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Validation of a New "Objective Pain Score" Vs. "Numeric Rating Scale" For the Evaluation of Acute Pain: A Comparative Study.

Tandon M, Singh A, Saluja V, Dhankhar M, Pandey CK, Jain P - Anesth Pain Med (2016)

Bottom Line: There were 25 disagreements in 8 patients.The OPS is a good stand-alone pain score and is better than the NRS for defining mild and moderate pain.It may even be used to supplement NRS when it is indicative of mild or moderate pain.

View Article: PubMed Central - PubMed

Affiliation: Department of Anesthesiology, Institute of Liver and Biliary Sciences, New Delhi, India.

ABSTRACT

Background: Pain scores are used for acute pain management. The assessment of pain by the patient as well as the caregiver can be influenced by a variety of factors. The numeric rating scale (NRS) is widely used due to its easy application. The NRS requires abstract thinking by a patient to assign a score to correctly reflect analgesic needs, and its interpretation is subject to bias.

Objectives: The study was done to validate a 4-point objective pain score (OPS) for the evaluation of acute postoperative pain and its comparison with the NRS.

Patient and methods: A total of 1021 paired readings of the OPS and NRS of 93 patients who underwent laparotomy and used patient-controlled analgesia were evaluated. Acute pain service (APS) personnel recorded the OPS and NRS. Rescue analgesia was divided into two incremental levels (level 1-paracetamol 1 g for NRS 2 - 5 and OPS 3, Level 2-Fentanyl 25 mcg for NRS ≥ 6 and OPS 1 and 2). In cases of disagreement between the two scores, an independent consultant decided the rescue analgesia.

Results: The NRS and OPS agreed across the range of pain. There were 25 disagreements in 8 patients. On 24 occasions, rescue analgesia was increased from level 1 to 2, and one occasion it was decreased from level 2 to 1. On all 25 occasions, the decision to supplement analgesia went in favor of the OPS over the NRS. Besides these 25 disagreements, there were 17 occasions in which observer bias was possible for level 2 rescue analgesia.

Conclusions: The OPS is a good stand-alone pain score and is better than the NRS for defining mild and moderate pain. It may even be used to supplement NRS when it is indicative of mild or moderate pain.

No MeSH data available.


Related in: MedlinePlus

Numeric Rating Scale
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fig26033: Numeric Rating Scale

Mentions: PCA was standardized according to the protocol at the institute. Intravenous PCA (IVPCA) contained 10 mcg/mL of fentanyl. The total dose delivered every hour was limited to 2 mcg/kg. The total calculated dose was divided into 5 equal parts and delivered upon activation of the PCA device with a lockout time of 10 minutes. The total dose activation allowed in IVPCA was 5 per hour. There was no background infusion for IVPCA. Epidural PCA (PCEA) contained 0.1% bupivacaine. For PCEA, the total dose was calculated as 1.5 mL/dermatome that had to be covered. The total calculated dose was divided into 2 equal parts with a lockout of 10 minutes. A background infusion equal to one calculated dose was given in PCEA. The total dose activation allowed per hour was 2. Pain was assessed simultaneously using the printed NRS (Figure 1), which the patient used to score his pain, and the OPS (Table 1), which was used by the APS resident to score the pain. In cases of postoperative nausea and vomiting (PONV), patients received standard treatment with i.v. ondansetron 4 mg. Rescue analgesia for breakthrough pain was divided into Level 1 (analgesia was supplemented with an injection of paracetamol 1 g for NRS 2 - 5 and OPS 3) and Level 2 (analgesia was supplemented with an injection of Fentanyl 25 mcg for NRS ≥ 6 and OPS 1 and 2). When there was any disagreement between the two scores, the consultant in charge of the acute pain service (APS) and not involved in the study was consulted to determine the need for analgesic supplementation. Analgesic measures were targeted to achieve NRS ≤ 3 and or OPS ≥ 3.


