Background & Aims

The reliance on unidimensional scales for pain assessment has been criticised(1). It has been suggested to include a question about pain tolerability to improve pain management(2), or to use multi-dimensional pain scales(3). In the context of a transcultural validation of a French version of the multi-dimensional “Defense and Veterans pain rating scale DVPRS”(4), we also included questions about the tolerability of the current pain intensity, and the maximum pain intensity deemed tolerable. The aim was to validate this scale for patients with acute and chronic pain, and to investigate differences in pain tolerance. The DVPRS contains a primary numeric rating scale with visual aids and phrases linking pain intensity to the ability to perform activities, and supplemental questions about the impact of pain on activities, sleep, mood, and stress.

Methods

Secondary analysis of a prospective observational study in two large hospitals of the French-speaking region of Switzerland, recruiting patients (convenience samples) from surgical intervention lists on surgical wards, outpatient pain clinics, the palliative care unit, a geriatric unit, and a unit for internal medicine and rehabilitation. Inclusion criteria were patients older than 18 years with acute or chronic pain and able to speak and understand French. The French translation of the DVPRS, named “functional pain scale (FPS)” and a customized evaluation questionnaire was completed by patients after a short explanation by the investigator.

Results

A total of 232 patients were included, 132 patients with acute and 98 patients with chronic pain. Mean pain intensity was 5.3 (SD 2.3) for chronic and 3.4 (SD2.4) for acute pain on the 0-10 FPS. Only 6.7% of patients with acute, but 25.5% of patients with chronic pain claimed that their current pain intensity was not acceptable for them. Binary logistic regression analysis yielded “impact on activities” as the only significant factor explaining whether current pain intensity was acceptable or not for patients with acute pain. For patients with chronic pain, the only significant factor was “impact on mood”. When asked which value was the maximum tolerable pain intensity, patients with acute pain indicated a median level of 6.0 (mean 6.1, SD 1.7), patients with chronic pain a median of 5.0 (mean 5.5, SD 1.9). The difference was significant (Mann-Whitney-U-test).

Conclusions

Compared to patients with acute pain, patients with chronic pain consider lower pain levels as tolerable but indicate higher levels of current pain, and in consequence more often judge the current pain level as not acceptable. During pain evaluation, a direct question about the tolerability of the current pain level may help, but the supplemental questions of the DVPRS/FPS, particularly those about pain impact on activities and mood, can also clarify pain tolerability for patients with both acute and chronic pain, and offer the possibility to discuss specific treatment goals with each patient. These results add to the validity of the DVPRS/FPS for use in patients with both acute and chronic pain.

References

1.Levy N, Sturgess J, Mills P. “Pain as the fifth vital sign” and dependence on the “numerical pain scale” is being abandoned in the US: Why? British Journal of Anaesthesia. 2018 Mar 1;120(3):435–8.
2.Markman JD, Gewandter JS, Frazer ME. Comparison of a Pain Tolerability Question With the Numeric Rating Scale for Assessment of Self-reported Chronic Pain. JAMA Netw Open. 2020 Apr 1;3(4):e203155.
3.van Boekel RLM, Vissers KCP, van der Sande R, Bronkhorst E, Lerou JGC, Steegers MAH. Moving beyond pain scores: Multidimensional pain assessment is essential for adequate pain management after surgery. PLoS One. 2017;12(5):e0177345.
4.Buckenmaier CC 3rd, Galloway KT, Polomano RC, McDuffie M, Kwon N, Gallagher RM. Preliminary validation of the Defense and Veterans Pain Rating Scale (DVPRS) in a military population. Pain Med. 2013 Jan;14(1):110–23.

Presenting Author

Karima Amanzou

Poster Authors

Benno Rehberg

MD

Service d'Anesthesiologie

Lead Author

Karima Amanzou

Hôpitaux Universitaires de Genève

Lead Author

Laszlo Safran

MD

Hôpital du Valais

Lead Author

Petra Vayne-Bossert

MD

Hôpitaux Universitaires de Genève

Lead Author

Topics

  • Assessment and Diagnosis