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Do 0-10 numeric rating scores translate into clinically meaningful pain measures for children?
Terri Voepel-Lewis1, Constance N Burke, Nicole Jeffreys
1University of Michigan Health Systems, 1500 E. Medical Center Drive, Ann Arbor, MI 48109-5211, USA. terriv@umich.edu
Insights
The numerical rating scale (NRS) for pain is a valid tool for children, but specific cut-points for treatment decisions are not appropriate due to score variability. This study evaluated NRS pain scores against perceived need for medicine, pain relief, and satisfaction in children postoperatively.
Area of Science:
- Pediatric Pain Management
- Clinical Measurement
- Patient-Reported Outcomes
Background:
- Self-reported pain scores are widely used but their interpretation in children remains unclear.
- Understanding pain score interpretability is crucial for effective pediatric care.
- This study focuses on the postoperative setting, a common scenario for pain assessment in children.
Purpose of the Study:
- To evaluate the interpretability of the 0-10 numerical rating scale (NRS) pain scores in children.
- To examine the relationship between NRS pain scores and clinically meaningful outcomes like perceived need for medicine (PNM), pain relief (PR), and perceived satisfaction (PS).
- To determine the validity of NRS scores in assessing pain intensity and treatment effectiveness in pediatric postoperative patients.
Main Methods:
- A prospective, observational study involving children aged 7-16 years undergoing surgery.
- Collected 1-4 observations within 24 hours postoperatively, recording NRS pain scores, PNM, and PS.
- Utilized receiver operator characteristic curves to identify potential NRS cut-points and calculated the minimum clinically significant difference (MCSD) for PR.
Main Results:
- NRS scores associated with PNM were significantly higher (median 6) than for 'no need' (median 3).
- NRS scores >4 showed moderate ability to discriminate PNM, but with notable false positives/negatives.
- MCSD for PR was -1 or +1, and NRS scores >6 had moderate sensitivity/specificity for treatment dissatisfaction, yet many children remained satisfied.
Conclusions:
- The NRS is a valid measure of pain intensity concerning PNM, PR, and PS in the acute postoperative setting for children.
- Variability in NRS scores relative to other outcomes indicates that fixed cut-points are inappropriate for individual treatment decisions.
- Further research may refine the interpretation of NRS scores in pediatric pain management.
Background:
Self-reported pain scores are used widely in clinical and research settings, yet little is known about their interpretability in children. In this prospective, observational study we evaluated the relationship between 0 to 10 numerical rating scale (NRS) pain scores and other self-reported, clinically meaningful outcomes, including perceived need for medicine (PNM), pain relief (PR), and perceived satisfaction (PS) with treatment in children postoperatively.
Methods:
This study included children ages 7 to 16 years undergoing surgery associated with postoperative pain. One to 4 observations were recorded in each child within the first 24 hours postoperatively. At each assessment, children rated their pain with the NRS, stated their PNM, and rated their satisfaction with pain management. Assessments were repeated within 1 to 2 hours, and children additionally rated their PR as the same, better, or worse in comparison with the earlier assessment. Receiver operator characteristic curves were developed to examine potential NRS cut-points for PNM and PS, and the minimum clinically significant difference (MCSD) in pain score associated with PR was calculated.
Results:
Three hundred ninety-seven observations (including 189 pairs) were recorded in 113 children. NRS scores associated with PNM were significantly higher than "no need" (median 6 vs. 3; P < 0.001). NRS scores >4 had good sensitivity (0.81) and specificity (0.70) to discriminate PNM, but with a large number of false positives and negatives (e.g., 42% of children with scores >4 did not need analgesia). The MCSD in NRS scores was -1 (95% confidence interval [CI] -0.5 to 1) or +1 (CI 0.5 to 2.7) in relation to feel "a little better" or "worse," respectively (P < 0.001 vs. the same). NRS scores >6 had a sensitivity of 0.82 and specificity of 0.76 in discriminating dissatisfaction with treatment, yet 46% and 24% of children with scores >6, respectively, were somewhat to very satisfied with their analgesia.
Conclusions:
This study provides important information regarding the clinical interpretation of NRS pain scores in children. Data further support the NRS as a valid measure of pain intensity in relation to the child's PNM, PR, and PS in the acute postoperative setting. However, the variability in scores in relation to other clinically meaningful outcomes suggests that application of cut-points for individual treatment decisions is inappropriate.
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