69 Defining Numerical Cutoff Values for Mild, Moderate, and Severe Pain in Adult Burn Survivors

Abstract Introduction Pain is a common and often debilitating sequelae of a significant burn injury. Clinicians and researchers need clinically valid, reliable pain measures to guide treatment decisions and to provide evidence for study protocol development. Pain rating scores that represent mild, moderate, and severe pain in the burn survivor population have not been established. The aim of this study was to determine the numerical pain intensity rating scores that best represent mild, moderate, and severe pain in adult burn survivors. Methods Average pain intensity visual analog scale (VAS; 0–10) and customized PROMIS pain interference short form was administered to adult burn survivors (age ≥18) treated at a regional burn center at hospital discharge and at 6, 12, and 24-months postburn. To identify the optimal VAS scores for mild, moderate, and severe pain we computed F values and Bayesian Information Criterion (BIC) statistics associated with multiple ANOVA comparisons for mean pain interference scores by various VAS pain intensity cut points. Six possible cut points (CP) were compared: CP 3,6; CP 3,7; CP 4,6; CP 4,7; CP 2,5; and CP 3,5. For example, CP 3,6 refers to pain categorized as mild (0–3), moderate (4–6), and severe (7–10). Optimal cutoffs were those with the highest ANOVA F statistics. Models with similar F statistics were compared using changes in BIC. Results 178 participants (85% white, 65% male, mean age of 46 years) with pain intensity and interference scores at one or more timepoints comprised the study sample. The optimal classification for mild, moderate, and severe pain at baseline and 12-months was CP 2,5. Although CP 3,6 had the highest F value at 6-months, there was not strong evidence to support CP 3,6 over CP 2,5 (BIC difference: 2.9); similarly, CP 3,7 had the highest value at 24-months, but the BIC difference over CP 2,5 was minimal (2.2). Conclusions We recommend that visual analog pain intensity scores for adult burn survivors be categorized as mild (0–2), moderate (3–5), and severe (6–10). These findings advance our understanding regarding the meaning of pain intensity ratings following a burn injury and provide an objective definition for clinical management, quality improvement, and pain research.

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Pain Intensity and Pain Interference in Older Adults: Role of Gender, Obesity and High-Sensitivity C-Reactive Protein

Gerontology ◽

10.1159/000446651 ◽

2016 ◽

Vol 63 (1) ◽

pp. 3-12 ◽

Cited By ~ 16

Author(s):

Vahid Eslami ◽

Mindy J. Katz ◽

Robert S. White ◽

Erin Sundermann ◽

Julie M. Jiang ◽

...

Keyword(s):

Older Adults ◽

Pain Intensity ◽

Short Form ◽

High Sensitivity ◽

Pain Interference ◽

C Reactive Protein ◽

Medical Outcomes ◽

Cross Sectional ◽

Reactive Protein ◽

Aging Study

Background: Among older adults, pain intensity and pain interference are more common in women than men and associated with obesity and inflammatory markers. Objective: We examined whether the obesity and pain relationship is mediated by the high-sensitivity C-reactive protein (hsCRP), a nonspecific marker of systemic inflammation, and whether this relationship differs by sex. Methods: Items from Medical Outcomes Study Short Form-36 were used to measure pain intensity and pain interference in daily life. Ordinal logistic regression was used to assess the cross-sectional association among body mass index (BMI), hsCRP levels, pain intensity and pain interference using gender-stratified models adjusted for demographic variables. Results: Participants included 667 community-residing adults over the age of 70 years, free of dementia, enrolled in the Einstein Aging Study (EAS). In women (n = 410), pain intensity was associated with obesity [BMI ≥30 vs. normal, odds ratio (OR) = 2.29, 95% confidence interval (CI) 1.43-3.68] and higher hsCRP (OR = 1.28, 95% CI 1.08-1.51). In a model with obesity and hsCRP, both remained significant, but the association between hsCRP and pain intensity was somewhat attenuated. Obesity (OR = 3.04, 95% CI 1.81-5.11) and higher hsCRP levels (OR = 1.30, 95% CI 1.08-1.56) were also independently associated with greater pain interference in women. After adjustment for pain intensity and BMI, hsCRP was no longer associated with pain interference in women. Greater pain intensity and being overweight or obese continued to be significantly associated with pain interference in women. In men (n = 257), obesity and hsCRP were not associated with pain intensity or pain interference. Conclusions: In women, the relationship between obesity and higher levels of pain intensity or interference may be accounted for by factors related to hsCRP.

