Maximum pain on visual analog scales in spinal disorders

Area of Science:

• Orthopedics
• Pain Management
• Spine Surgery

Background:

• Patient-reported pain intensity is subjective.
• Visual analog scale (VAS) is a common tool for pain assessment.

Purpose of the Study:

• To compare symptom improvement in patients reporting maximum pain (10/10 VAS) versus those with milder pain.
• To investigate factors influencing pain improvement in spinal disorder patients.

Main Methods:

• Retrospective chart review of 6,779 spinal disorder patients.
• Analysis of VAS pain scores, smoking status, depression, gender, and secondary gain.
• Inclusion of patients with lumbar degenerative disk disease and/or spinal stenosis.

Main Results:

• 160 patients (2.9%) reported initial 10/10 VAS pain.
• Median VAS pain improvement was 3 points.
• Higher odds (1.500) of at least 40% VAS improvement compared to submaximal pain.
• Secondary gain was more prevalent in the 10/10 VAS group (p=.001).
• Dramatic pain improvement (≥4 points) associated with older age, less secondary gain, and non-smoking status.
• Persistent 10/10 pain linked to higher smoking frequency (p=.016).

Conclusions:

• Secondary gain significantly impacts reported pain scores.
• Maximum pain (10/10 VAS) may represent an acute phenomenon with substantial improvement potential.
• Consideration of psychosocial factors is crucial in pain management.