van Dijk Jacqueline F M, Kappen Teus H, Schuurmans Marieke J, van Wijck Albert J M
Pain Clinic, Department of Anesthesiology, University Medical Center Utrecht, Utrecht, the Netherlands.
Department of Anesthesiology, University Medical Center Utrecht, Utrecht, the Netherlands.
Pain Pract. 2015 Sep;15(7):604-9. doi: 10.1111/papr.12217. Epub 2014 Apr 16.
Postoperative pain is commonly assessed through a numerical rating scale (NRS), an 11-point scale where 0 indicates no pain and 10 indicates the worst imaginable pain. Guidelines advise the administration of analgesics at NRS pain scores above 3 or 4. In clinical practice, not all patients with pain scores above the treatment threshold are willing to accept additional analgesic treatment, especially when opioids are offered. The objective of this study is to measure the relation between patients' NRS pain scores and their desire for additional opioids.
This cross-sectional study examined 1,084 patients in an academic hospital the day after surgery between January 2010 and June 2010. The day after surgery, patients were asked to score their pain and desire for opioids. Sensitivity, specificity, positive predictive value, and negative predictive value of the desire for opioids and the different NRS thresholds were calculated.
Only when patients scored an 8 or higher on the NRS did the majority express a need for opioids. Many patients did not desire opioids, because they considered their pain tolerable, even at an NRS score above 4.
With the current guidelines (ie, using pain scores above 3 or 4 for prescribing opioids), many patients could be overtreated. Therefore, scores generated by the NRS should be interpreted individually.
术后疼痛通常通过数字评分量表（NRS）进行评估，该量表为11分制，0表示无疼痛，10表示难以想象的最严重疼痛。指南建议在NRS疼痛评分高于3或4分时给予镇痛药。在临床实践中，并非所有疼痛评分高于治疗阈值的患者都愿意接受额外的镇痛治疗，尤其是当提供阿片类药物时。本研究的目的是测量患者的NRS疼痛评分与其对额外阿片类药物的需求之间的关系。
这项横断面研究在2010年1月至2010年6月期间对一家学术医院的1084例患者进行了术后第二天的检查。术后第二天，要求患者对其疼痛程度和对阿片类药物的需求进行评分。计算了对阿片类药物的需求以及不同NRS阈值的敏感性、特异性、阳性预测值和阴性预测值。
只有当患者在NRS上的评分达到8分或更高时，大多数患者才表示需要阿片类药物。许多患者不想要阿片类药物，因为他们认为自己的疼痛是可以忍受的，即使NRS评分高于4分。
按照当前指南（即使用高于3或4的疼痛评分来开具阿片类药物），许多患者可能会接受过度治疗。因此，NRS产生的评分应进行个体化解读。
