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Updated: Jun 19, 2026
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Determining Pain Detection and Tolerance Thresholds Using an Integrated, Multi-Modal Pain Task Battery
Published on: April 14, 2016
Exploring alternative approaches to routine outpatient pain screening
Karl A Lorenz1, Erin E Krebs, Tanya G K Bentley
1Veterans Administration Greater Los Angeles Healthcare System, Division of General Internal Medicine, Los Angeles, CA 90073, USA. karl.lorenz@med.va.gov
Pain Medicine (Malden, Mass.)
|October 13, 2009
Summary
Assessing pain-related bother may improve routine pain detection. Alternative strategies to the numeric rating scale (NRS) show promise for better pain screening in clinical settings.
Area of Science:
- Pain Management
- Clinical Assessment
- Health Services Research
Background:
- The numeric rating scale (NRS) is commonly used for pain screening.
- Limitations exist in accurately identifying all patients with significant unrelieved pain using current methods.
Purpose of the Study:
- To evaluate alternative pain screening methods beyond the standard NRS.
- To identify strategies that improve the detection of important unrelieved pain in routine clinical practice.
Main Methods:
- A cross-sectional study was conducted across 19 Veterans Affairs outpatient clinics.
- 528 veterans completed surveys assessing their clinic experience and pain.
- Sensitivity, specificity, and AUC were used to evaluate alternative pain screening items against the Brief Pain Inventory (BPI) interference scale.
Main Results:
- 43.6% of veterans reported unrelieved pain.
- Alternative screening items, particularly those assessing pain-related bother over the past week, demonstrated higher accuracy than the traditional 'fifth vital sign'.
- A sequential approach combining pain-related bother and a 1-week NRS showed good discriminatory ability (AUCs of 0.86).
Conclusions:
- Pain screening strategies incorporating pain-related bother may enhance the detection of significant unrelieved pain.
- Alternative or combined approaches to the NRS could improve routine pain assessment.