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Predictors of itch and pain in the 12 months following burn injury: results from the Burns Registry of Australia and New Zealand (BRANZ) Long-Term Outcomes Project

Burns & Trauma ◽

10.1093/burnst/tkz004 ◽

2020 ◽

Vol 8 ◽

Cited By ~ 2

Author(s):

Lincoln M Tracy ◽

Dale W Edgar ◽

Rebecca Schrale ◽

Heather Cleland ◽

Belinda J Gabbe ◽

...

Keyword(s):

Quality Of Life ◽

Severe Pain ◽

Burn Injury ◽

Short Form ◽

Bodily Pain ◽

Health Related Quality ◽

Sf 36 ◽

Related Quality ◽

Health Related

Abstract Background Itch and pain are common complaints of patients with burn injuries. This study aimed to describe the prevalence and predictors of itch and moderate to severe pain in the first 12 months following a burn injury, and determine the association between itch, moderate to severe pain, work-related outcomes, and health-related quality of life following a burn injury. Methods Burn patients aged 18 years and older were recruited from five Australian specialist burn units. Patients completed the 36-item Short Form Health Survey Version 2 (SF-36 V2), the Sickness Impact Profile (SIP) work scale, and a specially developed questionnaire relating to itch at 1, 6, and 12 months post-injury. Moderate to severe pain was defined as a score less than 40 on the bodily pain domain of the SF-36 V2. Multivariate mixed-effects regression models were used to identify patient and burn injury predictors of itch and moderate to severe pain. Results Three hundred and twenty-eight patients were included. The prevalence of itch decreased from 50% at 1 month to 27% at 12 months. Similarly, the prevalence of moderate to severe pain decreased from 23% at 1 month to 13% at 12 months. Compared to patients aged 18-34, the adjusted odds of experiencing any itch were 59% (95% CI: 0.20, 0.82) and 55% (95% CI: 0.22, 0.91) lower for patients aged between 35 and 49 and ≥ 50 years, respectively. Compared to patients aged 18-34, the adjusted odds of experiencing moderate to severe pain were 3.12 (95% CI: 1.35, 7.20) and 3.42 (95% CI: 1.47, 7.93) times higher for patients aged 35-49 and ≥ 50 years, respectively. Conclusions Less than 15% of patients reported moderate or severe pain at 12 months, while approximately one-quarter of the patients reported itch at the same period. The presence of moderate to severe pain was associated with a greater negative impact on health-related quality of life and work outcomes compared to itch. Further research is needed to improve our ability to identify patients at higher risk of persistent itch and pain who would benefit from targeted review and intervention studies.

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Effect of abiraterone acetate (AA) on patient-reported pain in metastatic castration-resistant prostate cancer (mCRPC) post-docetaxel: Results of longitudinal sensitivity analyses.

Journal of Clinical Oncology ◽

10.1200/jco.2013.31.15_suppl.9618 ◽

2013 ◽

Vol 31 (15_suppl) ◽

pp. 9618-9618 ◽

Cited By ~ 2

Author(s):

Yanni Hao ◽

Charles S. Cleeland ◽

Dennis Gagnon ◽

Derek Espindle ◽

Arturo Molina ◽

...

Keyword(s):

