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The association between pain and disability.

Judith A Turner1, Gary Franklin, Patrick J Heagerty

  • 1Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, 1959 NE Pacific St., Room BB1517a Box 356560, Seattle, WA 98195-6560, USA Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, WA, USA Occupational Epidemiology and Health Outcomes Program, Department of Environmental and Occupational Health Sciences, University of Washington School of Public Health and Community Medicine, Seattle, WA, USA Washington State Department of Labor and Industries, Olympia, WA, USA Department of Biostatistics, University of Washington School of Public Health and Community Medicine, Seattle, WA, USA Department of Health Services, University of Washington School of Public Health and Community Medicine, Seattle, WA, USA.

Pain
|November 25, 2004
PubMed
Summary

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Understanding pain intensity is key for effective treatment. This study found pain rating cutpoints vary by injury type (carpal tunnel syndrome vs. low back), impacting disability assessment and treatment goals.

Area of Science:

  • Occupational health
  • Pain medicine
  • Rehabilitation science

Background:

  • Pain intensity and disability are crucial for setting treatment goals in work-related injuries.
  • Optimal pain intensity cutpoints for discriminating disability levels are not well-established for conditions like carpal tunnel syndrome (CTS) and low back (LB) injuries.

Purpose of the Study:

  • Determine optimal pain intensity cutpoints for discriminating disability levels in workers with CTS and LB injuries.
  • Examine if cutpoints differ between injury types and disability measures.
  • Assess the linearity of the pain intensity-disability relationship for each injury group.

Main Methods:

  • Surveyed 2183 workers (1059 with CTS, 1124 with LB) approximately 3 weeks post-injury claim.
  • Collected data on pain intensity (0-10 scale) and various disability measures.

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  • Analyzed data to identify optimal pain intensity cutpoints and assess the pain-disability relationship.

    • Main Results:

    • For LB injuries, pain categories 1-4, 5-6, and 7-10 effectively discriminated disability levels across all measures.
    • No single pain intensity categorization scheme was superior for all disability measures in the CTS group.
    • The pain-disability relationship was linear for CTS but nonlinear for LB injuries.
    • For LB injuries, a 1-point pain decrease improved function with pain 1-4, while a 2-point decrease was needed with pain 5-10.

    Conclusions:

    • Classifying numerical pain ratings into disability-related categories can aid in setting treatment goals.
    • Pain intensity cutpoints and the pain-disability relationship vary significantly by injury condition (CTS vs. LB).
    • Classification schemes for pain intensity and disability must be validated for specific pain conditions.