What Should be the Optimal Cut Points for Mild, Moderate, and Severe Pain?

Li, Kathy K.; Harris, Kristin; Hadi, Stephanie; Chow, Edward

doi:10.1089/jpm.2007.0087

Cited by 147 publications

(131 citation statements)

References 16 publications

Supporting

Mentioning

120

Contrasting

Unclassified

Order By: Relevance

“…This definition of SP aims to incorporate both severity and change in pain in response to pegfilgrastim. Although not validated in this setting, there is evidence in support of a score of ≥ l as corresponding to moderate pain at minimum, and an absolute change of 2 as meaningful (21, 22). The primary endpoint was benefit from loratadine prophylaxis, defined as a reported decrease in WPS difference from Day 1 to 8 of at least 2 points between OBS and TRT.…”

Section: Methodsmentioning

confidence: 97%

Randomized phase II study of loratadine for the prevention of bone pain caused by pegfilgrastim

Moukharskaya¹,

Abrams

Ashikaga

et al. 2016

Support Care Cancer

View full text Add to dashboard Cite

Purpose Bone pain is a common side-effect of pegfilgrastim and can interfere with quality of life and treatment adherence. This study i nvestigated the impact of antihistamine prophylaxis on pegfilgrastim-induced bone pain. Methods This is a two stage enrichment trial design. Patients receiving an initial dose of pegfilgrastim after chemotherapy were enrolled into the observation stage (OBS). Those who developed significant back or leg bone pain (SP) were enrolled into the treatment stage (TRT) and randomized to daily loratadine 10 mg or placebo for 7 days. SP was defined by Brief Pain Inventory as back or leg pain score ≥ 5 and a 2 point increase after pegfilgrastim. The primary end-point of TRT was reduction of worst back or leg bone pain with loratadine, defined as 2 point decrease after treatment compared to OBS. Results 213 patients were included in the final analysis. Incidence of SP was 30.5%. The SP subset had a worse overall Functional Assessment of Cancer Therapy – Bone Pain score (33.9 vs. 51.7, p < 0.001) and a higher mean white blood cell count (15.4 vs. 8.4 K/cm3, p = 0.013) following pegfilgrastim than those without SP. 46 patients were randomized in the TRT. Benefit was 77.3% with loratadine and 62.5% with placebo (p = 0.35). Baseline NSAID use was documented in 4 patients (18.2%) in loratadine arm and 2 patients (8.3%) in placebo arm, with baseline non-NSAID use documented in 5 (22.7%) and 6 (25%) patients respectively. Eight additional patients used NSAIDS by day 8 compared to day 1 (6 in the loratadine and 2 in the placebo arm). A total of 6 additional patients used non-NSAIDS by day 8 compared to day 1 (4 in the loratadine and 2 in the placebo arm). Conclusions Administration of prophylactic loratadine does not decrease the incidence of severe bone pain or improve quality of life in a high-risk patient population.

show abstract

Section: Methodsmentioning

confidence: 97%

Randomized phase II study of loratadine for the prevention of bone pain caused by pegfilgrastim

Moukharskaya¹,

Abrams

Ashikaga

et al. 2016

Support Care Cancer

View full text Add to dashboard Cite

show abstract

“…19 Adding to its usefulness are estimations made within different clinical populations, based on the 0 to 10 scale, of cut-scores for different levels of pain (e.g., mild, moderate, severe). [30][31][32] However, this recommendation is qualified by the empirical findings of nonequivalence between individual scores. [21][22][23][24] No measure of pain intensity can fully capture individuals' experiences of pain.…”

