Determination of moderate-to-severe postoperative pain on the numeric rating scale: a cut-off point analysis applying four different methods
Determination of moderate-to-severe postoperative pain on the numeric rating scale: a cut-off point analysis applying four different methods
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DOI：
10.1093/bja/aer195
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发表时间：
2011-10-01
影响因子：
9.8
通讯作者：
Meissner, W.
中科院分区：
文献类型：
--
作者：
Gerbershagen, H. J.;Rothaug, J.;Meissner, W.
背景。数字评定量表（NRS 0-10）的分界点（CPs）通常用于术后疼痛治疗。然而，没有足够的证据来确定轻度和中度疼痛之间的最佳CP。共有435名接受普通、创伤或口腔颌面外科手术的患者被研究。为了确定疼痛治疗的最佳CP，采用了四种方法：首先，患者在手术前估计其可忍受的术后疼痛强度；其次，术后24小时，他们表示是否愿意接受更多的镇痛药；第三，对疼痛治疗的满意度进行分析，第四，采用多变量分析计算疼痛强度对运动、呼吸、睡眠和情绪干扰的最佳CP。术前可耐受的术后疼痛中位数（范围）为NRS 4.0（0-10）。希望使用更多镇痛药的患者报告手术后的平均疼痛明显高于没有这种要求的患者[NRS中位数5.0 (0-9)][NRS 3.0(0-8)]。对疼痛治疗满意的患者报告的平均疼痛强度中位数NRS为3.0(0-8)，而不太满意的患者的NRS为5.0（2-9）。分析术后平均疼痛与疼痛相关的情绪和活动干扰的关系，表明疼痛分类为NRS 0-2、轻度；3 - 4,温和;5-10，重度疼痛。四种方法中有三种方法确定了NRS平均疼痛的治疗阈值>= 4。这被认为是识别中度至重度疼痛的患者。这个临界值被确定为可耐受痛阈。
Background. Cut-off points (CPs) of the numeric rating scale (NRS 0-10) are regularly used in postoperative pain treatment. However, there is insufficient evidence to identify the optimal CP between mild and moderate pain.Methods. A total of 435 patients undergoing general, trauma, or oral and maxillofacial surgery were studied. To determine the optimal CP for pain treatment, four approaches were used: first, patients estimated their tolerable postoperative pain intensity before operation; secondly, 24 h after surgery, they indicated if they would have preferred to receive more analgesics; thirdly, satisfaction with pain treatment was analysed, and fourthly, multivariate analysis was used to calculate the optimal CP for pain intensities in relation to pain-related interference with movement, breathing, sleep, and mood.Results. The estimated tolerable postoperative pain before operation was median (range) NRS 4.0 (0-10). Patients who would have liked more analgesics reported significantly higher average pain since surgery [median NRS 5.0 (0-9)] compared with those without this request [NRS 3.0 (0-8)]. Patients satisfied with pain treatment reported an average pain intensity of median NRS 3.0 (0-8) compared with less satisfied patients with NRS 5.0 (2-9). Analysis of average postoperative pain in relation to pain-related interference with mood and activity indicated pain categories of NRS 0-2, mild; 3-4, moderate; and 5-10, severe pain.Conclusions. Three of the four methods identified a treatment threshold of average pain of NRS >= 4. This was considered to identify patients with pain of moderate-to-severe intensity. This cut-off was indentified as the tolerable pain threshold.