Comparison of the visual analog scale (vas) and the scaling pain relief (spr) measurements in the assessment of the results of spinal cord stimulation trial and therapy: A prospective study
ABSTRACT
Objectives: The goal of this study was to compare the results of evaluating the success of spinal cord stimulation (SCS) using the Visual Analog Scale (VAS) and a Scaling Pain Relief (SPR) measurement. Methods: This prospective study included 29 patients, who were considered good candidates for an SCS trial. In the immediate post trial period, immediate post implant period, and one-month post implant period, pain relief was assessed by VAS percent change and using an SPR measurement (direct patient report of pain relief). Statistical analysis of the results included a repeated measures analysis of variance (ANOVA) comparing VAS percent change versus direct patient report of percentage of pain relief (SPR) at the post trial, post implant, and one month follow-ups for all patients that received a permanent implant. Results: Twenty-one patients had a successful trial and 20 were implanted with a permanent system. There was a strong positive correlation between the two pain relief measures at every measured timepoint. Direct patient reports of percentage of pain relief (SPR) were statistically higher than VAS percent change at the post trial period. Seven patients were considered good candidates for implantation based on the SPR measurement, but not VAS percent reduction. These patients went on to achieve clinically significant changes. Discussion: SPR measurements such as direct patient reports of pain relief should be considered in place of VAS percent change when determining SCS trial success.
Cite this paper
Mironer, Y. , Satterthwaite, J. and J. Hutcheson, K. (2014) Comparison of the visual analog scale (vas) and the scaling pain relief (spr) measurements in the assessment of the results of spinal cord stimulation trial and therapy: A prospective study. Pain Studies and Treatment, 2, 1-5. doi: 10.4236/pst.2014.21001.
Mironer, Y. , Satterthwaite, J. and J. Hutcheson, K. (2014) Comparison of the visual analog scale (vas) and the scaling pain relief (spr) measurements in the assessment of the results of spinal cord stimulation trial and therapy: A prospective study. Pain Studies and Treatment, 2, 1-5. doi: 10.4236/pst.2014.21001.
References
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[1] Shealy, C.N., Mortimer, J.T. and Reswick, J.B. (1967) Electrical inhibition of pain by stimulation of the dorsal columns. Anesthesia and Analgesia, 46, 489-491. http://dx.doi.org/10.1046/j.1525-1403.2000.00059.x [2] Wetzel, F.T., Hassenbusch, S., Oakley, J.C., et al. (2000) Treatment of chronic pain in failed back surgery patients with spinal cord stimulation: A review of current literature and proposal for future investigation. Neuromodulation, 3, 59-74. http://dx.doi.org/10.1046/j.1525-1403.2002.02027.x [3] Sharan, A., Cameron, T. and Barolat, G. (2002) Evolving patterns of spinal cord stimulation in patients implanted for intractable low back and leg pain. Neuromodulation, 5, 161-179. [4] Mironer, Y.E. (2002) Neurostimulation techniques. In: Tollison, C.D., Satterthwaite, J.R. and Tollison, J.W., Eds., Practical Pain Management, Lippincott, Philadelphia, 155-173. [5] Burchiel, K.J., Anderson, V.C., Brown, F.D., et al. (1996) Prospective, multicenter study of spinal cord stimulation for relief of chronic back and extremity pain. Spine, 21, 2786-2794. http://dx.doi.org/10.1097/00007632-199612010-00015 [6] North, R.B. and Guarino, A.H. (1999) Spinal cord stimulation for failed back surgery syndrome: Technical advances, patient selection and outcome. Neuromodulation, 2, 171-178. http://dx.doi.org/10.1046/j.1525-1403.1999.00171.x [7] Turner, J.A., Loeser, J.D. and Bell, K.G. (1995) Spinal cord stimulation for chronic low back pain: A systematic literature synthesis. Neurosurgery, 37, 1088-1096. http://dx.doi.org/10.1227/00006123-199512000-00008 [8] Litcher-Kelly, L., Martino, S.A., Broderick, J.E., et al. (2007) A systematic review of measures used to assess chronic musculoskeletal pain in clinical and randomized controlled clinical trials. The Journal of Pain, 8, 906-913. http://dx.doi.org/10.1016/j.jpain.2007.06.009 [9] Price, D.D., Bush, F.M., Long, S. and Harkins, S.W. (1994) A comparison of pain measurement characteristics of mechanical visual analog and simple numeric scales. Pain, 56, 