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Asking the community about cutpoints used to describe mild, moderate, and severe pain.

Palos GR, Mendoza TR, Mobley GM, Cantor SB, Cleeland CS

Department of Symptom Research, The University of Texas MD Anderson Cancer Center, Houston, 77030, USA. gpalos@mdanderson.org

Clinical practice guidelines recommend that numeric rating scales be used to document the severity of perceived pain, yet patients and clinicians often opt to use simpler classification systems such as mild, moderate, or severe. To assess how well the numeric scales correlate with the tri-level classification system for describing pain severity, we conducted a subanalysis of a larger population-based study of pain management preferences. Our primary objective was to identify the numeric boundaries used by 287 adults to describe pain as mild, moderate, or severe. We examined differences in the means of the upper and lower limits for mild, moderate, and severe pain according to demographic characteristics and type of pain. Ranges reported for each pain level were 1.3 to 3.6 (mild), 4.3 to 6.5 (moderate), and 7.5 to 9.8 (severe). The primary finding was that "healthy" community adults rated the pain severity cutpoints much as patients with clinical pain did, 1 to 4 for mild, 5 to 6 for moderate, and 7 to 10 for severe. These results suggest that numeric rating scales can be used in clinical practice with both patients and community-dwelling adults. Our findings also support encouraging the general public to use a 0 to 10 scale to rate their pain intensity. PERSPECTIVE: Methods used to describe numeric cutpoints for mild, moderate, and severe pain were applied to community adults. Having standard categories to describe pain severity might increase clinicians' confidence in using a numeric scale to make treatment decisions. Further studies of cutpoint methodology and its clinical importance are warranted.

Published 17 January 2006 in J Pain, 7(1): 49-56.
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