Department of Neurosurgery, Universitair Ziekenhuis Brussel, Brussels, Belgium.
Pain in Motion, International Research Group, Brussels, Belgium.
Disabil Rehabil. 2021 Jul;43(15):2157-2163. doi: 10.1080/09638288.2019.1694084. Epub 2019 Nov 24.
Pain researchers demonstrated that pain intensity is not the most reliable measure of the success of chronic-pain treatment. Several research groups have proposed "core outcome domains", such as measurements of disability, to assess the effect of an intervention in pain patients. Up till now, studies investigating the relation between pain intensity and disability in patients treated with spinal cord stimulation (SCS) are lacking. Therefore, the current objective is to examine which pain-reporting strategy, routinely used in pain research, associates best with the degree of disability in these patients.
Eighty-one failed back surgery syndrome patients (37 males and 44 females, mean age 54.6 years), treated with high-dose spinal cord stimulation (HD-SCS) are recruited. Pain intensity was scored on an 11-point numerical rating scale (NRS) for leg and back pain, while disability was assessed with the Oswestry disability index (ODI). The association between both variables was investigated with Spearman's correlation and Cramér's .
Significant correlations ( < 0.001) are found between the absolute and relative differences of the ODI and NRS. Significant associations were found between reported cut-offs in literature (≤3, ≤5, and 50% pain relief) and the degree of disability. Finally, a significant association ( < 0.001) was found between the minimal clinical important difference.
In this study, we showed that the degree of disability was strongly associated with the pain intensity as measured using different methods. The standard method for reporting pain intensity reduction (50%) seems to associate the strongest with the degree of disability. However, a low degree of disability does not always reflect a low pain intensity.Implications for rehabilitationThe degree of disability reveals a good association with the reporting methods of pain intensity from the literature.The Oswestry disability index could serve as a valid tool to measure the effect of spinal cord stimulation on pain.Disability measures offer a better insight in the clinical profile of chronic pain patients than a pain intensity score.
疼痛研究人员表明，疼痛强度并不是慢性疼痛治疗成功的最可靠衡量标准。几个研究小组提出了“核心结局领域”，如残疾测量，以评估干预措施对疼痛患者的效果。到目前为止，缺乏研究脊髓刺激（SCS）治疗后疼痛强度和残疾之间关系的研究。因此，目前的目标是研究在常规用于疼痛研究的疼痛报告策略中，哪一种与这些患者的残疾程度关联最好。
招募了 81 名接受高剂量脊髓刺激（HD-SCS）治疗的失败性腰椎手术综合征患者（37 名男性和 44 名女性，平均年龄 54.6 岁）。腿部和背部疼痛的疼痛强度用 11 分数字评分量表（NRS）评分，而残疾程度则用 Oswestry 残疾指数（ODI）评估。使用 Spearman 相关系数和 Cramér 的 检验来研究这两个变量之间的关系。
ODI 和 NRS 的绝对和相对差异之间存在显著相关性（ < 0.001）。在文献中报道的截止值（≤3、≤5 和 50%疼痛缓解）与残疾程度之间存在显著关联。最后，最小临床重要差异之间存在显著关联（ < 0.001）。
在这项研究中，我们表明残疾程度与使用不同方法测量的疼痛强度密切相关。报告疼痛强度降低的标准方法（50%）似乎与残疾程度关联最强。然而，低残疾程度并不总是反映低疼痛强度。
残疾程度与文献中报告疼痛强度的方法有很好的关联。Oswestry 残疾指数可以作为衡量脊髓刺激对疼痛影响的有效工具。残疾测量比疼痛强度评分更能深入了解慢性疼痛患者的临床特征。
