Measuring acute postoperative pain using the visual analog scale: The minimal clinically important difference and patient acceptable symptom state

P. S. Myles, D. B. Myles, Wendy Galagher, D. Boyd, Neil Macdonald, Ashley A. Dennis

Research output: Contribution to journalArticleResearchpeer-review

Abstract

Background. The 100mmvisual analog scale (VAS) score is widely used to measure pain intensity after surgery. Despite this widespread use, it is unclear what constitutes the minimal clinically important difference (MCID); that is, what minimal change in score would indicate a meaningful change in a patient's pain status. Methods. We enrolled a sequential, unselected cohort of patients recovering from surgery and used a VAS to quantify pain intensity. We compared changes in the VAS with a global rating-of-change questionnaire using an anchor-based method and three distribution-based methods (0.3 SD, standard error of the measurement, and 5% range). We then averaged the change estimates to determine the MCID for the pain VAS. The patient acceptable symptom state (PASS) was defined as the 25th centile of the VAS corresponding to a positive patient response to having made a good recovery from surgery. Results. We enrolled 224 patients at the first postoperative visit, and 219 of these were available for a second interview. The VAS scores improved significantly between the first two interviews. Triangulation of distribution and anchor-based methods resulted in an MCID of 9.9 for the pain VAS, and a PASS of 33. Conclusions. Analgesic interventions that provide a change of 10 for the 100mmpain VAS signify a clinically important improvement or deterioration, and a VAS of 33 or less signifies acceptable pain control (i.e. a responder), after surgery.

Original languageEnglish
Pages (from-to)424-429
Number of pages6
JournalBritish Journal of Anaesthesia
Volume118
Issue number3
DOIs
Publication statusPublished - 2017

Keywords

  • Analgesia
  • Pain measurement
  • Surgery

Cite this

Myles, P. S. ; Myles, D. B. ; Galagher, Wendy ; Boyd, D. ; Macdonald, Neil ; Dennis, Ashley A. / Measuring acute postoperative pain using the visual analog scale : The minimal clinically important difference and patient acceptable symptom state. In: British Journal of Anaesthesia. 2017 ; Vol. 118, No. 3. pp. 424-429.
@article{732cb34a3341481088de34288ad8f650,
title = "Measuring acute postoperative pain using the visual analog scale: The minimal clinically important difference and patient acceptable symptom state",
abstract = "Background. The 100mmvisual analog scale (VAS) score is widely used to measure pain intensity after surgery. Despite this widespread use, it is unclear what constitutes the minimal clinically important difference (MCID); that is, what minimal change in score would indicate a meaningful change in a patient's pain status. Methods. We enrolled a sequential, unselected cohort of patients recovering from surgery and used a VAS to quantify pain intensity. We compared changes in the VAS with a global rating-of-change questionnaire using an anchor-based method and three distribution-based methods (0.3 SD, standard error of the measurement, and 5{\%} range). We then averaged the change estimates to determine the MCID for the pain VAS. The patient acceptable symptom state (PASS) was defined as the 25th centile of the VAS corresponding to a positive patient response to having made a good recovery from surgery. Results. We enrolled 224 patients at the first postoperative visit, and 219 of these were available for a second interview. The VAS scores improved significantly between the first two interviews. Triangulation of distribution and anchor-based methods resulted in an MCID of 9.9 for the pain VAS, and a PASS of 33. Conclusions. Analgesic interventions that provide a change of 10 for the 100mmpain VAS signify a clinically important improvement or deterioration, and a VAS of 33 or less signifies acceptable pain control (i.e. a responder), after surgery.",
keywords = "Analgesia, Pain measurement, Surgery",
author = "Myles, {P. S.} and Myles, {D. B.} and Wendy Galagher and D. Boyd and Neil Macdonald and Dennis, {Ashley A.}",
year = "2017",
doi = "10.1093/bja/aew466",
language = "English",
volume = "118",
pages = "424--429",
journal = "British Journal of Anaesthesia",
issn = "0007-0912",
publisher = "Oxford University Press",
number = "3",

}

Measuring acute postoperative pain using the visual analog scale : The minimal clinically important difference and patient acceptable symptom state. / Myles, P. S.; Myles, D. B.; Galagher, Wendy; Boyd, D.; Macdonald, Neil; Dennis, Ashley A.

In: British Journal of Anaesthesia, Vol. 118, No. 3, 2017, p. 424-429.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Measuring acute postoperative pain using the visual analog scale

T2 - The minimal clinically important difference and patient acceptable symptom state

AU - Myles, P. S.

AU - Myles, D. B.

AU - Galagher, Wendy

AU - Boyd, D.

AU - Macdonald, Neil

AU - Dennis, Ashley A.

PY - 2017

Y1 - 2017

N2 - Background. The 100mmvisual analog scale (VAS) score is widely used to measure pain intensity after surgery. Despite this widespread use, it is unclear what constitutes the minimal clinically important difference (MCID); that is, what minimal change in score would indicate a meaningful change in a patient's pain status. Methods. We enrolled a sequential, unselected cohort of patients recovering from surgery and used a VAS to quantify pain intensity. We compared changes in the VAS with a global rating-of-change questionnaire using an anchor-based method and three distribution-based methods (0.3 SD, standard error of the measurement, and 5% range). We then averaged the change estimates to determine the MCID for the pain VAS. The patient acceptable symptom state (PASS) was defined as the 25th centile of the VAS corresponding to a positive patient response to having made a good recovery from surgery. Results. We enrolled 224 patients at the first postoperative visit, and 219 of these were available for a second interview. The VAS scores improved significantly between the first two interviews. Triangulation of distribution and anchor-based methods resulted in an MCID of 9.9 for the pain VAS, and a PASS of 33. Conclusions. Analgesic interventions that provide a change of 10 for the 100mmpain VAS signify a clinically important improvement or deterioration, and a VAS of 33 or less signifies acceptable pain control (i.e. a responder), after surgery.

AB - Background. The 100mmvisual analog scale (VAS) score is widely used to measure pain intensity after surgery. Despite this widespread use, it is unclear what constitutes the minimal clinically important difference (MCID); that is, what minimal change in score would indicate a meaningful change in a patient's pain status. Methods. We enrolled a sequential, unselected cohort of patients recovering from surgery and used a VAS to quantify pain intensity. We compared changes in the VAS with a global rating-of-change questionnaire using an anchor-based method and three distribution-based methods (0.3 SD, standard error of the measurement, and 5% range). We then averaged the change estimates to determine the MCID for the pain VAS. The patient acceptable symptom state (PASS) was defined as the 25th centile of the VAS corresponding to a positive patient response to having made a good recovery from surgery. Results. We enrolled 224 patients at the first postoperative visit, and 219 of these were available for a second interview. The VAS scores improved significantly between the first two interviews. Triangulation of distribution and anchor-based methods resulted in an MCID of 9.9 for the pain VAS, and a PASS of 33. Conclusions. Analgesic interventions that provide a change of 10 for the 100mmpain VAS signify a clinically important improvement or deterioration, and a VAS of 33 or less signifies acceptable pain control (i.e. a responder), after surgery.

KW - Analgesia

KW - Pain measurement

KW - Surgery

UR - http://www.scopus.com/inward/record.url?scp=85015994359&partnerID=8YFLogxK

U2 - 10.1093/bja/aew466

DO - 10.1093/bja/aew466

M3 - Article

VL - 118

SP - 424

EP - 429

JO - British Journal of Anaesthesia

JF - British Journal of Anaesthesia

SN - 0007-0912

IS - 3

ER -