Maximum Pain on Visual Analog Scales in Spinal Disorders.

Spine J. 2016 Dec 6.

Behrend CJ Schönbach et al

BACKGROUND CONTEXT:
Determining pain intensity is largely dependent on the patient’s report.
PURPOSE:
To test the hypothesis that patients initially reporting 10/10 pain on visual analog scales (VAS) would experience symptom improvement to a degree similar to patients reporting milder pain.
RESULTS:
The proportion of patients with identifiable secondary gain was higher (P=0.001) than among those with submaximal pain. Patients whose pain scores improved dramatically (i.e. at least 4 points on VAS), tend to be older (p=0.001), to less often have secondary gain from their disease (p=0.007), and to have a negative current smoking status (p=0.002). Patients whose pain remained 10/10 during the course of treatment smoked more frequently (p=0.016).
CONCLUSIONS:
Our analysis supports the need to consider the influence of secondary gain on the patients’ reported VAS pain scores. Maximum pain seems to be a more acute phenomenon with some likelihood to significantly improve.