The most commonly used measure for pain screening may only
be modestly accurate, according to researchers from the Indiana
University School of Medicine and the University of North Carolina.
In a study that appears in the October issue of the Journal
of General Internal Medicine, they evaluate the usefulness of
a scale that asks patients in primary care to rate their current
pain from 0 (no pain) to 10 (worst pain).
Universal pain screening is an increasingly common practice,
largely because of the Joint Commission on Accreditation of
Healthcare Organization’s requirement that accredited hospitals
and clinics routinely assess all patients for pain. JCAHO is
the nation’s predominant standards-setting and accrediting body
in health care.
“Our study is the first to evaluate the accuracy of the widely-used
numeric rating scale [NRS] as a screening test to identify primary
care patients with clinically important pain. Accurate screening
is important because pain symptoms, both serious and not so
serious, are among the most common complaints in primary care,”
said Erin E. Krebs, M.D., M.P.H., assistant professor of medicine
at the IU School of Medicine and a Regenstrief Institute research
scientist. “To be helpful, a screening test needs to provide
accurate information that doctors can use to improve care. If
a test isn’t very accurate or useful, doctors learn to tune
out the numbers.”
The authors found that, while the NRS is easy to administer,
it fails to identify about a third of patients with pain serious
enough to impair day-to-day functioning. Most patients in this
study had long-standing pain, and many had more than one pain
problem. The authors did not evaluate the accuracy of pain ratings
in settings where short-term pain is more common, such as after
surgery. The researchers noted that because it focuses on current
pain, the NRS may miss intermittent symptoms. They also reported
that “pain” was not the preferred word for some patients. For
example, one study participant indicated that he felt discomfort,
but not pain.
“Universal pain screening has become widespread despite a lack
of research evaluating its accuracy and effectiveness. We know
that pain is a serious problem in primary care, but pain screening
may not be the best way to address this problem,” said Dr. Krebs,
who is also with the Center on Implementing Evidence-based Practice
at the Roudebush Veterans Affairs Medical Center in Indianapolis.
