Bakshi Sumitra G, Rathod Akanksha, Salunkhe Supriya
Department of Anaesthesia, Critical Care and Pain, Tata Memorial Hospital and Homi Bhabha National Institute, Mumbai, Maharashtra, India.
Indian J Anaesth. 2021 Mar;65(3):216-220. doi: 10.4103/ija.IJA_130_21. Epub 2021 Mar 13.
Assessment of pain using pain scales is essential. In the Numeric Rating Scale (NRS), patients are asked to score their pain intensity on a scale from 0 to 10 (10- worst pain). This requires some abstract thinking by the patient, also the pain scores (PS) may not essentially communicate the patients' need for more analgesia. We planned a study to evaluate the change in patients' self-assessed PS after understanding clinical interpretation of the NRS.
This prospective study was registered after approval from our hospital ethics board. Sample size estimated for the trial was 360 patients. All postoperative patients were recruited after informed consent. Patients having prolonged stay in Intensive Care Unit (more than 48 h), or those who underwent emergency surgeries were excluded. During Acute Pain Service (APS) rounds, patients were asked to rate their PS on the NRS. This was followed by a briefing about the clinical interpretation of the scale, and the patients were asked to re score their pain using the same scale. The change in pain severity was compared using Chi-square test.
Following explanation, a change in severity was seen for PS at rest [ (9, N- 360) = 441, < 0.001] and at movement [X (9, N- 360) = 508, < 0.001]. Overall, a change in PS severity was seen in 162 patients (45%). A decrease and an increase in the severity of pain was seen in 119 and 41 patients respectively.
Explaining the clinical interpretation of PS on a NRS does lead to a change in patients' self-assessed PS.
使用疼痛量表评估疼痛至关重要。在数字评分量表（NRS）中，要求患者在0至10的量表上对其疼痛强度进行评分（10为最严重疼痛）。这需要患者进行一些抽象思维，而且疼痛评分（PS）可能无法确切传达患者对更多镇痛的需求。我们计划开展一项研究，以评估患者在理解NRS的临床解读后自我评估的PS变化。
这项前瞻性研究在获得我院伦理委员会批准后进行注册。该试验估计的样本量为360名患者。所有术后患者在获得知情同意后被纳入。排除在重症监护病房停留时间延长（超过48小时）的患者或接受急诊手术的患者。在急性疼痛服务（APS）查房期间，要求患者在NRS上对其PS进行评分。随后对该量表的临床解读进行简要说明，并要求患者使用同一量表重新对其疼痛进行评分。使用卡方检验比较疼痛严重程度的变化。
经过解释后，静息时PS的严重程度发生了变化[卡方值（9，N = 360）= 441，P < 0.001]，活动时也发生了变化[卡方值（9，N = 360）= 508，P < 0.001]。总体而言，162名患者（45%）的PS严重程度发生了变化。疼痛严重程度降低和增加的患者分别有119名和41名。
解释NRS上PS的临床解读确实会导致患者自我评估的PS发生变化。
