Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, USA.
Pediatr Blood Cancer. 2013 Oct;60(10):1689-95. doi: 10.1002/pbc.24624. Epub 2013 Jun 17.
Limited understanding of the interpretability of patient-reported pain scores may impact pain management. The current study assessed the minimal clinically significant improvement in pain and pain scores signifying patient-reported need for medication and treatment satisfaction in patients with sickle cell disease (SCD).
Patients, 8-18-years-old, with SCD were recruited while receiving treatment for pain. Patients completed initial pain severity ratings using the Visual Analog Scale (VAS) and the Numeric Rating Scale (NRS). Serial assessments of pain severity, pain relief, perceived need for medication, and treatment satisfaction were completed in the emergency department and the hospitalization. Data were used to calculate the minimal clinically significant improvement in pain and pain scores associated with perceived need for pain medication and treatment satisfaction.
Twenty-eight patients completed 305 assessments during 37 total visits. A decrease in pain severity score of 0.97 cm for the VAS and 0.9 for the NRS was found to be the minimum clinically significant improvement in pain. Pain scores >7.45 cm on the VAS or 7.5 on the NRS were suggestive of patient-reported need for pain medication. Pain scores <7.35 cm on the VAS or 8.5 on the NRS were suggestive of patient-reported treatment satisfaction discrimination.
The minimal clinical significant improvement was defined for the VAS and NRS and both scales were able to discriminate between important clinical findings including pain relief, need for pain medication, and treatment satisfaction. Collectively, this study provides data to improve our understanding of pain ratings of pediatric patients with SCD.
对患者报告的疼痛评分可解释性的理解有限，可能会影响疼痛管理。本研究评估了镰状细胞病（SCD）患者疼痛的最小临床显著改善程度，以及疼痛评分表示患者对药物治疗的需求和治疗满意度的变化。
在接受疼痛治疗时，招募了 8-18 岁的 SCD 患者。患者使用视觉模拟量表（VAS）和数字评分量表（NRS）完成初始疼痛严重程度评分。在急诊科和住院部完成了疼痛严重程度、疼痛缓解、对药物治疗的需求感知和治疗满意度的连续评估。使用这些数据来计算与对疼痛药物治疗的需求感知和治疗满意度相关的疼痛和疼痛评分的最小临床显著改善。
28 名患者在 37 次就诊中完成了 305 次评估。VAS 疼痛严重程度评分降低 0.97cm，NRS 评分降低 0.9，被认为是疼痛最小临床显著改善。VAS 疼痛评分>7.45cm 或 NRS 评分>7.5 提示患者报告需要疼痛药物治疗。VAS 疼痛评分<7.35cm 或 NRS 评分<8.5 提示患者报告治疗满意度的差异。
VAS 和 NRS 的最小临床显著改善程度已经确定，两种量表都能够区分重要的临床发现，包括疼痛缓解、对疼痛药物的需求和治疗满意度。总的来说，这项研究提供了数据，有助于我们更好地理解患有 SCD 的儿科患者的疼痛评分。