Missing Data ◽

Pain Intensity ◽

Short Form ◽

Mixed Effects ◽

Pain Interference ◽

Sensitivity Analyses ◽

Repeated Measure ◽

Patient Reported ◽

Pain Outcomes ◽

The Impact

9618 Background: The COU-AA-301 phase 3 trial showed that AA + prednisone (P) improved overall survival in mCRPC patients (pts) post-docetaxel. Compared with P alone, AA + P also had significant benefits on patient-reported pain. Here we describe post hoc sensitivity analyses of pain data from that trial, using different methods to compensate for the potential impact of missing data. Methods: Pts with mCRPC progressing after docetaxel-based chemotherapy were randomized 2:1 to AA + P or placebo + P. Pain intensity and interference of pain with daily activities were assessed with the Brief Pain Inventory-Short Form (BPI-SF) questionnaire at baseline, Day 15 of Cycle 1, and Day 1 of each 28-day treatment cycle thereafter until treatment discontinuation. The effect of treatment on BPI-SF scores was analyzed using repeated measure mixed-effects (RMM) models, piecewise linear mixed-effects (PWLME) models, and joint mixed-effects and log time-to-dropout (JMEL) models. RMM and PWMLE models assumed missing data (due to death, study dropout, or administrative issues) to be missing at random, the JMEL model to be missing not at random. Model results were compared between treatment arms. Results: 797 pts were randomized to AA + P, and 398 to P only. RMM model estimates suggested statistically significant (p < 0.05) differences in change from baseline for pain intensity and pain interference scores in favor of AA + P at the majority of study visits through cycle 11. PWLME models yielded significantly smaller areas under the curve (AUCs) for AA + P vs P for pain intensity (p = 0.0031) and pain interference (p = 0.0006); smaller AUCs reflect better pain outcomes. Results using JMEL models were nearly identical to those with PWLME models, with AUCs for AA + P significantly smaller than for P alone for pain intensity (p = 0.0031) and pain interference (p = 0.0007). Conclusions: Using various modeling methods that assess the impact of missing data, AA + P showed superior patterns of pain outcomes over time compared with P only in mCRPC pts refractory to docetaxel. These results support the previously reported pain benefits of AA + P over P alone from the same trial. Clinical trial information: NCT00638690.

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Effect of Milnacipran on Pain in Patients with Rheumatoid Arthritis with Widespread Pain: A Randomized Blinded Crossover Trial

The Journal of Rheumatology ◽

10.3899/jrheum.150550 ◽

2015 ◽

Vol 43 (1) ◽

pp. 38-45 ◽

Cited By ~ 12

Author(s):

Yvonne C. Lee ◽

Elena Massarotti ◽

Robert R. Edwards ◽

Bing Lu ◽

ChihChin Liu ◽

...

Keyword(s):

Rheumatoid Arthritis ◽

Pain Intensity ◽

Short Form ◽

Experimental Pain ◽

Study Drug ◽

Widespread Pain ◽

Double Blind ◽

Link Type ◽

Average Pain Intensity ◽

Average Pain

Objective.Clinical trials have shown that serotonin norepinephrine reuptake inhibitors, such as milnacipran, decrease pain in noninflammatory pain conditions such as fibromyalgia and osteoarthritis. We examined the effect of milnacipran on self-reported pain intensity and experimental pain sensitivity among patients with rheumatoid arthritis (RA) with widespread pain and stable RA disease activity.Methods.In this double-blind, crossover study, patients with RA with widespread pain, receiving a stable treatment regimen, were randomized (by a random number generator) to receive milnacipran 50 mg twice daily or placebo for 6 weeks, followed by a 3-week washout and crossed over to the other arm for the remaining 6 weeks. The primary outcome was change in average pain intensity, assessed by the Brief Pain Inventory short form. The sample size was calculated to detect a 30% improvement in pain with power = 0.80 and α = 0.05.Results.Of the 43 randomized subjects, 41 received the study drug, and 32 completed the 15-week study per protocol. On a 0–10 scale, average pain intensity decreased by 0.39 (95% CI −1.27 to 0.49, p = 0.37) more points during 6 weeks of milnacipran treatment compared with placebo. In the subgroup of subjects with swollen joint count ≤ 1, average pain intensity decreased by 1.14 more points during 6 weeks of milnacipran compared with placebo (95% CI −2.26 to −0.01, p = 0.04). Common adverse events included nausea (26.8%) and loss of appetite (9.7%).Conclusion.Compared with placebo, milnacipran did not improve overall, self-reported pain intensity among subjects with widespread pain receiving stable RA medications. Trial registration:ClinicalTrials.govNCT01207453.

