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Determining Pain Detection and Tolerance Thresholds Using an Integrated, Multi-Modal Pain Task Battery
Published on: April 14, 2016
A method for overcoming the ceiling effect of bounded pain scales
M W Hartmannsgruber1, C P Swamidoss, A Budde
1Department of Anesthesiology, Yale University School of Medicine, New Haven, CT 06520-8051, USA.
Journal of Clinical Monitoring and Computing
|February 13, 2003
Summary
The Verbal Numerical Scale (VNS) for pain is limited. Integrating VNS with magnitude estimation (VNSext) shows the VNS ceiling can restrict pain descriptions, but VNSext may overcome this.
Area of Science:
- Pain Perception Research
- Psychophysics
- Quantitative Sensory Testing
Background:
- The Verbal Numerical Scale (VNS) is a common tool for pain assessment, ranging from 0 (no pain) to 10 (worst imaginable pain).
- The bounded nature of the VNS may limit its ability to accurately capture extremely high pain intensities.
Purpose of the Study:
- To investigate the limitations of the VNS when assessing intense pain stimuli.
- To explore the utility of integrating the VNS with magnitude estimation of relative change to overcome VNS ceiling effects.
Main Methods:
- Volunteers received graded electrical stimuli, with a reference stimulus (S) set at a VNS score >5.
- Magnitude estimations were obtained for stimuli with currents of S, S(+10 mA), S(+20 mA), S(1/2), and Srepeat.
- An extrapolated VNS score (VNSext) was calculated by multiplying magnitude estimates by the VNS score for S.
Main Results:
- Seventy percent of stimuli exceeding the reference stimulus intensity yielded a VNSext score greater than 10.
- Stimuli S(+10) and S(+20) had mean magnitude estimations of 186% and 242%, respectively.
- These resulted in mean VNSext values of 12.4 and 16.2, significantly differing (p=0.019).
Conclusions:
- The VNS ceiling effect can significantly limit patients' capacity to describe new, intense pain stimuli.
- Combining VNS with magnitude estimation (VNSext) offers a method to overcome the limitations of bounded pain scales.
- VNSext may provide a more comprehensive assessment of high-intensity pain.
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