217-226. http://dx.doi.org/10.1016/0304-3959(94)90097-3 [10] Price, D.D., Riley, J.L. and Wade, J.B. (2001) Psychophysical approaches to measurement of the dimensions and stages of pain. In: Turk, D.C. and Melzack, R., Eds., Handbook of Pain Assessment (2nd edition), The Guilford Press, New York, 53-75. [11] Price, D.D., Patel, R., Robinson, M.E. and Staud, R. (2008) Characteristics of electronic visual analogue and numeric scales for ratings of experimental pain in healthy subjects and fibromyalgia patients. Pain, 140, 158-166. http://dx.doi.org/10.1016/j.pain.2008.07.028 [12] Revill, S.I. (1976) The reliability of a linear analog for evaluating pain. Anaesthesia, 31, 1191-1198. http://dx.doi.org/10.1111/j.1365-2044.1976.tb11971.x [13] Kremer, E., Atkinson, J.H. and Ignelzi, R.J. (1980) Measurement of pain: Patient preference does not confound pain measurement. Pain, 10, 241-248. http://dx.doi.org/10.1016/0304-3959(81)90199-8 [14] Gagliese, L. and Melaka, R. (1997) Age differences in the quality of chronic pain: A preliminary study. Pain Research & Management, 2, 157-162. [15] Herr, K.A. and Mobily, P.R. (1993) Comparison of selected pain assessment tools for use with elderly. Applied Nursing Research, 6, 39-46. http://dx.doi.org/10.1016/S0897-1897(05)80041-2 [16] Jensen, M.P., Karoly, P. and Braver, S. (1986) The measurement of clinical pain intensity: A comparison of six methods. Pain, 27, 117-126. http://dx.doi.org/10.1016/0304-3959(86)90228-9 [17] Gagliese, L. and Katz, J. (2003) Age differences in post- operative pain are scale dependent: A comparison of measures of pain intensity and quality in younger and older surgical patients. Pain, 103, 11-20. http://dx.doi.org/10.1016/S0304-3959(02)00327-5 [18] Gagliese, L. and Melzack, R. (2003) Age related differences in the qualities but not the intensity of chronic pain. Pain, 104, 597-608. http://dx.doi.org/10.1016/S0304-3959(03)00117-9 [19] Gagliese, L., Weizblit, N., Ellis, W. and Chan, V.W.S. (2005) The measurement of postoperative pain: A comparison of intensity scales in younger and older surgical patients. Pain, 117, 412-420. http://dx.doi.org/10.1016/j.pain.2005.07.004 [20] Herr, K.A., Spratt, K., Mobily, P.R. and Richardson, G. (2004) Pain intensity assessment in older adults: Use of experimental pain to compare psychometric properties and usability of selected pain scales with younger adults. The Clinical Journal of Pain, 20, 207-219. http://dx.doi.org/10.1097/00002508-200407000-00002 [21] Peters, M.L., Patijn, J. and Lame, I. (2007) Pain assessment in younger and older pain patients: Psychometric properties and patient preference of five commonly used measures of pain intensity. Pain Medicine, 8, 601-610. http://dx.doi.org/10.1111/j.1526-4637.2007.00311.x [22] Dworkin, R.H., Turk,, D.C., Farrar,, J.T., et al. (2005) Core outcome measures for chronic pain clinical trials: IMMPACT recommendations. Pain, 113, 9-19. http://dx.doi.org/10.1016/j.pain.2004.09.012 [23] Hunter, M., Philips, C. and Rachman, S. (1979) Memory for pain. Pain, 6, 35-46. http://dx.doi.org/10.1016/0304-3959(79)90138-6 [24] Kwilosz, D.M., Gracely, R.H. and Torgerson, W.S. (1984) Memory for postsurgical dental pain. Pain, 2, S426. http://dx.doi.org/10.1016/0304-3959(84)90761-9 [25] Eich, E. (1985) Memory for pain: Relation between past and present pain intensity. Pain, 23, 375-380. http://dx.doi.org/10.1016/0304-3959(85)90007-7 [26] Carlsson, A.M. (1983) Assessment of chronic pain. Aspects of the reliability and validity of the visual analog scale. Pain, 16, 87-101. http://dx.doi.org/10.1016/0304-3959(83)90088-X [27] Kremer, E.F., Block, A.J. and Gaylor, M.S. (1980) Beha- vioral approaches to treatment of chronic pain: The inaccuracy of patient self-report measures. Archives of Physical Medicine and Rehabilitation, 62, 188. [28] Chapman, C.R. and Syrjala, K.L. (1990) Measurement of pain. In: Bonica, J.J., Ed., The Management of Pain (2nd edition), Lea&Febiger Publishers, Philadelphia, 580-594. [29] Mironer, Y.E., Satterthwaite, J.R., Lewis, E.M., et al. (2008) Efficacy of a single, percutaneous, across midline, octrode lead using a “midline anchoring” technique in the treatment of chronic low back and/or lower extremity pain. Neuromodulation, 11, 286-295. http://dx.doi.org/10.1111/j.1525-1403.2008.00178.x [30] Seres, J.L. (1999) The fallacy of using 50% pain relief as the standard for satisfactory pain treatment outcome. Pain Forum, 8, 183-188. http://dx.doi.org/10.1016/S1082-3174(99)70005-X