Exploring alternative approaches to routine outpatient pain screening.
OBJECTIVE
To evaluate potential alternatives to the numeric rating scale (NRS) for routine pain screening.


METHODS
Cross-sectional.


METHODS
Nineteen Veterans Affairs outpatient clinics in Southern California at two hospitals and six community sites.


METHODS
Five hundred twenty-eight veterans from primary care, cardiology, and oncology clinics sampled in proportion to the total number of visits made to each clinic during the previous year.


METHODS
Veterans were approached following clinic visits to complete researcher-administered surveys about their clinic experience. Using the Brief Pain Inventory (BPI) interference scale of > or =5 as a reference standard for important unrelieved pain, we evaluated potential alternative pain screening items and item combinations by analyzing sensitivity and specificity, area under the receiver operating curve (AUC), and likelihood ratios.


RESULTS
Of the veterans, 43.6% had unrelieved pain as measured by the reference standard. Approximately half had painful musculoskeletal diagnoses and one-third had comorbid mental health or substance use disorders. The fifth vital sign detected pain less accurately than did an NRS with a 1-week timeframe and an item assessing pain-related bother over the past week. AUCs were 0.79, 0.86, and 0.86, respectively. A sequential approach combining the pain-related bother and NRS with a 1-week timeframe items had good discriminatory ability.


CONCLUSIONS
Alternative single or combined pain screening strategies assessing pain-related bother may improve routine pain detection.
Lorenz
Karl A
KA
Veterans Administration Greater Los Angeles Healthcare System, Division of General Internal Medicine, Los Angeles, CA 90073, USA. karl.lorenz@med.va.gov
Krebs
Erin E
EE
Bentley
Tanya G K
TG
Sherbourne
Cathy D
CD
Goebel
Joy R
JR
Zubkoff
Lisa
L
Lanto
Andy B
AB
Asch
Steven M
SM
D002140:California / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods* / Q000706:statistics & numerical data; D008875:Middle Aged; D010045:Outpatients / Q000706:statistics & numerical data*; D010146:Pain / Q000175:diagnosis* / Q000453:epidemiology*; D010147:Pain Measurement / Q000379:methods* / Q000706:statistics & numerical data; D015995:Prevalence; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014728:Veterans / Q000706:statistics & numerical data*