DOI: 10.1097/PHM.0b013e318286d04e
,
Issn Print: 0894-9115
Publication Date: 2013/03/01
Facebook
Twitter
LinkedIn
Email
 |
Checking for direct PDF access through Ovid | |
Excerpt
Marlis Gonzalez-Fernandez, MD, PhD; Nilasha Ghosh, BA; Tambrea Ellison, MD; Julia McLeod, MD; Cathy Pelletier, PhD; Kayode A. Williams, MD, MBA
Introduction: Pain is a ubiquitous issue in the field of medicine, presenting itself across almost every specialty in a variety of ways. It is a subjective experience influenced by culture and meaning,1 and thus, quantifying it to determine appropriate treatment presents a challenge for clinicians. The most common tool used to quantify pain is the visual analog scale (VAS). The VAS was initially established as a way to measure subjective phenomena, such as emotion and mood.2–4 It has since served as the scale for pain measurement.5 However, using this scale presents some challenges, most commonly “ceiling” effects, which can conceal variation in perceived pain intensity at the high end of the scale.6 For patients with severe pain rating at the high end of the scale, ceiling effects leave them with no ability to quantify worsening pain.7 Furthermore, ceiling effects cause compression of all intensity ratings, not just at the top of the scale.8 To address these limitations, the general labeled magnitude scale (gLMS) was developed in other fields. The upper limit of the scale was labeled as the “strongest imaginable sensation of any kind.”9 By creating this label, the investigators were able to eliminate the upper limit of 10 on the VAS and bring in imagined sensations/pain into the picture, broadening the spectrum of pain reporting. We hypothesized that by eliminating ceiling effects, the gLMS would have a proportionately larger range available at the top of the scale compared with the VAS scale. Thus, patients would rate their pain at a lower level when using the gLMS as compared with the VAS. We also hypothesized that the scale would be simple to use and easy to understand, as measured by how quickly patients were able to fill out the scale and how many were able to complete it successfully.
Methods: The subjects were recruited from the patients scheduled for a pain-related evaluation at the investigators’ interventional pain clinic (K. A. Williams: one site) or general physiatry clinics (M. Gonzalez-Fernandez: two sites). Potential subjects were approached at the end of their clinic visit for inclusion in the study by the treating physician. If agreeable, the purpose of this study was explained, and informed consent was obtained by the investigator or the research assistant administering the test. Subjects presenting with a painful complaint who were not in acute distress and who agreed to participate were included. Patients who were not English proficient were excluded from this study. Patients who did not understand the scale, as evidenced by incorrect ordering of increasing auditory sensations (as described below), were also excluded.
Measures: The patients were asked to rate their pain using the VAS and the proposed scale (gLMS). We recorded the test results and the time it took to administer the gLMS (from the time instructions are provided to the time the final pain rating is obtained). The investigators accessed the patient’s medical record to extract other key demographic data and the underlying diagnoses associated with the subject’s pain. The gLMS is a scale with qualitative descriptors to guide rating, starting from no pain perception to “the strongest imaginable sensation of any kind.” The qualitative descriptors are present: imperceptible, barely, weak, moderate, strong, very strong, and strongest imaginable sensation of any kind.9 However, the numerical rating is not visible to the rater. Rather, it is measured later.
