Assessment of Functional Pain Score by Comparing to Traditional Pain Scores

Pain assessments, such as the Numerical Pain Scale (NPS) and Wong-Baker FACEs (FACEs), offer methods to quantify pain with simplistic descriptions on a scale of 0-10 or facial expressions. These tools have limitations and deliver insufficient information to the provider developing a pain management plan. A new Functional Pain Scale (FPS) assesses other scopes of pain, including the loss of function in activities of daily living, sleep habits, and communication. Although NPS and FACEs are traditionally used in clinical practice, FPS provides a functional assessment to help patients self-report their pain to their providers.  Aim: Our study attempts to show a comparative data analysis of the FPS to NPS and FACEs. The purpose of our study is not to demonstrate FPS's superiority over NPS and FACEs but to fill the gaps of information necessary to communicate the type of pain a patient has to their provider. Due to its descriptive nature and clear scores, FPS should be implemented within electronic medical records (EMR) to help providers assess patients' pain and evaluate the efficacy of interventions selected based on that pain.

A prospective, observational, single-center, cohort study was performed, with simultaneously administered surveys to compare pains scores on a new FPS to the common NPS and FACEs. The target sample was postoperative orthopedic patients above 18 years of age who can read and speak English. Patients were surveyed on all three pain scales: FPS, NPS, and FACEs and were asked to rate their pain perioperatively after their respective orthopedic procedures.

Spearman correlation method was used to test for correlation between the three pain scales and Wilcoxon rank-sum test was used to compare means between FPS and NPS.

FPS has a strong correlation with FACEs (r = 0.647, p<0.05) and with NPS (r = 0.634, p<0.05). There is a significant difference in mean scores between FPS and NPS. Conclusion and study implications: The most reliable marker of pain is patient self-reporting. In routine assessment, because pain is one-dimensional, we as providers need to better define the range of 0-10. This can only be done via an algorithm regarding which functions are lost as pain intensities increase. FPS fits those requirements by offering suitable descriptions with each pain score. The implications of the study include a chance to remedy the opioid crisis that plagues healthcare. We need tools that assess and educate patients about their pain level and appropriately convey that information to providers. Furthermore, this study is a chance for innovative tools to be implemented to better change healthcare practice. If FPS gains traction, it can improve pain communication between patients and providers.