Skip to main content
Article Publicly Available

Measuring outcomes of pain management

  • EMAIL logo
Published/Copyright: October 1, 2016
Download Article (PDF)
Become an author with De Gruyter Brill
Author Information Explore this Subject
Scandinavian Journal of Pain
From the journal Scandinavian Journal of Pain Volume 13 Issue 1

In this issue of the Scandinavian Journal of Pain Paul Peloso, Andrew Moore and their co-workers evaluated whether osteoarthritis patients achieving the greatest pain control and lowest pain states also have the greatest improvement in functioning and quality of life [1].

1 Assessment of outcomes of management of chronic pain

Pain is a complex and subjective experience that poses a number of measurement challenges [2, 3]. The aim of treatment is to improve outcomes. Outcomes measurement refers to the systematic collection and analysis of information that is used to evaluate the efficacy of an intervention. How can we track the changes? Ideally, we would like to have an objective, physiologic marker of pain [4]. And indeed, several physiologic variables have been evaluated for this purpose, like skin conductance, heart rate, and pupillary reactions. However, these markers do not correlated strongly enough with patients’ experience of suffering to warrant their use as surrogate markers [2].

Work continues in this area, but in the meantime, we have to rely on a number of accepted tools for tracking pain-related treatment outcomes. Chronic pain assessment and its impact on physical, emotional, and social functions require multidimensional qualitative tools and health-related quality of life instruments. These instruments range from quick, one-item assessments of pain intensity, to long surveys that tap into multiple dimensions of the pain experience and overall functioning [2]. In daily practice, a simple outcome measure, as advocated by Andrew Moore and co-workers (“no worse than mild pain”) [5] is very useful.

2 Instruments for tracking qualitative aspects of pain treatment outcomes

Despite the difficulty inherent to measuring pain, there are a number of accepted tools for tracking pain-related treatment outcomes. In the article by Paul Peloso and Andrew Moore and their coworkers [1], a number of instruments were used in order to assess qualitative aspects of chronic pain and its impact on function. The Western Ontario and McMaster Universities Arthritis Index (WOMAC) was developed specifically for Hip and Knee Osteoarthritis; The Brief Pain Inventory (BPI), was originally developed for cancer pain, but now used widely in other pain conditions; The Short Form Health Survey (SF-36) measures health status, including physical and mental components. These are relevant tools for the study population in question [1].

It is certainly an advantage to use an instrument developed for the disease to be studied. But we should also remember that disease-specific measures of physical functioning have not been developed and validated for many chronic pain conditions. However, one must always take into account the limitations of results based on self-report measures to determine the impact of pain [6]. Memory of pain is not accurate and often coloured by changing context factors. This is true even for a short time period of 24 h as required for parts of the WOMAC-survey [7].

3 The more pain is relieved, the more quality of life improves [1]

The authors point out that evidence from different painful conditions demonstrates that well-controlled pain has benefits on quality of life, functional, and associated economic benefits [1]. At first glance this looks rather obvious. To put it rudely: Is it better to be healthy, rich and beautiful compared to being sick, poor and ugly; meaning: We already know that Quality of Life (QoL) is related to pain, health in general, and a number of social factors.

Although there are commonalities across different pain states, there are also differences. In a group of chronic pain patients entering pain therapy at an outpatient clinic, Sator-Katzenschlager and co-workers reported that reducing pain intensity improves behaviour and cognitive dimensions but not psychological well-being and cognitive assessment [8]. As pointed out by the authors [1], there are a number of studies of pain conditions other than osteoarthritis that have concluded that improvements in pain were correlated with improvement in at least one other important aspect of QoL or functional improvement. It is not surprising that this holds true also for osteoarthritis patients [1].

However, there are some interesting data in the article by Paul Peloso and Andrew Moore and their co-workers that add information to the existing literature regarding pain and function [1]. The patients with the greatest improvement in osteoarthritis pain also have the greatest improvements in QoL and function. While clinicians may believe this relationship to be true, this has not previously been documented in osteoarthritis.

4 Gender, age, cultural background and more factors influence outcome of pain management

Exploration of commonalities and variations in health related function across pain groups is important. Also in osteoarthritis pain patients there are a number of factors that need to be identified. Data explored in this study were taken from a single trial in a single country [1]. The authors identify several limitations in their report. In order to extrapolate results into larger patient groups, more questions should be explored, controlling for sociodemographic characteristics.

Are there gender differences? Gender differences have been identified in other patient groups regarding pain treatment response. Pain can be a sex-specific determinant of satisfaction with QoL. In a study of poststroke pain, Bergés and coworkers demonstrated that in this group of patients, as level of pain increased, men’s satisfaction with QoL decreased more than women’s QoL [9].

