Measurement Properties of Visual Analogue Scale,Numeric Rating Scale,and Pain Severity Subscale of the Brief Pain Inventory in Patients With Low Back Pain: A Systematic Review

The Visual Analogue Scale (VAS), Numeric Rating Scale (NRS), and Pain Severity subscale of the Brief Pain Inventory (BPI-PS) are the most frequently used instruments to measure pain intensity in low back pain. However, their measurement properties in this population have not been reviewed systematically. The goal of this study was to provide such systematic evidence synthesis. Six electronic sources (MEDLINE, EMBASE, CINAHL, PsycINFO, SportDiscus, Google Scholar) were searched (July 2017). Studies assessing any measurement property in patients with nonspecific low back pain were included. Two reviewers independently screened articles and assessed risk of bias using the COSMIN checklist. For each measurement property, evidence quality was rated as high, moderate, low, or very low (GRADE approach) and results were classified as sufficient, insufficient, or inconsistent. Ten studies assessed the VAS, 13 the NRS, 4 the BPI-PS. The 3 instruments displayed low or very low quality evidence for content validity. High-quality evidence was only available for NRS insufficient measurement error. Moderate evidence was available for NRS inconsistent responsiveness, BPI-PS sufficient structural validity and internal consistency, and BPI-PS inconsistent construct validity. All VAS measurement properties were underpinned by no, low, or very low quality evidence; likewise, the other measurement properties of NRS and BPI-PS.

Developmental Data Supporting Simplification of Self-Report Pain Scales for Preschool-Age Children

Claims regarding the ability of preschool-age children to provide accurate self-reports using standard pain scales are not well supported by age-specific evidence. Responses of children younger than 5 years are often idiosyncratic and subject to biases. Simplifying the task of self-report of pain would make it more developmentally appropriate for 3- to 5-year-olds. A binary question is asked: “Does it hurt?” or an equivalent. If yes, a simplified scale is presented, comprising 3 categories representing low, medium, and high pain severity. Children aged 3 to 5 years (N = 184) were recruited from preschools and day care centers. Following parental consent and child assent, children were randomly assigned to use either the Faces Pain Scale-Revised or a 3-face scale preceded by a yes-no question to rate pain in 9 picture stories from the Charleston Pediatric Pain Pictures portraying no pain, moderate pain, and severe pain. The simplified pain rating task made no difference for 5-year-olds, whose mean scores were nearly identical using the 2 approaches. However, discrimination of the 3 levels of Charleston Pediatric Pain Pictures items was significantly better in 3- and 4-year-olds with the simplified task than with the Faces Pain Scale-Revised. Simplifying the task improved preschool-age children's ability to estimate pain intensity.     

"长海痛尺"在疼痛评估中的应用

目的 探讨“长海痛尺”在临床应用中的可行性和实用性。方法 设计“长海痛尺”并将其应用于临床6个月后，调查评估及患对此量表的评价。结果 疼痛评估对“长海痛尺”的满意度为88．28％，患对“长海痛尺”的满意度为90％。结论 “长海痛尺”设计合理，使用方便，在疼痛评估时能更好地满足医护人员及患的需要。     

Results of a Double-Blind,Randomized, Placebo-Controlled Study of Nabiximols Oromucosal Spray as an Adjunctive Therapy in Advanced Cancer Patients with Chronic Uncontrolled Pain

Context

Prior Phase 2/3 studies found that cannabinoids might provide adjunctive analgesia in advanced cancer patients with uncontrolled pain.

Verbal scales in the acute treatment of migraine: semantic categories and clinical relevance

Verbal scales are currently used as efficacy parameters in acute migraine trials. In order to determine the correlation between headache intensity, functional disability, and relevant pain reduction, 100 patients completed a questionnaire. Our results showed that a verbal scale of headache intensity alone has different implications from one that includes pain intensity and functional ability. The reduction from a moderate to a mild headache was satisfactory to only 15% of the patients. In contrast, 77% of patients were satisfied when the headache intensity was reduced from severe to mild. These findings imply that, in assessing the efficacy of drugs used for migraine, a redaction in pain intensity from moderate to mild should not be considered as a good outcome.     

The Effect of 2 Different Exercise Programs on Pain Intensity and Muscle Dimensions in Patients With Chronic Low Back Pain: A Randomized Controlled Trial

Objectives

The purpose of this study was to compare the effect of 2 exercise programs combined with electrotherapy on pain intensity and lumbar stabilizer muscles dimensions in patients with nonspecific chronic low back pain.

