More about Pain Management

[Red931]

Here is some more information that I found that I thought may be helpful to the members.

Measuring Improvement in Pain Intensity

Not surprisingly, the primary measure of a treatment's effectiveness has been pain intensity.  The most frequently used tools to evaluate a patient's pain are:

•  Numerical Rating Scale (NRS) – Patients are asked to rate their pain by a number between 0 (no pain) to 10 (worst pain imaginable).  This is the scale most often used in doctors' offices and hospitals.  
•  Visual Analog Scale (VAS) – Patients are asked to mark their pain intensity along a line 100 mm long, with 0 (no pain) at one end and 100 (worst pain imaginable) at the other end.

The IMMPACT group reviewed several studies and found that patients evaluate the success of a treatment by the following criteria:

•  Substantial improvement – 4 or more points reduction on the NRS, or 50% or more reduction on the VAS;
•  Moderately important improvement – 2 points NRS reduction, or 30 – 36% VAS reduction;
•  Mimimally important change – 1 point NRS reduction, or 10-20% VAS reduction.

From that it was surmised that most patients consider a treatment satisfactory or successful if they experience at least a 50% reduction in the level of their pain.  

How These Studies Apply to You

Before beginning any pain management plan, I think it's important for the doctor and patient to discuss expectations and agree on realistic goals.  If the patient is expecting complete pain relief but the doctor considers the treatment a success if there is a 50% reduction in pain, both are going to be dissatisfied.  The patient will end up feeling like the doctor doesn't care about her pain and the doctor may start to think the patient is just looking for more drugs.  

It's also a good idea to periodically reassess your pain management plan, evaluating your progress (or lack of it) and possibly setting new goals.  When you first began pain management, you were probably happy with any degree of pain relief you could get.  But after a while, you may feel that a 30% reduction in pain is just not enough to allow you to function as you need to and you want to try for better pain control.  You doctor needs to know if your goals have changed so you both are aiming for the same target.


Other Measures of Treatment Success

I think most of us would agree that significantly reducing the intensity level of pain should be the primary goal of any pain treatment.  However, chronic pain also causes numerous other problems that shouldn't be overlooked when forumlating a pain management plan.    

In order to determine which aspects of life were most significantly and negatively impacted by chronic pain, the  IMMPACT group, together with the American Chronic Pain Association, surveyed 956 chronic pain patients.  Nineteen areas were identified as having the greatest negative impact on patients' lives.  Below is a list of the 19 areas in their order of importance, as determined by the patients surveyed.  Following each item is a number that indicates where that item fell on the scale of importance, with 0 representing “not at all important” and 10 representing “extremely important.”

1.  Enjoyment of life – 8.8
2.  Fatigue, feeling tired – 8.8
3.  Emotional well-being (feeling sad, depressed, less motivated) – 8.6
4.  Physical activities (walking, climbing stairs, bending, squatting, lifting) – 8.4
5.  Weakness – 8.3
6.  Staying asleep at night – 8.3
7.  Difficulty concentrating – 8.0
8.  Household activities (cleaning, cooking, running errands) – 7.9
9.  Falling asleep at night – 7.8
10. Relations with family, relatives or significant others – 7.7
11. Participating in family events/activities – 7.7
12. Participating in recreational and social activities – 7.7
13. Employment – 7.6
14. Difficulty remembering things – 7.6
15. Relations with friends – 7.2
16. Taking care of family such as children, spouses, parents or other relatives – 7.1
17. Hobbies – 7.1
18. Planning activities – 7.0
19. Sex life – 6.6

It's also interesting to note that the ranking of these 19 areas was remarkably consistent for all of the chronic pain conditions studied, which included migraine, rheumatoid arthritis, osteoarthritis, low back pain, neck or shoulder pain, fibromyalgia and neuropathy.  

Now the question becomes, how much does chronic pain affect these other areas of life?  We can't necessarily assume that relieving the intensity of the pain will automatically eliminate the other problems.  In most cases, it will certainly help.  But depending on the individual and the particular chronic pain condition, some of these problems may remain.  For example, a key symptom of fibromyalgia, in addition to pain, is extreme fatigue.  Reducing the pain may not significantly impact the level of fatigue.  That doesn't mean that the pain treatment wasn't successful; it just means that the  fatigue needs to be treated separately.  

While I don't think these other areas should necessarily be measured in clinical trials to determine the success of a treatment designed to reduce the intensity of pain, I do think they need to be considered when evaluating an individual patient's pain management plan.  Regaining the ability to function in life is important to the patient and, therefore, should be an important consideration in developing and assessing a treatment plan.

[Tuckamore]

Thanks for the information. It's good to see it in print. I think many of us may have known these things but to have them laid out certainly helps immensely with understanding.

I was surprised to learn from my PCP that most of her chronic pain patients beleive that that pain management means their pain should gone, 100%. They become angry with her when they are not pain free. I am thankful for any reduction in my pain as I know most of you are also.    

Thanks again Red.

[Mollyrae]

Red:

This might be helpful in our Group. Maybe you want to poat it there as well...It's great information.

Take care,
Molly