‘Is your pain tolerable?’ Asking may result in less risky pain management

Clinicians who ask their patients “is your pain tolerable?” before asking them to rate their pain on the numeric scale may make less risky pain management decisions, according to researchers.

“The exclusive focus of the numeric rating scale on pain intensity reduces the experience of chronic pain to a single dimension,” John D. Markman, MD, director of the Translational Pain Research Program at the University of Rochester School of Medicine and Dentistry, and colleagues wrote in JAMA Network Open. “Furthermore, continually asking patients to rate their pain on a scale that is anchored by a pain-free state implies that being pain free is a readily attainable treatment goal, which may contribute to unrealistic expectations for complete relief.”

Markman and colleagues asked 537 patients (median age, 62.2 years; 61.6% women) if their pain was tolerable. Patients answered either “yes,” “no,” or “not in pain.” Patients then used the numeric rating scale to rate their average pain intensity during the past 24 hours. Markman and colleagues then used logistic regression models to compare the answers.

Researchers found that intolerable pain ratings were associated with a higher score on the numeric rating scale (OR per 1-point increase on scale = 1.1; 95% CI, 1.02-1.2). Of the 211 patients who described their pain as moderate (from 4 to 6 points), 19% described their pain as intolerable. Of the 137 patients who described their pain as severe (from 7 to 10 points), 52.6% considered it intolerable.

 

“The tolerability of pain rated between 4 and 6 varies substantially among patients,” Markman and colleagues wrote. “In this middle range, if a patient describes pain as tolerable, this might decrease the clinician’s inclination to initiate higher risk treatments.”

Future studies should examine how asking about pain tolerance is linked to patient satisfaction regarding communication, treatment goal setting and treatment effects, the researchers wrote. – by Janel Miller

Disclosures: Markman reports serving on the advisory boards of Aptrinyx, Biogen, Braeburn, Chromocell, Clexio Bioscience, Daiichi Sankyo, Eli Lilly and Co., Esteve Pharmaceuticals, Merck, Merck AG, Pfizer, Quark Therapeutics, SwanBio, Sophren, Trevena, Tremeau Pharmaceuticals; serving as a consultant for Averitas, Editas Medicine and Plasma Surgical; serving on the advisory board and data safety monitoring committee for Novartis; and owning equity in YellowBlack Corp. The other authors report no relevant financial disclosures.