Are there age-difference? Rustøen et al. demonstrated the pain prevalence and pain experience do indeed vary with age [10].

Are there cultural differences? Practice of modern medicine as well as measuring outcomes should be assisted by an exploration of the possibility of cultural differences in medical beliefs and practices in the multiethnic and racially diverse patient populations [11].

Furthermore, pain response over time is important: Unlike acute pain, chronic pain unfolds over time. The pain experience will ultimately influence most factors of QoL, whether recovery or improvement is possible. Monitoring the temporal aspects in a wider time-frame is a challenge [12].

5 Treat the person, not only the pain

The goal of pain management is to improve not only physical conditions, but also pain behaviour, social, and psychological aspects of the patient’s life. We need to utilize all available means of understanding pain’s complexity, and treat the person and not simply the pain. It is good to know that good improvements in osteoarthritis pain are a proxy for both function and QoL.

DOI of refers to article: http://dx.doi.org/10.1016/j.sjpain.2016.07.002.

Division of Emergencies and Critical Care, Dept of Anaesthesiology, Oslo University Hospital, Postbox 4950, 0424 Oslo, Norway. Tel.: +47 22934105.

  1. Conflict of interest: None declared.

References

[1] Peloso P, Moore RA, Chen W-J, Lin H-Y, Gates DF, Straus WL, Popmihajlov Z. Osteoarthritis patients with pain improvement are highly likely to also have improved quality of life and functioning. A post-hoc analysis of a clinical trial. Scand J Pain 2016;13:175–81.Search in Google Scholar

[2] Younger J, McCue R, Mackey S, Pain Outcomes:. A brief review of instruments and techniques. Curr Pain Headache Rep 2009;13:39–43.Search in Google Scholar

[3] Jensen MP, Turner JA, Romano JM, Fisher LD. Comparative reliability and validity of chronic pain intensity measures. Pain 1999;83:157–62.Search in Google Scholar

[4] Chizh BA, Hobson AR. Using objective markers and imaging in the development of novel treatments of chronic pain. Expert Rev Neurother 2007;7:443–7.Search in Google Scholar

[5] Moore RA, Straube S, Aldington D. Pain measure and cut-offs – “no worse than mild pain” as a simple, universal outcome. Anaesthesia 2013;68:400–12.Search in Google Scholar

[6] Nguen TM, La Caze A, Cottrell N. What are validated self-report adherence scales really measuring? A systematic review. Br J Clin Pharmacol 2014;44: 427–45.Search in Google Scholar

[7] Breivik H, Ljosaa TM, Stengaard-Pedersen K, Persson J, Aro H, Villumsen J, Tvinnerose D. A 6-months, randomised, placebo-controlled evaluation of efficacy and tolerability of 7 day buprenorphine transdermal patch in osteoarthritis patients naïve to potent-opioids. Scand J Pain 2010;1:122–41.Search in Google Scholar

[8] Sator-Katzenschalager SM, Schiesser AW, Kozek-Langenecker SA, Benetha G, Langer G, Kress H-G. Does pain relief improve pain behavior and mood in chronic pain patients? Anesth Analg 2003;97:791–7.Search in Google Scholar

[9] Bergés I-M, Ottenbacher KJ, Kuo Y-F, Smith PM, Smith D, Ostir GV. Satisfaction with quality of life poststroke: effect of sex differences in pain response. Arch Phys Med Rehabil 2007;88:413–7.Search in Google Scholar

[10] Rustøen T, Wahl AK, Hanestad BR, Lerdal A, Paul S, Miaskowski C. Age and the experience of chronic pain: differences in health and quality of life among younger, middle-aged, and older adults. Clin J Pain 2005;21:513–23.Search in Google Scholar

[11] More M. Cross-cultural conceptions of pain and pain control. Proc Bay Univ Med Cent 2002;15:143–5.Search in Google Scholar

[12] Elliott AM, Smith BH, Hannaford PC, Smith WC, Chambers WA. Assessing change in chronic pain severity: the chronic pain grade compared with retrospective perceptions. Br J Gen Pract 2002;52:269–74.Search in Google Scholar
Published Online: 2016-10-01
Published in Print: 2016-10-01

