Behrend Caleb J, Schönbach Etienne M, Vaccaro Alexander R, Coyne Ellen, Prasarn Mark L, Rechtine Glenn R
Carilion Clinic Orthopaedics, Virginia Tech, 2331 Franklin Rd, Roanoke, VA 24014, USA.
Wilmer Eye Institute, Johns Hopkins University School of Medicine, 600 N. Wolfe St, Baltimore, MD 21287, USA.
Spine J. 2017 Aug;17(8):1061-1065. doi: 10.1016/j.spinee.2016.11.017. Epub 2016 Dec 6.
Determining pain intensity is largely dependent on the patient's report.
The objective of this study was to test the hypothesis that patients initially reporting a pain score of 10 out of 10 on the visual analog scale (VAS) would experience symptom improvement to a degree similar to patients reporting milder pain.
This study is a retrospective chart review.
A total of 6,779 patients seeking care for spinal disorders were included in the study.
The outcome measures used in the study were pain scores on the VAS pain scale, smoking status, morbid depression, gender, and the presence of known secondary gain.
Patients with lumbar degenerative disk disease with or without spinal stenosis who reported a VAS pain score of 10 out of 10 were identified. Changes in reported VAS pain, patient age, smoking status, morbid depression, gender, and the presence of known secondary gain were examined.
A total of 160 individuals (2.9%) reported a maximum pain score of 10 out of 10 on a VAS at their initial presentation. The patients had a median improvement of 3 points in reported VAS pain between the first visit and the last follow-up appointment. The odds to improve by at least 40% on the VAS were 1.500 (95% confidence interval 1.090-2.065) compared with patients reporting submaximal pain. The proportion of patients with identifiable secondary gain was higher (p=.001) than that of patients with submaximal pain. Patients whose pain scores improved dramatically (ie, at least 4 points on the VAS) tended to be older (p=.001), to less often have secondary gain from their disease (p=.007), and to have a negative current smoking status (p=.002). Patients whose pain remained 10 out of 10 during the course of treatment smoked more frequently (p=.016).
Our analysis supports the need to consider the influence of secondary gain on the patients' reported VAS pain scores. Maximum pain seems to be a more acute phenomenon with some likelihood to significantly improve.
疼痛强度的确定很大程度上取决于患者的报告。
本研究的目的是检验以下假设：最初在视觉模拟量表（VAS）上报告疼痛评分为10分的患者，其症状改善程度与报告较轻疼痛的患者相似。
本研究是一项回顾性病历审查。
共有6779名因脊柱疾病寻求治疗的患者纳入本研究。
本研究中使用的结果测量指标为VAS疼痛量表上的疼痛评分、吸烟状况、病态抑郁、性别以及是否存在已知的继发获益。
识别出腰椎间盘退变疾病伴或不伴椎管狭窄且报告VAS疼痛评分为10分的患者。检查报告的VAS疼痛、患者年龄、吸烟状况、病态抑郁、性别以及是否存在已知继发获益的变化情况。
共有160名个体（2.9%）在初次就诊时报告VAS上的最大疼痛评分为10分。患者在首次就诊和最后一次随访预约之间报告的VAS疼痛中位数改善了3分。与报告次最大疼痛的患者相比，VAS改善至少40%的几率为1.500（95%置信区间1.090 - 2.065）。可识别继发获益的患者比例高于（p = 0.001）报告次最大疼痛的患者。疼痛评分显著改善（即VAS上至少4分）的患者往往年龄较大（p = 0.001），疾病继发获益的情况较少（p = 0.007），且当前吸烟状态为阴性（p = 0.002）。在治疗过程中疼痛始终为10分的患者吸烟更频繁（p = 0.016）。
我们的分析支持需要考虑继发获益对患者报告的VAS疼痛评分的影响。最大疼痛似乎是一种更急性的现象，有显著改善的可能性。
