Department of Orthopedic Surgery, Horsens Regional Hospital, Denmark.
Department of Orthopedic Surgery, Svendborg Hospital, Denmark.
Acta Orthop. 2024 Nov 7;95:625-632. doi: 10.2340/17453674.2024.42182.
Pain intensity is an important outcome in clinical trials of surgery because pain relief is important to patients. Currently, recommended scales are the numeric rating scale 0-10 and visual analogue scale. However, these scales allow for considerable influence of individual imagination, previous experience, and coping skills, limiting proficiency in comparative clinical trials. We aimed to explore postoperative expressions of "how much it hurts"-the first step to improve pain intensity measurement.
This was a qualitative study using inductive content analysis: words and visual cues describing pain intensity were collected from (i) existing pain intensity measures by search of COSMIN, PubMed, and Google, (ii) patient interviews recorded and transcribed word-for-word, (iii) clinician interviews transcribed likewise, and (iv) 100 patient telephone interviews with notes taken. After familiarization, the collected expressions were labelled inductively in categories and assembled in tables (case and theme-based matrices).
Descriptors fell into 12 categories: intensity (slight/strong), evaluative (negligible/unbearable), cognitive impact (distracting/can be ignored), activity impact (limits some/all activity), sleep impact (can/cannot sleep), examples (like stubbing a toe), physical signs (crying/writhing), associated symptoms (nauseating/tiring), treatment (ice helps/need morphine), affective (annoying/dreadful), discriminative (aching/piercing), and general recovery (hindering recovery/functional interference). Many visual cues were also identified. Literature and recorded interviews gave rise to the categories, and telephone interviews found saturation, providing no further categories.
Pain intensity is expressed by terms that fall into 12 categories and by a variety of graphic elements. This advances development of a patient-reported outcome measure of pain intensity for orthopedic trials.
疼痛强度是手术临床研究中的一个重要结果，因为缓解疼痛对患者很重要。目前，推荐的量表是 0-10 数字评分量表和视觉模拟量表。然而，这些量表允许个人想象、先前的经验和应对技能产生相当大的影响，限制了在比较临床试验中的熟练程度。我们旨在探讨术后“有多痛”的表达，这是改善疼痛强度测量的第一步。
这是一项使用归纳内容分析的定性研究：通过在 COSMIN、PubMed 和 Google 上搜索、记录并逐字转录患者访谈、同样转录临床医生访谈以及对 100 名患者进行电话访谈并记录笔记，从（i）现有的疼痛强度测量中收集描述疼痛强度的词语和视觉线索。在熟悉之后，将收集到的表达进行归纳分类，并以表格形式（基于案例和主题的矩阵）组合。
描述符分为 12 类：强度（轻微/强烈）、评估（可忽略/无法忍受）、认知影响（分散/可忽略）、活动影响（限制部分/全部活动）、睡眠影响（可/无法入睡）、示例（如脚趾被撞）、身体迹象（哭泣/扭动）、伴随症状（恶心/疲倦）、治疗（冰敷有帮助/需要吗啡）、情感（恼人/可怕）、鉴别（隐隐作痛/刺痛）和一般恢复（阻碍恢复/功能干扰）。还确定了许多视觉线索。文献和记录访谈产生了这些类别，而电话访谈则发现了饱和度，没有产生进一步的类别。
疼痛强度通过属于 12 个类别的术语和各种图形元素来表达。这为骨科试验中患者报告的疼痛强度测量结果的发展提供了帮助。