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Pain intensity and interference with functioning and well-being in subgroups of patients with chronic pain treated with once-daily hydrocodone tablets

Journal of Opioid Management ◽

10.5055/jom.2015.0305 ◽

2015 ◽

Vol 11 (6) ◽

pp. 519 ◽

Cited By ~ 8

Author(s):

Adrian Bartoli, MD ◽

Edward Michna, MD ◽

Ellie He, PhD ◽

Warren Wen, PhD

Keyword(s):

Sleep Quality ◽

Pain Intensity ◽

Rating Scale ◽

Short Form ◽

Well Being ◽

Pain Interference ◽

Dose Titration ◽

Meaningful Improvement ◽

Once Daily ◽

Subgroup Differences

Background: A previous 52-week trial of patients with chronic noncancer, nonneuropathic pain (CNNP) showed clinically meaningful improvement in pain intensity, pain interference, and physical health-related quality of life (HRQL) following daily treatment with an extended-release, once-daily hydrocodone (Hysingla® ER; HYD) bitartrate tablet.Objective: To examine treatment response within patient subgroups and to assess between-subgroup differences in effectiveness and side effect profile. Methods: Data were from an open-label 52-week trial of treatment with HYD tablets (20-120 mg, once-daily) for patients with moderate-to-severe CNNP. Binary subgroups were defined for the following six factors: age, gender, opioid experience, baseline pain severity, history of depression, and stable HYD dose at completion of a 45-day dose-titration period. Univariable and multivariable models examined changes in average pain intensity (API; 11-point numeric rating scale), pain interference (Brief Pain Inventory-Interference subscale [BPI-I]), physical and mental HRQL (36-item Short Form health survey Physical and Mental Component Summaries [PCS and MCS]), and sleep quality (Medical Outcomes Study Sleep Scale Sleep Problems Index [SPI]) from baseline to maintenance, and subgroup differences in adverse events.Results: All subgroups showed clinically meaningful improvements in API, BPII, and PCS scores; no subgroups showed improvements in MCS or SPI. Between subgroup comparisons found greater improvements for opioid-naïve patients and for patients with severe baseline pain. Incidence of adverse events differed minimally between subgroups.Conclusion: Regardless of subgroup, patients with CNNP treated with HYD showed clinically meaningful improvements in pain intensity, pain interference, and physical HRQL, although not in mental HRQL or sleep quality. Improvements were generally larger for opioid-naïve patients and patients with severe baseline pain.

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Interpreting Life Impact Burn Recovery Evaluation Profile Scores for Use by Clinicians, Burn Survivors, and Researchers

Journal of Burn Care & Research ◽

10.1093/jbcr/iraa100 ◽

2020 ◽

Author(s):

Mary D Slavin ◽

Colleen M Ryan ◽

Jeffrey C Schneider ◽

Amy Acton ◽

Flor Amaya ◽

...

Keyword(s):

Social Participation ◽

Burn Injury ◽

Sexual Relationships ◽

Cut Points ◽

Delphi Approach ◽

Patient Reported ◽

Burn Survivors ◽

Life Impact ◽

Four Levels ◽

Different Levels

Abstract The Life Impact Burn Recovery Evaluation (LIBRE) Profile is a patient-reported outcome measure developed to assess social participation in adult burn survivors. This study identified numeric score cut-points that define different levels of social participation ability and described each level. An expert panel identified numeric score cut-points that distinguish different levels of social participation for the six LIBRE Profile domains. Methods employed an iterative, modified-Delphi approach, and bookmarking to review calibrated item banks. Analyses (using calibration sample data and repeated in a validation sample) examined means, SDs, and sample distributions for each level. Analyses of variance examined score differences between levels. The panel developed descriptions for each established level. Initial cut-points resulted in four levels for five domains (Social Activities, Social Interactions, Romantic Relationships, Sexual Relationships, and Work & Employment) and five levels for the sixth domain (Relationships with Family & Friends). Comparisons demonstrated significant differences between level mean scores for all domains (P < .05) except Relationships with Family & Friends. Based on follow-up surveys, Relationships with Family & Friends score cut-points were adjusted to identify four levels with significant score differences between all levels. Panelists reached consensus for level descriptions. Score cut-points and descriptions identify different levels of social participation, providing a relevant context for interpreting LIBRE Profile numeric scores. LIBRE Profile Social Participation levels will help clinicians and persons with burn injury interpret LIBRE Profile numeric scores and promote use of this important new assessment.

