Abstract
ObjectiveThe pain numerical rating scale (NRS) is widely used in pain research and clinical settings to represent pain intensity. For an individual with chronic pain, NRS reporting requires representation of a complex subjective state as a numeral. To evaluate the process of NRS reporting, this study examined the relationship between reported pain NRS levels and imagined painful events reported by study subjects.DesignA total of 149 subjects with chronic low back pain characterized by the NIH Research Task Force Recommended Minimal Dataset reported current pain NRS and provided imagined examples of painful experiences also attributing to these an NRS. We present a quantitative and qualitative analysis of the 797 pain examples provided by the study subjects.ResultsStudy subjects tended to be able to imagine both highly painful 10/10 events and non-painful events with relative agreement across subjects. While NRS for the pain examples tended to increase with example severity, for many types of examples there was wide dispersion around the mean pain level. Examination of pain examples indicated unexpected relationships between current pain and the intensity and nature of the imagined painful events.ConclusionsOur results indicate that the pain NRS does not provide a reliably interpretable assessment of current physical pain intensity for an individual with chronic pain at a specific moment.
Highlights
Low back pain has widespread socioeconomic impact worldwide, with an estimated 539,907,000 cases of low back pain in 2015 resulting in its status as the leading cause of years lived with disability globally (Gbd 2015 Diease and Injury Incidence and Prevalence Collaborators, 2016), and has been the subject of extensive research
During the enrollment period of 113 days, 264 potential subjects were approached for consent, and 77 declined to participate. 13 were excluded due to non-English speaking, 12 excluded due to 0/10 current back pain, eleven were excluded due to current injection done at office visit, one was excluded due to cognitive impairment, one was excluded due to age
Study subjects had elevated levels of pain interference and low levels of physical function relative to the United States general population mean based on PROMIS-29 scoring (Table 2)
Summary
Low back pain has widespread socioeconomic impact worldwide, with an estimated 539,907,000 cases of low back pain in 2015 resulting in its status as the leading cause of years lived with disability globally (Gbd 2015 Diease and Injury Incidence and Prevalence Collaborators, 2016), and has been the subject of extensive research Both in the back pain literature, and in Qualitative Pain Examples the clinical care of individuals with low back pain, the problem of evaluating, quantifying, and reporting back pain is a crucial concern (Chapman et al, 2011; Deyo et al, 2014; Chiarotto et al, 2015). The extent to which brief cool water immersion is a reasonable “gold standard” for pain intensity experienced by chronic pain patients remains unclear,
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