Criteria Useful in Measurement of Pain and Monitoring Treatment Outcomes

Objective: Persistent pain has profound effects on the health and quality of life. A reliable, comprehensive yet simple, measurement tool is essential for research, optimising clinical practice and treatment outcomes for persistent pain patients. We seek to devise a tool to aid physicians in assessing persistent pain.

Design: A scoring tool was developed to measure the direct and indirect markers of persistent pain across the following domains: Score of pain(S), Physical activity (P), Additional medication (A), Additional GP/ED visit (A), Sleep quality (S), Mood (M) and Side-effects of pain medication (S). These characteristics were rated and scored monthly in persistent pain patients for 9 months. SPAASMS score was inversely proportional to improved pain management.

Results: The test-retest analysis for SPAASMS score (n=20) showed a concordance correlation coefficient of 0.94; 95%-confidence interval=0.86, 0.97 and Cronbach’s alpha for Reading 1 and 2 were 0.66 (p=0.001) and 0.67 (p<0.001), respectively. Comparison of the score with the Numerical Rating Scale (NRS), Physical Disability Index (PDI), Depression, Anxiety, Stress Scale (DASS21) and a combined score of NRS, PDI and DASS21 showed improved sensitivity except for DASS21. The score declined when patients responded well but remained high in patients not responding to treatment or increased with precipitating events like further trauma. With optimum relief, scores remained static.

Conclusion: SPAASMS is a simple, rapid and comprehensive tool which quantifiably indicated the progress of the patient under treatment. It can also be used to determine symptoms which have not responded to it.

Author(s): Farzana Mitra, Shahead Chowdhury, Mike Shelley and Petra Buettner

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