Pain as bad as you can imagine or extremely severe pain? A randomized controlled trial comparing two pain scale anchors
(2023) In Journal of Patient-Reported Outcomes 7(1).- Abstract
Background: A common method of pain assessment is the numerical rating scale, where patients are asked to rate their pain on a scale from 0 to 10, where 0 is “no pain” and 10 is “pain as bad as you can imagine”. We hypothesize such language is suboptimal as it involves a test of a cognitive skill, imagination, in the assessment of symptom severity. Methods: We used a large-scale online research registry, ResearchMatch, to conduct a randomized controlled trial to compare the distributions of pain scores of two different pain scale anchors. We recruited adults located in the United States who reported a chronic pain problem (> 3 months) and were currently in pain. Participants were randomized in a 1:1 ratio to receive pain assessment... (More)
Background: A common method of pain assessment is the numerical rating scale, where patients are asked to rate their pain on a scale from 0 to 10, where 0 is “no pain” and 10 is “pain as bad as you can imagine”. We hypothesize such language is suboptimal as it involves a test of a cognitive skill, imagination, in the assessment of symptom severity. Methods: We used a large-scale online research registry, ResearchMatch, to conduct a randomized controlled trial to compare the distributions of pain scores of two different pain scale anchors. We recruited adults located in the United States who reported a chronic pain problem (> 3 months) and were currently in pain. Participants were randomized in a 1:1 ratio to receive pain assessment based on a modified Brief Pain Inventory (BPI), where the anchor for a score of 10 was either “extremely severe pain”, or the original BPI, with the anchor “pain as bad as you can imagine”. Participants in both groups also answered additional questions about pain, other symptomatology and creativity. Results: Data were obtained from 405 participants for the modified and 424 for the original BPI. Distribution of responses to pain questions were similar between groups (all p-values ≥ 0.12). We did not see evidence that the relationship between pain score and the anchor text differed based on self-perceived creativity (all interaction p-values ≥ 0.2). However, in the key analysis, correlations between current pain assessments and known correlates (fatigue, anxiety, depression, current pain compared to a typical day, pain compared to other people) were stronger for “extreme” vs. “imaginable” anchor text (p = 0.005). Conclusion: Pain rating scales should utilize the modified anchor text “extremely severe pain” instead of “pain as bad as you can imagine”. Further research should explore the effects of anchors for other symptoms.
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- author
- Tin, Amy L. ; Austria, Mia ; Ogbennaya, Gabriel ; Chimonas, Susan ; Andréll, Paulin ; Atkinson, Thomas M. ; Vickers, Andrew J. and Carlsson, Sigrid V. LU
- organization
- publishing date
- 2023-12
- type
- Contribution to journal
- publication status
- published
- subject
- keywords
- Numeric rating scale, Pain, Patient-reported outcomes, Validity
- in
- Journal of Patient-Reported Outcomes
- volume
- 7
- issue
- 1
- article number
- 123
- publisher
- Springer
- external identifiers
-
- pmid:38019328
- scopus:85178237206
- ISSN
- 2509-8020
- DOI
- 10.1186/s41687-023-00665-w
- language
- English
- LU publication?
- yes
- additional info
- Funding Information: The author’s work was supported in part by funding from the National Institutes of Health/National Cancer Institute (P30-CA008748, and K22-CA234400 to S.V.C.). Funding Information: We sincerely thank the following for permission to use the survey instruments for the study: Dr. Charles Cleeland at MD Anderson Cancer Center (Brief Pain Inventory), Dr. Eduardo Bruera, MD Anderson Cancer Center (Edmonton Symptom Assessment System scale), Dr. Krishna Kumar, West Chester University of Pennsylvania (Kumar-Holman Global Measure of Creativity Capacity), and Dr. Harald Breivik, Oslo University Hospital, Norway (chronic pain questions and pain location). Funding Information: Participants were recruited from the online database ResearchMatch, a national health volunteer registry that was created by several academic institutions and supported by the United States National Institutes of Health (NIH) as part of the Clinical Translational Science Award (CTSA) program []. ResearchMatch has a large population of volunteers who have consented to be contacted by researchers about health studies for which they may be eligible. The total number of volunteers in the registry varies by day and was approximately 156,200 at the time the study was conducted. A total of 31,102 participants were randomly sampled from the ResearchMatch database and contacted for participating in the study, using a contact message e-mailed to participants in ResearchMatch. Individuals expressing interest in participating volunteered into the study through reviewing a study information sheet and were redirected to the online survey. The survey completion time took about 5 to 10 min. Publisher Copyright: © 2023, The Author(s).
- id
- ae7d11b6-9fe0-4526-970c-6706235e372b
- date added to LUP
- 2023-12-21 11:48:36
- date last changed
- 2024-04-19 21:19:11
@article{ae7d11b6-9fe0-4526-970c-6706235e372b,
abstract = {{<p>Background: A common method of pain assessment is the numerical rating scale, where patients are asked to rate their pain on a scale from 0 to 10, where 0 is “no pain” and 10 is “pain as bad as you can imagine”. We hypothesize such language is suboptimal as it involves a test of a cognitive skill, imagination, in the assessment of symptom severity. Methods: We used a large-scale online research registry, ResearchMatch, to conduct a randomized controlled trial to compare the distributions of pain scores of two different pain scale anchors. We recruited adults located in the United States who reported a chronic pain problem (> 3 months) and were currently in pain. Participants were randomized in a 1:1 ratio to receive pain assessment based on a modified Brief Pain Inventory (BPI), where the anchor for a score of 10 was either “extremely severe pain”, or the original BPI, with the anchor “pain as bad as you can imagine”. Participants in both groups also answered additional questions about pain, other symptomatology and creativity. Results: Data were obtained from 405 participants for the modified and 424 for the original BPI. Distribution of responses to pain questions were similar between groups (all p-values ≥ 0.12). We did not see evidence that the relationship between pain score and the anchor text differed based on self-perceived creativity (all interaction p-values ≥ 0.2). However, in the key analysis, correlations between current pain assessments and known correlates (fatigue, anxiety, depression, current pain compared to a typical day, pain compared to other people) were stronger for “extreme” vs. “imaginable” anchor text (p = 0.005). Conclusion: Pain rating scales should utilize the modified anchor text “extremely severe pain” instead of “pain as bad as you can imagine”. Further research should explore the effects of anchors for other symptoms.</p>}},
author = {{Tin, Amy L. and Austria, Mia and Ogbennaya, Gabriel and Chimonas, Susan and Andréll, Paulin and Atkinson, Thomas M. and Vickers, Andrew J. and Carlsson, Sigrid V.}},
issn = {{2509-8020}},
keywords = {{Numeric rating scale; Pain; Patient-reported outcomes; Validity}},
language = {{eng}},
number = {{1}},
publisher = {{Springer}},
series = {{Journal of Patient-Reported Outcomes}},
title = {{Pain as bad as you can imagine or extremely severe pain? A randomized controlled trial comparing two pain scale anchors}},
url = {{http://dx.doi.org/10.1186/s41687-023-00665-w}},
doi = {{10.1186/s41687-023-00665-w}},
volume = {{7}},
year = {{2023}},
}