title: The Relation Between Patients' NRS Pain Scores and Their Desire for Additional Opioids after Surgery.
abstract: BACKGROUND
  Postoperative pain is commonly assessed through a numerical rating scale (NRS), an 11-point scale where 0 indicates no pain and 10 indicates the worst imaginable pain. Guidelines advise the administration of analgesics at NRS pain scores above 3 or 4. In clinical practice, not all patients with pain scores above the treatment threshold are willing to accept additional analgesic treatment, especially when opioids are offered. The objective of this study is to measure the relation between patients' NRS pain scores and their desire for additional opioids.
  
  
  METHODS
  This cross-sectional study examined 1,084 patients in an academic hospital the day after surgery between January 2010 and June 2010. The day after surgery, patients were asked to score their pain and desire for opioids. Sensitivity, specificity, positive predictive value, and negative predictive value of the desire for opioids and the different NRS thresholds were calculated.
  
  
  RESULTS
  Only when patients scored an 8 or higher on the NRS did the majority express a need for opioids. Many patients did not desire opioids, because they considered their pain tolerable, even at an NRS score above 4.
  
  
  CONCLUSIONS
  With the current guidelines (ie, using pain scores above 3 or 4 for prescribing opioids), many patients could be overtreated. Therefore, scores generated by the NRS should be interpreted individually.
authors.affiliation: Pain Clinic, Department of Anesthesiology, University Medical Center Utrecht, Utrecht, the Netherlands.
authors.forename: Jacqueline F M
authors.initials: JF
authors.lastname: van Dijk
authors.affiliation: Department of Anesthesiology, University Medical Center Utrecht, Utrecht, the Netherlands.
authors.forename: Teus H
authors.initials: TH
authors.lastname: Kappen
authors.affiliation: Department of Nursing Science, University Medical Center Utrecht, Utrecht, the Netherlands.
authors.forename: Marieke J
authors.initials: MJ
authors.lastname: Schuurmans
authors.affiliation: Pain Clinic, Department of Anesthesiology, University Medical Center Utrecht, Utrecht, the Netherlands.
authors.forename: Albert J M
authors.initials: AJ
authors.lastname: van Wijck
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000701:Analgesics, Opioid / Q000627:therapeutic use*; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009042:Motivation; D010147:Pain Measurement / Q000379:methods / Q000523:psychology*; D017288:Pain Threshold / Q000523:psychology*; D010149:Postoperative Pain / Q000175:diagnosis / Q000188:drug therapy* / Q000523:psychology*; D055815:Young Adult
chemical_list: D000701:Analgesics, Opioid
keywords: NRS; analgesics; desire for opioids; numeric rating scale; opioid; opioid requirement; pain assessment; patient acceptance; postoperative pain