mentioning

confidence: 99%

Pain assessment using the NIH Toolbox

Cook

Dunn²,

Griffith³

et al. 2013

Neurology

109

View full text Add to dashboard Cite

Objective: Pain is an important component of health and function, and chronic pain can be a problem in its own right. The purpose of this report is to review the considerations surrounding pain measurement in the NIH Toolbox, as well as to describe the measurement tools that were adopted for inclusion in the NIH Toolbox assessment battery.Methods: Instruments to measure pain in the NIH Toolbox were selected on the basis of scholarly input from a diverse group of experts, as well as review of existing instruments, which include verbal rating scales, numerical rating scales, and graphical scales.Results: Brief self-report measures of pain intensity and pain interference were selected for inclusion in the core NIH Toolbox for use with adults. A 0 to 10 numerical rating scale was recommended for measuring pain intensity, and a 6-item Patient Reported Outcome Measurement Information System (PROMIS) short form for measuring pain interference. The 8-item PROMIS Pediatric Pain Interference measure was recommended as a supplemental measure. No specific measure was recommended for measuring pain intensity in children.Conclusions: Core and supplemental measures were recommended for the NIH Toolbox.Additional measures were reviewed for investigators who seek tools for measuring pain intensity in pediatric samples. Neurology Pain is an important component of health and function. The NIH Toolbox somatosensation team took responsibility for considering the best methods for evaluating pain in the general population. In the International Classification of Functioning, Disability and Health, sensory functions and pain are grouped together as body functions; however, sensation of pain is distinguished from sensory functions such as proprioception or touch, as well as functions related to temperature and other stimuli. 1 The definition of somatosensory function includes the "detection, discrimination, and recognition" of pain (Dunn et al., this issue). However, pain is more than a biological process and can be integral to function, role participation, and overall quality of life. As such, its assessment often becomes a primary end point in clinical trials and treatment effectiveness studies. This led the Toolbox team to consider pain and its assessment in parallel with somatosensory function and to dedicate separate manuscripts to discussions of pain and somatosensation.The science of pain measurement has benefited from recent advances in measurement approaches and applications.2-4 The field of outcomes research has well-developed, self-reported pain measures that have been validated in a range of acute and chronic medical conditions. For this reason, the team chose not to develop new pain measures but to adopt existing instruments that would add to the battery of tests included in the NIH Toolbox. In this article, we describe the importance of pain to the assessment of health and discuss its multidimensional nature. We

show abstract

“…Li et al repeated the study in 199 patients with painful bone metastases referred for palliative radiotherapy, again employing BPI [9]. Their result concurred with that of Serlin et al that mild pain was best categorized as scores between 1 to 4, moderate pain as 5 and 6, and severe pain as 7 to 10.…”

Section: Discussionmentioning

confidence: 60%

“…Serlin et al included patients from both inpatient and outpatient settings with cancer-related pain from different etiologies in four different countries [8]. Li et al [9] and Paul et al [10] recruited outpatients with painful bone metastases in Toronto, Canada, and Northern California, USA, respectively.…”

Section: Discussionmentioning

confidence: 99%

“…However, the pain severity cut points have been inconsistent across studies with the upper boundary for mild and moderate pain ranging from 3 to 5 and 6 to 8, respectively. The previous studies primarily correlated the pain categorization with interference in daily functioning [9,10]. In addition, pain severity may be associated with poor outcomes [1].…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Revisiting classification of pain from bone metastases as mild, moderate, or severe based on correlation with function and quality of life

Chow

Ding

Parulekar

et al. 2015

Support Care Cancer

Self Cite

View full text Add to dashboard Cite

Purpose The objective of our study was to determine the optimal cut points for classification of pain scores as mild, moderate, and severe based on interference with function and quality of life (QOL). Methods We evaluated 822 patients who completed the Brief Pain Inventory (BPI) and/or the European Organization for Research and Treatment of Cancer (EORTC) QOL Questionnaire Core 30 (QLQ-C30) prior to receiving repeat radiation therapy for previously irradiated painful bone metastases. Optimal cut points for mild, moderate, and severe pain were determined by the MANOVA that yielded the largest F ratio for the between category effect on the seven interference items of BPI and the six functional domains of QOL (physical, role, emotional, cognitive, social functioning, and global QOL) as indicated by Pillai's Trace, Wilk's λ, and Hostelling's Trace F statistics. Results For BPI and for QOL domains separately, the two largest F ratios for Wilk's λ, Pillai's Trace, and Hotelling's Trace F statistics were from the cut points 4, 8 and 6, 8. When combining both, the optimal cut points were 4, 8 with 1-4 (mild), 5-8 (moderate), and 9-10 (severe). With this classification, the mean scores of all the seven interference items in BPI and the six functional domains were all highly statistically Electronic supplementary material The online version of this article

show abstract

What Should be the Optimal Cut Points for Mild, Moderate, and Severe Pain?

Abstract: These findings are pivotal in further understanding the meaning of pain intensity levels and the assessment of pain in patients with metastatic cancer. However, further research in alternative methods of defining the optimal CP and clinically important change should be considered.

Cited by 147 publications

References 16 publications

Randomized phase II study of loratadine for the prevention of bone pain caused by pegfilgrastim

Randomized phase II study of loratadine for the prevention of bone pain caused by pegfilgrastim

Pain assessment using the NIH Toolbox

Revisiting classification of pain from bone metastases as mild, moderate, or severe based on correlation with function and quality of life

Contact Info

Product

Resources

About