Assessing Pain in Older People With Persistent Pain: The NRS Is Valid But Only Provides Part of the Picture

This study examined the assessment of pain intensity and pain distress with the Numerical Rating Scale (NRS) in elderly patients (age >60 years) with persistent pain. A consecutive sample of 800 elderly patients were categorized by age into 3 groups: 61 to 70 years (n = 366), 71 to 80 years (n = 308), and 81 years and over (n = 126). Participants completed 3 Numerical Rating Scales assessing current pain intensity, and both the usual level of pain and average pain distress in the preceding week. The failure rate for scale completion was low for all scales for all age groups, but was significantly higher in the oldest group compared to the youngest group for the scales assessing current pain intensity and average pain distress in the preceding week. The NRS was shown to be a reliable and valid measure of pain intensity and pain distress in all these age groups. Distress related to pain appeared to be specific to the pain experience and was only weakly related to more generalized affective distress. These findings confirm that measures of pain intensity and pain distress, like the NRS, capture only part of the pain experience in older patients and should be supplemented by other measures in the assessment process.     

Pain Acceptance, Hope, and Optimism: Relationships to Pain and Adjustment in Patients With Chronic Musculoskeletal Pain

There is growing interest in the role that positive aspects of psychological adjustment, such as pain acceptance, hope, and optimism, may play in explaining adjustment in persons suffering from persistent pain. This study conducted in obese patients with persistent musculoskeletal pain (N = 89) examined the degree to which pain acceptance and hope explained pain intensity, pain unpleasantness, psychological distress, and pain-related disability, after controlling for the effects of optimism. In correlational analyses, pain acceptance and optimism were associated with psychological distress and pain disability with hope being related to only psychological distress. Pain acceptance, optimism, and hope were not significantly associated with pain. Hierarchical linear regression (HLR) analyses found that pain acceptance remained a significant predictor of psychological distress and pain disability after controlling for optimism, demographic, and medical variables. HLR analyses found that hope was not a significant predictor of psychological distress after controlling for optimism, pain acceptance, and demographic and medical variables. The results of this study are important because they indicate that pain acceptance, hope, and optimism are all related to pain adjustment. They also highlight the importance of controlling for optimism when examining the effects of pain acceptance and hope on pain adjustment.

Perspective

In a sample of obese patients with persistent musculoskeletal pain, pain acceptance was a significant predictor of psychological distress and pain disability even after controlling for optimism, demographic, and medical variables. These results add to the growing literature on the importance of pain acceptance in understanding adjustment to persistent pain.     

Linguistic Indicators of Pain Catastrophizing in Patients With Chronic Musculoskeletal Pain

The present study examined markers of pain catastrophizing in the word use of patients with chronic pain. Patients (N = 71) completed the Pain Catastrophizing Scale and wrote about their life with pain. Quantitative word count analysis examined whether the essays contained linguistic indicators of catastrophizing. Bivariate correlations showed that catastrophizing was associated with greater use of first person singular pronouns, such as “I” (r = .27, P ≤ .05) and pronouns referencing other people (r = .28, P ≤ .05). Catastrophizing was further significantly associated with greater use of sadness (r = .35, P ≤ .01) and anger (r = .30, P ≤ .05) words. No significant relationships with positive emotion and cognitive process words were evident. Controlling for patients' engagement in the writing task, gender, age, pain intensity, and neuroticism in multiple regression, the linguistic categories together uniquely explained 13.6% of the variance in catastrophizing (P ≤ .001). First person singular pronouns (β = .24, P ≤ .05) and words relating to sadness (β = .25, P ≤ .05) were significant, and pronouns referencing other people (β = .19, P ≤ .10) were trending. The results suggest that pain catastrophizing is associated with a “linguistic fingerprint” that can be discerned from patients’ natural word use.

疼痛强度评估量表应用于老年腰痛患者的同时效度与偏好性

目的探讨疼痛强度评估量表在老年腰痛患者疼痛评估中的同时效度与选择量表时的偏好。方法由测评人员对30例有腰痛临床症状的老年患者进行疼痛强度评估量表测试,包括数字评定量表(NRS)、视觉模拟评分表(VAS)、词语描述量表(VDS)、修改版面部表情疼痛量表(FPS-R)和组合型疼痛评估表(MIX)。以NRS为校标工具,通过Spearman相关系数检验NRS与FPS-R、MIX、VAS和VDS之间的相关程度来确定FPS-R、MIX、VAS和VDS的同时效度。统计患者对5种评估量表的首选率。结果 FPS-R、MIX、VAS和VDS与NRS高度正相关(r=0.753～0.957,P<0.001)。首选疼痛强度评估量表依次为FPS-R、NRS、VDS、MIX、VAS。结论 FPS-R、MIX、VAS和VDS具有良好的同时效度,疼痛强度评估量表的同时效度适用于老年腰痛人群的评估。FPS-R是首选率最高的量表。     

慢性疼痛病人心理状态分析及护理干预

为探讨慢性疼痛病人的心理状态及个性特征，以采取相应的护理干预，采用症状自评量表和艾森克个性问卷对52例慢性疼痛病人进行测试，结果：心身症状检出率88．5％，其中心身症状以躯体化，焦虑，恐怖，精神病性，抑郁显著，神经质及内向性格是慢性疼痛病人的主要个性特征。建议：及早对慢性疼痛病人实施以心理干预为主的综合护理，以促进身心健康。