title: Short-term variability in outpatient pain intensity scores in a national sample of older veterans with chronic pain.
abstract: OBJECTIVE
  The Department of Veterans Affairs (VA) uses the 11-point pain numeric rating scale (NRS) to gather pain intensity information from veterans at outpatient appointments. Yet, little is known about how NRS scores may vary over time within individuals; NRS variability may have important ramifications for treatment planning. Our main objective was to describe variability in NRS scores within a 1-month timeframe, as obtained during routine outpatient care in older patients with chronic pain treated in VA hospitals. A secondary objective was to explore for patient characteristics associated with within-month NRS score variability.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  National sample of veterans 65 years or older seen in VA in 2010 who had multiple elevated NRS scores indicating chronic pain.
  
  
  METHODS
  VA datasets were used to identify the sample and demographic and clinical variables including NRS scores. For the main analysis, we identified subjects with two or more NRS scores obtained in each of two or more months in a 12-month period; we examined ranges in NRS scores across the first two qualifying months.
  
  
  RESULTS
  Among 4,336 individuals in the main analysis cohort, the mean and median of the average NRS score range across the 2 months were 2.7 and 2.5, respectively. In multivariable models, main significant predictors of within-month NRS score variability were baseline pain intensity, overall medical comorbidity, and being divorced/separated.
  
  
  CONCLUSIONS
  The majority of patients in the sample had clinically meaningful variation in pain scores within a given month. This finding highlights the need for clinicians and their patients to consider multiple NRS scores when making chronic pain treatment decisions.
authors.affiliation: Center to Improve Veteran Involvement in Care, Portland Veterans Affairs Medical Center, Portland, Oregon, USA.|Department of Psychiatry, Oregon Health & Science University, Portland, Oregon, USA.
authors.forename: Steven K
authors.initials: SK
authors.lastname: Dobscha
authors.affiliation: Center to Improve Veteran Involvement in Care, Portland Veterans Affairs Medical Center, Portland, Oregon, USA.|Department of Psychiatry, Oregon Health & Science University, Portland, Oregon, USA.
authors.forename: Benjamin J
authors.initials: BJ
authors.lastname: Morasco
authors.affiliation: Center to Improve Veteran Involvement in Care, Portland Veterans Affairs Medical Center, Portland, Oregon, USA.
authors.forename: Anne E
authors.initials: AE
authors.lastname: Kovas
authors.affiliation: Department of Public Health & Preventive Medicine, Oregon Health & Science University, Portland, Oregon, USA.
authors.forename: Dawn M
authors.initials: DM
authors.lastname: Peters
authors.affiliation: Center to Improve Veteran Involvement in Care, Portland Veterans Affairs Medical Center, Portland, Oregon, USA.
authors.forename: Kyle
authors.initials: K
authors.lastname: Hart
authors.affiliation: Department of Psychiatry, Oregon Health & Science University, Portland, Oregon, USA.|Department of Public Health & Preventive Medicine, Oregon Health & Science University, Portland, Oregon, USA.
authors.forename: Bentson H
authors.initials: BH
authors.lastname: McFarland
mesh_terms: D000368:Aged; D059350:Chronic Pain; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D010045:Outpatients; D010147:Pain Measurement / Q000379:methods*; D012189:Retrospective Studies; D014728:Veterans
keywords: Aged; Chronic Pain; Numeric Rating Scale; Veterans