Kang Matthew, Rice David, Helsby Nuala, Somogyi Andrew, Kluger Michal, Chiang Daniel
Department of Anaesthesiology, Perioperative & Pain Medicine, Health New Zealand, Te Whatu Ora Waitemata, Auckland, New Zealand.
Health and Rehabilitation Research Institute, Auckland University of Technology, Auckland, New Zealand.
Pain Rep. 2025 Jun 13;10(4):e1297. doi: 10.1097/PR9.0000000000001297. eCollection 2025 Aug.
The patient-acceptable symptom state (PASS) is a threshold score on patient-reported outcome measures beyond which patients consider their symptoms unacceptable (PASS negative). The PASS may guide the interpretation of outcomes associated with persistent pain after breast cancer surgery (PPBCS).
This study aimed to identify PASS cut-off values for the numerical rating scale (NRS) on the brief pain inventory (BPI) items for pain at 6 months after breast cancer surgery and describe functional and psychological outcomes associated with an unacceptable (PASS-negative) pain state.
This prospective cohort study included patients undergoing primary breast cancer surgery. Patients were assessed preoperatively and postoperatively at 2 weeks and 6 months using validated questionnaires. Patient-acceptable symptom state was evaluated at 6 months after surgery. Patients were classified into PASS-positive (acceptable pain state) or PASS-negative groups using a pain-specific anchor question. Patient-acceptable symptom state thresholds for the BPI items were determined using the Youden index on a receiver operating characteristic curve.
Of the 140 included patients, 13.6% reported a PASS-negative state at 6 months after surgery. Compared to PASS-positive patients, PASS-negative patients reported greater pain severity, pain interference, psychological distress, upper limb disability, and neuropathic pain (all < 0.008). Numerical rating scale patient-acceptable symptom state cut-off values for the BPI items were 1.5 (worst pain), 0.5 (average pain), and 0.8 (pain interference).
The NRS scores for the BPI worst pain >1.5, average pain >0.5, and pain interference >0.8 delineated patients with "unacceptable" PPBCS. These values may define clinically meaningful PPBCS and offer pain cut-off values for research.
患者可接受症状状态（PASS）是患者报告结局测量中的一个阈值分数，超过该分数患者认为其症状不可接受（PASS阴性）。PASS可指导对乳腺癌手术后持续性疼痛（PPBCS）相关结局的解释。
本研究旨在确定乳腺癌手术后6个月时简短疼痛问卷（BPI）项目数字评定量表（NRS）的PASS临界值，并描述与不可接受（PASS阴性）疼痛状态相关的功能和心理结局。
这项前瞻性队列研究纳入了接受原发性乳腺癌手术的患者。术前以及术后2周和6个月使用经过验证的问卷对患者进行评估。在术后6个月评估患者可接受症状状态。使用特定于疼痛的锚定问题将患者分为PASS阳性（可接受疼痛状态）或PASS阴性组。使用受试者工作特征曲线上的约登指数确定BPI项目的患者可接受症状状态阈值。
在纳入的140例患者中，13.6%在术后6个月报告为PASS阴性状态。与PASS阳性患者相比，PASS阴性患者报告的疼痛严重程度、疼痛干扰、心理困扰、上肢残疾和神经性疼痛更高（均P<0.008）。BPI项目的数字评定量表患者可接受症状状态临界值为：最严重疼痛1.5、平均疼痛0.5和疼痛干扰0.8。
BPI最严重疼痛NRS评分>1.5、平均疼痛>0.半和疼痛干扰>0.8界定了“不可接受”的PPBCS患者。这些值可能定义具有临床意义的PPBCS，并为研究提供疼痛临界值。