© 2016 Scandinavian Association for the Study of Pain

Articles in the same Issue

  2. Scandinavian Journal of Pain
  3. Editorial comment
  4. Increased deep pain sensitivity in persistent musculoskeletal pain but not in other musculoskeletal pain states
  5. Clinical pain research
  6. Increased deep pain sensitivity in persistent musculoskeletal pain but not in other musculoskeletal pain states
  7. Editorial comment
  8. Patient Reported Outcomes (PROs) are sensitive outcome-variables in patients with chronic pain: Importance of self-efficacy
  9. Observational study
  10. Using patient reported outcomes in oncology clinical practice
  11. Editorial comment
  12. Cortical reorganization of the healthy hand in upper-limb complex regional pain syndrome(CRPS): Is reorganizations of common beliefs about CRPS necessary?
  13. Original experimental
  14. An exploration into the cortical reorganisation of the healthy hand inupper-limb complex regional pain syndrome
  15. Editorial comment
  16. Is there hope for the most complicated chronic pain patients facing back surgery?
  17. Educational case report
  18. A preoperative interdisciplinary biopsychosocial opioid reduction program in patients on chronic opioid analgesia prior to spine surgery: A preliminary report and case series
  19. Editorial comment
  20. Pain management in the Emergency Department – Still a long way to go?
  21. Clinical pain research
  22. Mandatory documentation of pain in the emergency department increases analgesic administration but does not improve patients’ satisfaction of pain management
  23. Editorial comment
  24. Pain relief during childbirth: Efficacy and safety of prolonging labour-analgesia with morphine directly into the lumbar cerebro-spinal-fluid (CSF)
  25. Systematic review
  26. Prolonging the duration of single-shot intrathecal labour analgesia with morphine: A systematic review
  27. Editorial comment
  28. The intricate relationship amongst pain intensity, fear and avoidance
  29. Systematic review
  30. A meta-analysis of fear-avoidance and pain intensity: The paradox of chronic pain
  31. Editorial comment
  32. Local infiltration analgesia(LIA), risk of local anaesthetic systemic toxicity (LAST) and kidney failure from NSAID in elderly patients
  33. Topical review
  34. Local infiltration analgesia in knee and hip arthroplasty efficacy and safety
  35. Editorial comment
  36. Analysis of pain-intensity measurements
  37. Topical review
  38. How to analyze the Visual Analogue Scale: Myths, truths and clinical relevance
  39. Editorial comment
  40. The relationship between chronic pain and cardiovascular disease: Squaring the circle?
  41. Systematic review
  42. Assessing the relationship between chronic pain and cardiovasculardisease: A systematic review and meta-analysis
  43. Editorial comment
  44. Optimists fare better when chronic pain strikes – Or does pain related disability make us pessimists?
  45. Observational study
  46. Constructs of health belief and disabling distal upper limb pain
  47. Editorial comment
  48. Attitude and belief of pain-therapists are important when trying to help chronic pain patients: The Norwegian version of the Pain Attitudes and Beliefs Scale (PABS) improved by Rasch analysis
  49. Observational study
  50. Rasch analysis resulted in an improved Norwegian version of the Pain Attitudes and Beliefs Scale(PABS)
  51. Editorial comment
  52. Anxiety could play a larger role than depression in migraine headache
  53. Clinical pain research
  54. The relative importance of anxiety and depression in pain impact in individuals with migraine headaches
  55. Editorial comment
  56. Bringing the lab to the people: Experimental pain testing in the general population
  57. Clinical pain research
  58. Pressure and cold pain threshold reference values in a large, young adult, pain-free population
  59. Editorial comment
  60. Improving pain treatment in children
  61. Clinical pain research
  62. A randomized controlled trial of amitriptyline versus gabapentin for complex regional pain syndrome type I and neuropathic pain in children
  63. Editorial comment
  64. Gut gateway to generalized pain
  65. Original experimental
  66. A low fermentable oligo-di-mono saccharides and polyols(FODMAP) diet reduced pain and improve ddaily life in fibromyalgia patients
  67. Editorial comment
  68. Measuring outcomes of pain management
  69. Clinical pain research
  70. Osteoarthritis patients with pain improvement are highly likely to also have improved quality of life and functioning. A post hoc analysis of a clinical trial
  71. Clinical pain research
  72. Construct validity and reliability of Finnish version of Örebro Musculoskeletal Pain Screening Questionnaire
  73. Observational study
  74. Total sleep deprivation and pain perception during cold noxious stimuli in humans
  75. Corrigendum
  76. Corrigendum to ‘Reliability of pressure pain threshold testing in healthy pain free young adults’ [Scand. J. Pain 9 (2015) 38–41]
https://doi.org/10.1016/j.sjpain.2016.09.003

