title: Pain scores show no monotonic upward or downward trend over time.
abstract: BACKGROUND
  Self-reported pain scales are commonly used in emergency departments (EDs). The 11-point (0-10) numerical rating scale is a commonly used scale for adults visiting EDs in the United States. Despite their widespread use, little is known about whether distribution of pain scores has remained consistent over time.
  
  
  OBJECTIVE
  The objective of this study is to determine if there were upwards or downwards (monotonic) trends in pain scores over time at a single hospital.
  
  
  METHODS
  Retrospective chart review for the years 2003-2011. All pain scores for May 1(st) and 2(nd) of those years were collected. Multinomial logistic regression was used to model the probability of a patient rating their pain in each of 11 categories (scores 0 to 10) as a function of the calendar year. Additional analysis was carried out with pain scores grouped into four categories.
  
  
  RESULTS
  Data were collected from 2934 patient charts. Pain scores were recorded in 2136 charts, and 1637 of these pain scores were above zero (i.e., 1-10). The pain score distribution differed significantly over time (p = 0.001); however, there was no monotonic (single-direction) trend.
  
  
  CONCLUSIONS
  Although there were significant shifts in pain scores over time, there is not a significant monotonic trend. At this hospital, there was no "inflation" or "deflation" in pain scores over time. Shifts in distribution, even when not in a single direction, may be important for researchers examining pain scores in the ED.
authors.affiliation: Department of Emergency Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania.
authors.forename: Paris B
authors.initials: PB
authors.lastname: Lovett
authors.affiliation: Department of Emergency Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania.
authors.forename: Brian C
authors.initials: BC
authors.lastname: Jerusik
authors.affiliation: Jefferson Medical College, Philadelphia, Pennsylvania.
authors.forename: Stephanie L
authors.initials: SL
authors.lastname: Bernard
authors.affiliation: Department of Emergency Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania.
authors.forename: Frederick T
authors.initials: FT
authors.lastname: Randolph
authors.affiliation: Department of Emergency Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania.
authors.forename: Rex G
authors.initials: RG
authors.lastname: Mathew
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007223:Infant; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement / Q000592:standards* / Q000706:statistics & numerical data / Q000639:trends; D012189:Retrospective Studies; D057566:Self Report; D013997:Time Factors; D014481:United States; D055815:Young Adult
keywords: emergency medicine; measurement; pain; pain management; pain scores; trends; triage