Comparative evaluation of pain scales

Full Text

Introduction. Pain is a subjective sensation that depends on many factors, including gender, age, emotional and somatic state of the patient, etc. [1]. Diagnosis and treatment of various diseases require a proper assessment of the pain syndrome. Scales and questionnaires are considered to be the most reliable and generally accepted tools in world practice for assessing the qualitative and quantitative characteristics of pain [2, 3, 4]. Their use makes it possible to quickly and adequately assess the patient's pain, and also creates the basis for a productive dialogue between the doctor and the patient [5, 6, 7].
Studies of pain syndrome, methods of quantitative and qualitative assessment of patient's pain sensations have been conducted for a relatively long time. Despite the fact that a number of pain assessment scales have been created and are widely used, none of them is ideal. In addition, the scales used are not interchangeable. The importance of creating a reliable and objective pain detection system is still relevant [8, 9, 10].
The aim of the study is to compile a comparative assessment of the most common pain syndrome scales and questionnaires.
Materials and methods of research. A search for pain intensity scales was carried out and the most correct scales were selected in relation to pain intensity assessment (a trial survey of 20 patients was conducted for this purpose), after the sample there were 10 scales left, with the help of which 42 patients of the surgical department of the GBUZ GKB No. 7 in Tver were interviewed. The distribution of respondents by gender was: 21 women and 21 men. The average age of the respondents was 52 years.
The results of the study. The selection of the most correct pain scales was carried out by a trial survey. The selected scales corresponded to the following points: the correctness of the questions, the patient's ability to fill out the questionnaire independently, and the adequacy of the volume of questionnaires. After the sample, there are 10 questionnaire scales left: 1. A short form of the McGill pain questionnaire. The questionnaire shows different types of pain, it was necessary to mark the number from 0 to 10, which best characterized the intensity of each type that bothered the patient, if this type did not correspond to the patient's pain, then 0. 2 was noted. A short pain questionnaire. It answered 9 consecutive questions. The advantage of this questionnaire is the ability to specify the location of pain. 3. Numerological evaluation scale. In this scale, the patient marked a number from 0 to 10, which corresponded to his pain. 4. The visual analog scale is similar to the numerological evaluation scale, but did not have markings and numbers. It was a continuous scale in the form of a horizontal (vertical) line 10 cm long with two extreme points located on it: "no pain" and "unbearable pain". The patient was asked to mark the intensity of pain on a scale, which then allowed quantifying the score as a percentage from 0 to 100%. 5. The Wong–Baker pain-face scale combined images of faces and numbers to assess pain. The six faces showed different expressions, from happy to extremely upset. Each was assigned a numerical score from 0 (smiling) to 5 (crying) 6. On the Elland scale, the intensity of pain was determined using color, which was further interpreted into an assessment of pain. The scale also made it possible to determine the localization of pain 7. The scale for determining pain is the scale of hands. A five-point scale that showed the intensity of pain with one hand. A clenched fist meant no pain, a fully open palm meant unbearable pain. 8 The 4–point verbal scale was a list of descriptions of the degree of pain and a numerical assessment next to it, the patient chose the most appropriate description of his pain. 9. The 5-point verbal scale is similar to the 4-point scale with the addition of one characteristic "very severe pain" 10. In the Abby pain scale, the pain was assessed by the doctor himself according to the appearance of the patient on 6 points. Of these scales, 3 scales are quantitative: a short form of the McGill questionnaire, a short pain questionnaire, NOSH, Abby, and 5 qualitative (with subsequent translation into an assessment): YOURS, Wong-Baker's face, Elland, hand scale, 4- and 5-ball verbal scales.
The selected scales vary in volume and scores, so a comparative assessment of the pain scales was carried out as a percentage. After interviewing 42 patients, an analysis of the questionnaires they completed was carried out. Next, the pain syndrome of each patient was assessed separately (the average percentage of pain was calculated). The next step was to determine the percentage difference between the scales and the average percentage of pain of each respondent.
Based on the data obtained, the percentage discrepancy between the pain assessment scales was calculated and the following results were obtained: the short form of the McGill pain questionnaire increased the pain assessment index by 17%, the numerological assessment scale by 14%, the visual analog scale by 4%, the Wong-Baker face by 15% and the 4-point verbal the scale is 11%. At the same time, there was a decrease in the pain assessment index in such scales as: the 5-point verbal scale by 1%, the hand scale by 8%, the short pain questionnaire by 6% and the Abby scale by 46%.
When comparing the time, there was no relationship between the time of completion of the questionnaires by patients and the deviation of the percentage of pain assessment. There was also no correlation between the percentage deviation and the volume of the pain questionnaire.
It should be noted that there was no significant difference between the indicators of the scales of the male and female sexes.
An important point is that the indicators of the verbal scales had high percentage deviations in comparison with each other: a 4-point verbal scale gave an indicator of "+11%", while a 5-point scale gave "-1%". These deviations are related to the fact that with a 4-point rating system, patients considered their pain to be "severe" and when adding the characteristic "very severe pain" to a 5-point scale, respondents did not always change their choice.
The largest deviation was observed on the Abby scale (-46%). This is due to the fact that the assessment was given by the doctor himself, assessing only the external manifestations of pain, patient behavior, physiological changes, but not assessing gender, age, and the state of the nervous system.
The smallest deviation was observed in scales such as the Wong-Baker faces and the 5-point verbal scale. With the help of facial images, it was more convenient for patients to transfer their perception of pain to a scale.
In the short form of the McGill pain Questionnaire, the deviation was "+17%", which exceeded the percentage deviations of a number of scales, but this scale had an advantage over others in that it also determined the type of pain, and not only the assessment in general terms.
Conclusions. None of the questionnaires used in the course of the work can fully and accurately describe pain in all parameters. For the most accurate assessment of pain syndrome, it is necessary to use several questionnaires at once. The problem of improving existing scales and creating a single scale or questionnaire that allows for an adequate and most accurate assessment of pain syndrome remains an urgent problem of modern medicine.

About the authors

Varvara Аlekseevna Sitnova

Tver State Medical University

Email: ammorozovv@gmail.com
ORCID iD: 0009-0007-2942-7875
Russian Federation, 170100, Russia, Tver, Sovetskaya str., 4

Alexandra Yurevna Smyslov

Tver State Medical University

Email: ammorozovv@gmail.com
ORCID iD: 0009-0007-9859-3869
Russian Federation, 170100, Russia, Tver, Sovetskaya str., 4

Artem Мihailovich Morozov

Tver State Medical University

Author for correspondence.
Email: ammorozovv@gmail.com
ORCID iD: 0000-0003-4213-5379
SPIN-code: 6815-9332

Candidate of Medical Sciences, Associate Professor, Associate Professor of the Department of General Surgery

Russian Federation, 170100, Russia, Tver, Sovetskaya str., 4

References

Supplementary files

There are no supplementary files to display.