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The scope and nature of pain in persons with multiple sclerosis

Multiple Sclerosis Journal ◽

10.1177/1352458506071346 ◽

2006 ◽

Vol 12 (5) ◽

pp. 629-638 ◽

Cited By ~ 96

Author(s):

D M Ehde ◽

T L Osborne ◽

M A Hanley ◽

M P Jensen ◽

G H Kraft

Keyword(s):

Multiple Sclerosis ◽

Pain Intensity ◽

Psychosocial Functioning ◽

Psychological Functioning ◽

Severe Pain ◽

Brief Pain Inventory ◽

Postal Survey ◽

Community Dwelling ◽

Pain Interference ◽

Standardized Measures

Much remains unknown about the scope, nature, and impact of pain on the lives of persons with multiple sclerosis (MS). In the present study, 180 community dwelling adults with MS completed a postal survey that included demographic measures, MS disease measures, and several standardized measures of pain, including pain intensity, variability, location, and pain-related interference. Some 66% of the sample reported pain, 25% of whom reported severe pain. Persons with pain reported an average of 6.6 distinct pain sites. Using the Brief Pain Inventory Interference Scale, the average level of overall pain interference was 3.33 (0- 10 scale) in the group reporting pain. The highest levels of pain interference were reported for sleep, recreational activities, and work in and outside the home. Persons with pain were more likely to report greater MS disease severity, poorer psychological functioning, and poorer health than persons with MS but not pain. Persons with pain were also less likely to be employed. These findings are consistent with previous research that shows that pain is common in MS, that it is severe in a substantial subset of these individuals and has the potential to negatively impact physical and psychosocial functioning over and above the effects of MS itself.

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PAIN INTENSITY AND PAIN INTERFERENCE AMONG TRAUMA PATIENTS: A LITERATURE REVIEW

Belitung Nursing Journal ◽

10.33546/bnj.34 ◽

2016 ◽

Vol 2 (6) ◽

pp. 131-139 ◽

Cited By ~ 1

Author(s):

Deya Prastika ◽

Luppana Kitrungrote ◽

Jintana Damkliang

Keyword(s):

Pain Intensity ◽

Tissue Damage ◽

Burn Injury ◽

Brief Pain Inventory ◽

The Body ◽

Pain Interference ◽

Trauma Patients ◽

Transfer Energy ◽

Functional Interference ◽

Specific Tissue

Background: The incidence of trauma has been high and has gained attention worldwide. The energy involved in trauma results in specific tissue damage. Such tissue damage generally leads to pain. The high pain intensity possibly is consequence of trauma due to transfer energy to the body from external force and absorbed in wide area. This pain affected patients’ physical and psychological function, in which well known as pain interference.Objective: The aim of this review is to describe the pain intensity and pain interference among trauma patients.Method: A systematic search of electronic databases (CINHAL, ProQuest, Science Direct, and Google scholar) was conducted for quantitative and qualitative studies measuring pain intensity and pain interference. The search limited to hospitalized trauma patients in adult age.Results: The search revealed 678 studies. A total of 10 descriptive studies examined pain intensity and pain interference and met inclusion criteria. The pain intensity and pain interference was assessed using Brief Pain Inventory (BPI). Pain intensity of hospitalized trauma patients were moderate to severe. These including 6 studies in orthopedic trauma, one study in musculoskeletal, two in studies in combinational between orthopedic and musculoskeletal, and two studies in burn injury. Moreover, the patients also reported pain was relentless & unbearable. In accordance, data showed that pain interference was moderate to severe from six studies. These studies result in vary of functional interference. However, those studies examined pain interference on sleep, enjoyment of life, mood, relationship with other, walking, general activity, and walking.Conclusion: The evidence from 10 studies included in this review indicates that hospitalized trauma patients perceived moderate to severe pain intensity and pain interference. Further research is needed to better evaluate the pain of hospitalized trauma patients.

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94 Agreement Between Proxy- and Self-Report PROMIS Scores in Pediatric Burn Survivors

Journal of Burn Care & Research ◽

10.1093/jbcr/irab032.098 ◽

2021 ◽

Vol 42 (Supplement_1) ◽

pp. S65-S65

Author(s):

Dagmar Amtmann ◽

Alyssa M Bamer ◽

Kara McMullen ◽

Barclay T Stewart ◽

Lewis E Kazis ◽

...

