moderate positive correlation for the postprocedure measurements, 0.68 (95% CI 0.56–0.77) and 0.67 (95% CI 0.55–0.77), for the nurses and researchers, respectively. Construct validity demonstrated an equally average significant reduction in pain from preprocedure to postprocedure, CBPS and NRS median (IQR) scores preprocedure (4 (2–6) and 6 (4–8)) and postprocedure (1 (0–2) and 3 (0–5)), p < 0.001. Discussion. The CBPS has been shown to have interrater reliability, concurrent validity, and construct validity. However, further testing is needed to show its potential benefits over other pain scales and its effectiveness in treating patients with chronic pain over a long-term. This study was registered with ClinicalTrial.gov with National Clinical Trial Number NCT02882971.

Highlights

Pain self-report continues to be considered the gold standard of pain assessment [1]
The purpose of this study is to introduce and validate a behavioral pain scale in the adult outpatient chronic pain setting. is scale has the potential to allow for an objective pain measurement that is reliable across multiple raters and comparable over time, which can help in judging the success of pain treatments
We could not obtain postprocedure data for 2 of these evaluations due to unperformed procedures. e researcher group consisted of two medical students and an anesthesiology resident, whereas the nurse group consisted of 8 chronic pain nurses

Summary

Introduction

Pain self-report continues to be considered the gold standard of pain assessment [1]. Ese scales require patients to place a quantitative rating on their pain sensation and convert a subjective feeling into a quantitative number for pain measurement and long-term evaluation over time While these scales may place an appropriate emphasis on the patient, they allow for bias and lack of objectivity due to the data being completely patientreported. Patient-reported pain scores are valid in the moment the scores are obtained but are unidimensional and do not account for the impact chronic pain has on a patient’s daily life [7] For this reason, multidimensional pain scoring systems have been developed to allow patients to better qualify their pain with standardized descriptive terms, measure the pain impact on their daily activities, and improvement in these activities after pain interventions [1].

Objectives

Methods

Results

Discussion

Conclusion