Validation of a New "Objective Pain Score" Vs. "Numeric Rating Scale" For the Evaluation of Acute Pain: A Comparative Study.

Tandon M, Singh A, Saluja V, Dhankhar M, Pandey CK, Jain P - Anesth Pain Med (2016)

Numeric Rating Scale
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4834447&req=5

fig26033: Numeric Rating Scale
Mentions: PCA was standardized according to the protocol at the institute. Intravenous PCA (IVPCA) contained 10 mcg/mL of fentanyl. The total dose delivered every hour was limited to 2 mcg/kg. The total calculated dose was divided into 5 equal parts and delivered upon activation of the PCA device with a lockout time of 10 minutes. The total dose activation allowed in IVPCA was 5 per hour. There was no background infusion for IVPCA. Epidural PCA (PCEA) contained 0.1% bupivacaine. For PCEA, the total dose was calculated as 1.5 mL/dermatome that had to be covered. The total calculated dose was divided into 2 equal parts with a lockout of 10 minutes. A background infusion equal to one calculated dose was given in PCEA. The total dose activation allowed per hour was 2. Pain was assessed simultaneously using the printed NRS (Figure 1), which the patient used to score his pain, and the OPS (Table 1), which was used by the APS resident to score the pain. In cases of postoperative nausea and vomiting (PONV), patients received standard treatment with i.v. ondansetron 4 mg. Rescue analgesia for breakthrough pain was divided into Level 1 (analgesia was supplemented with an injection of paracetamol 1 g for NRS 2 - 5 and OPS 3) and Level 2 (analgesia was supplemented with an injection of Fentanyl 25 mcg for NRS ≥ 6 and OPS 1 and 2). When there was any disagreement between the two scores, the consultant in charge of the acute pain service (APS) and not involved in the study was consulted to determine the need for analgesic supplementation. Analgesic measures were targeted to achieve NRS ≤ 3 and or OPS ≥ 3.

Bottom Line: There were 25 disagreements in 8 patients.The OPS is a good stand-alone pain score and is better than the NRS for defining mild and moderate pain.It may even be used to supplement NRS when it is indicative of mild or moderate pain.

View Article: PubMed Central - PubMed

Affiliation: Department of Anesthesiology, Institute of Liver and Biliary Sciences, New Delhi, India.

ABSTRACT

Background: Pain scores are used for acute pain management. The assessment of pain by the patient as well as the caregiver can be influenced by a variety of factors. The numeric rating scale (NRS) is widely used due to its easy application. The NRS requires abstract thinking by a patient to assign a score to correctly reflect analgesic needs, and its interpretation is subject to bias.

Objectives: The study was done to validate a 4-point objective pain score (OPS) for the evaluation of acute postoperative pain and its comparison with the NRS.

Patient and methods: A total of 1021 paired readings of the OPS and NRS of 93 patients who underwent laparotomy and used patient-controlled analgesia were evaluated. Acute pain service (APS) personnel recorded the OPS and NRS. Rescue analgesia was divided into two incremental levels (level 1-paracetamol 1 g for NRS 2 - 5 and OPS 3, Level 2-Fentanyl 25 mcg for NRS ≥ 6 and OPS 1 and 2). In cases of disagreement between the two scores, an independent consultant decided the rescue analgesia.

Results: The NRS and OPS agreed across the range of pain. There were 25 disagreements in 8 patients. On 24 occasions, rescue analgesia was increased from level 1 to 2, and one occasion it was decreased from level 2 to 1. On all 25 occasions, the decision to supplement analgesia went in favor of the OPS over the NRS. Besides these 25 disagreements, there were 17 occasions in which observer bias was possible for level 2 rescue analgesia.

Conclusions: The OPS is a good stand-alone pain score and is better than the NRS for defining mild and moderate pain. It may even be used to supplement NRS when it is indicative of mild or moderate pain.

No MeSH data available.


Related in: MedlinePlus