Keyword(s):

Peer Relationships ◽

Effect Size ◽

Short Form ◽

Intraclass Correlation ◽

Self Report ◽

Pain Interference ◽

Proxy Report ◽

Factors Associated ◽

Small Effect Size ◽

Burn Survivors

Abstract Introduction Reporting by proxy is necessary when patients are not able to report their own experience, such as young children or those too sick to respond. PROMIS pediatric proxy-report item banks are a set of generic measures that facilitate comparisons across populations and studies. Our objectives were to (1) examine agreement in pediatric burn survivors between child self- and caregiver proxy-report on multiple PROMIS domains and (2) examine factors associated with differences between self- and proxy-reports. Methods Data were collected from children 8–17 years with moderate to severe burn injury and their respective caregivers between 6 months and 15 years after injury. The PROMIS-25 and Anger v1.0 short form were completed by pediatric burn participants. Caregivers completed either custom (depression, pain interference) or standard (Physical Function (PF) 8a, Peer 7a, Anger 5a) PROMIS proxy short forms. Self- and proxy-report scores were compared using Wilcoxon sign rank test, Cohen’s effect size, and intraclass correlation coefficients (ICC(2,1)) and by agreement across severity of symptoms based on recommended cutoffs. Regression analyses examined child- (self-report score, age, gender, and ethnicity) and proxy-related (relationship to child) factors associated with score differences. Results A total of 274 child-caregiver pairs completed the PROMIS measures. Mean child age was 13.0 (SD:3) years. Caregivers reported significantly worse scores than the child on PF, pain, and anger (all p≤0.01). Cohen’s d ranged from 0.05 (depression) to 0.25 (PF), with all domains except PF in the small effect size range (< 0.2). Similarly, ICCs were all of moderate agreement and ranged from 0.51 (pain) to 0.69 (depression). The percentage of dyads in agreement by severity groups was high with only 5% (pain), 8% (PF, peer relationships), and 9% (depression, anger) of pairs discordant. Regression models indicated only higher self-report score was associated (all p< 0.05) with greater differences across all domains, though female gender was also associated with greater differences on depression only. Conclusions This study provides support for the use of pediatric proxy PROMIS depression, PF, peer relationships, pain interference, and anger scales in pediatric burn patients. Although agreement was moderate to good, proxy report should only be considered when self-report is not possible or practical. Caregivers typically report slightly worse severity of symptoms than children across all domains.

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Chronic pain in a large community sample of persons with multiple sclerosis

Multiple Sclerosis Journal ◽

10.1191/1352458503ms939oa ◽

2003 ◽

Vol 9 (6) ◽

pp. 605-611 ◽

Cited By ~ 124

Author(s):

Dawn M Ehde ◽

Laura E Gibbons ◽

Lydia Chwastiak ◽

Charles H Bombardier ◽

Mark D Sullivan ◽

...

Keyword(s):

Multiple Sclerosis ◽

Chronic Pain ◽

Pain Intensity ◽

Severe Pain ◽

Community Sample ◽

Large Community ◽

Average Pain Intensity ◽

Intensity Rating ◽

Average Pain ◽

Pain Problem

Introduction: This study examined the prevalence, intensity, interference, and biopsychosocial correlates of pain in a large community-based sample of persons with multiple sclerosis (MS). Methods: Mail surveys were returned by 442 members of the King C ounty (WA) MS Association. Average pain intensity, pain-related activity interference, depressive symptoms and severity of MS were assessed. Results: Forty-four percent reported persistent, bothersome pain in the three months prior to completing the survey. Participants with pain reported an average pain intensity rating of 5.2 (SD =2.3) on the 0 (no pain) to 10 (pain as bad as could be) scale. Twenty-seven percent reported severe pain (score of 7-10), while 51% of those with pain rated the interference of their pain with daily activities as none to minimal. Twenty percent reported severe interference in activities as a result of pain. In multivariate modeling, MS illness severity, marital status, and self-ratings of overall health were significantly associated with pain-related interference with activities. Conclusions: A pproximately a fourth of this sample described having a chronic pain problem characterized by severe pain intensity and significant pain-related interference with activities. Disability due to pain may be more important than previously recognized for the MS population.

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