Articles in the same Issue

  2. Scandinavian Journal of Pain
  3. Editorial comment
  4. Increased deep pain sensitivity in persistent musculoskeletal pain but not in other musculoskeletal pain states
  5. Clinical pain research
  6. Increased deep pain sensitivity in persistent musculoskeletal pain but not in other musculoskeletal pain states
  7. Editorial comment
  8. Patient Reported Outcomes (PROs) are sensitive outcome-variables in patients with chronic pain: Importance of self-efficacy
  9. Observational study
  10. Using patient reported outcomes in oncology clinical practice
  11. Editorial comment
  12. Cortical reorganization of the healthy hand in upper-limb complex regional pain syndrome(CRPS): Is reorganizations of common beliefs about CRPS necessary?
  13. Original experimental
  14. An exploration into the cortical reorganisation of the healthy hand inupper-limb complex regional pain syndrome
  15. Editorial comment
  16. Is there hope for the most complicated chronic pain patients facing back surgery?
  17. Educational case report
  18. A preoperative interdisciplinary biopsychosocial opioid reduction program in patients on chronic opioid analgesia prior to spine surgery: A preliminary report and case series
  19. Editorial comment
  20. Pain management in the Emergency Department – Still a long way to go?
  21. Clinical pain research
  22. Mandatory documentation of pain in the emergency department increases analgesic administration but does not improve patients’ satisfaction of pain management
  23. Editorial comment
  24. Pain relief during childbirth: Efficacy and safety of prolonging labour-analgesia with morphine directly into the lumbar cerebro-spinal-fluid (CSF)
  25. Systematic review
  26. Prolonging the duration of single-shot intrathecal labour analgesia with morphine: A systematic review
  27. Editorial comment
  28. The intricate relationship amongst pain intensity, fear and avoidance
  29. Systematic review
  30. A meta-analysis of fear-avoidance and pain intensity: The paradox of chronic pain
  31. Editorial comment
  32. Local infiltration analgesia(LIA), risk of local anaesthetic systemic toxicity (LAST) and kidney failure from NSAID in elderly patients
  33. Topical review
  34. Local infiltration analgesia in knee and hip arthroplasty efficacy and safety
  35. Editorial comment
  36. Analysis of pain-intensity measurements
  37. Topical review
  38. How to analyze the Visual Analogue Scale: Myths, truths and clinical relevance
  39. Editorial comment
  40. The relationship between chronic pain and cardiovascular disease: Squaring the circle?
  41. Systematic review
  42. Assessing the relationship between chronic pain and cardiovasculardisease: A systematic review and meta-analysis
  43. Editorial comment
  44. Optimists fare better when chronic pain strikes – Or does pain related disability make us pessimists?
  45. Observational study
  46. Constructs of health belief and disabling distal upper limb pain
  47. Editorial comment
  48. Attitude and belief of pain-therapists are important when trying to help chronic pain patients: The Norwegian version of the Pain Attitudes and Beliefs Scale (PABS) improved by Rasch analysis
  49. Observational study
  50. Rasch analysis resulted in an improved Norwegian version of the Pain Attitudes and Beliefs Scale(PABS)
  51. Editorial comment
  52. Anxiety could play a larger role than depression in migraine headache
  53. Clinical pain research
  54. The relative importance of anxiety and depression in pain impact in individuals with migraine headaches
  55. Editorial comment
  56. Bringing the lab to the people: Experimental pain testing in the general population
  57. Clinical pain research
  58. Pressure and cold pain threshold reference values in a large, young adult, pain-free population
  59. Editorial comment
  60. Improving pain treatment in children
  61. Clinical pain research
  62. A randomized controlled trial of amitriptyline versus gabapentin for complex regional pain syndrome type I and neuropathic pain in children
  63. Editorial comment
  64. Gut gateway to generalized pain
  65. Original experimental
  66. A low fermentable oligo-di-mono saccharides and polyols(FODMAP) diet reduced pain and improve ddaily life in fibromyalgia patients
  67. Editorial comment
  68. Measuring outcomes of pain management
  69. Clinical pain research
  70. Osteoarthritis patients with pain improvement are highly likely to also have improved quality of life and functioning. A post hoc analysis of a clinical trial
  71. Clinical pain research
  72. Construct validity and reliability of Finnish version of Örebro Musculoskeletal Pain Screening Questionnaire
  73. Observational study
  74. Total sleep deprivation and pain perception during cold noxious stimuli in humans
  75. Corrigendum
  76. Corrigendum to ‘Reliability of pressure pain threshold testing in healthy pain free young adults’ [Scand. J. Pain 9 (2015) 38–41]
Downloaded on 2.5.2026 from https://www.degruyterbrill.com/document/doi/10.1016/j.sjpain.2016.09.003/html?lang=en
Scroll to top button