Pain assessment in patients undergoing lumbar spine arthrodesis: application of unidimensional and multidimensional scale

Maciel, Juliana Aparecida; Lima, Márcia de Almeida; Pontin, José Carlos Baldocchi; Conceição, Luciana Sousa; Mafra, Andrea Dias Lamas

doi:10.5935/2595-0118.20210043

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ORIGINAL ARTICLE • BrJP 4 (3) • Jul-Sep 2021 • https://doi.org/10.5935/2595-0118.20210043 copy

Pain assessment in patients undergoing lumbar spine arthrodesis: application of unidimensional and multidimensional scale

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

BACKGROUND AND OBJECTIVES:

It is possible that patients submitted to lumbar spine surgery present chronic pain and need a multidimensional assessment of postoperative pain due to the variables that influence pain. The objective of this study was to evaluate the correlation between uni and multidimensional scales for postoperative pain assessment.

METHODS:

Longitudinal and observational study carried out in the inpatient units of an orthopedic reference hospital in São Paulo. 53 patients were selected in the preoperative period of lumbar spine arthrodesis, 28 were excluded and 25 were evaluated with the numerical verbal scale and Brief Pain Inventory on the preoperative day and on postoperative day 2.

RESULTS:

In the sample, all patients had chronic pain with a mean previous pain time of 9.24 years. There was variation between the pre and postoperative periods on the Brief Pain Inventory in almost all items, but only the item regarding the amount of pain ‘’right now’’ (in the moment) was equivalent to the numerical verbal scale (Kappa=almost complete correlation).

CONCLUSION:

The numerical verbal scale and Brief Pain Inventory were not comparable since the Numerical Verbal Scale showed a worsening of postoperative pain, while the Brief Pain Inventory reflected improvement in the perception of postoperative pain. The Brief Pain Inventory seemed to be a better tool for pain assessment in this study

Keywords:
Arthrodesis; Chronic pain; Low back pain; Pain; Pain measurement; Postoperative pain

	Pre			Post
	n	Mean	SD	n	Mean	SD	p-value
Presence of pain unrelated to the previous	17	68% no	32% yes	19	76% no	24% yes	0.7
Presence of pain unrelated to the previous	8	32% yes		6	24% yes		0.7
Diagram		56% up to 5 areas			88% up to 5 areas		0.0039
		28% up to 10 areas			4% up to 10 areas
		12% above 10 areas			18% above 10 areas
Intense pain		7.2	2.65		5.2	3.21	0.0047
Mild pain		3.8	2.54		1.48	1.47	0.0001
Mean of pain		6.28	2.32		2.92	2.09	0
Amount of pain in the moment		4.76	2.97		2.68	2.55	0.0016
Pharmacological treatment^ Pharmacological categories for intense,	For intense pain	42%			68%
	For moderate pain	29%			28%
	For mild pain	29%			4%
Pain improvement %		54	23		89	15	0.0001
General activities		7	2.82		4.68	3.13	0.0054
Mood		6.64	4.05		2.08	3.45	0.0008
Ability to walk		7.16	2.73		3.72	3.29	^* * The item "Ability to walk" presented no variation and therefore statistics were not computed;
Work		7.92	2.66		7.64	3.24	0.7
Relationship with people		4.36	4.01		1.04	2.12	0.0022
Sleep		5.16	4.26		3.16	3.31	0.07
Enjoyment of life		6.52	4.09		5.44	3.8	0.2

Variables	p-value
Numerical verbal scale	0.7986
Total of areas	0.7614
Intense pain	0.6112
Most mild pain	0.7893
Mean of pain	0.1494
Amount of pain in the moment	0.1875
Improvement %	0.4506
General activity	0.7296
Mood	0.5068
Walking	0.2177
Work	0.1966
Relationship	0.8244
Sleep	0.8185
Enjoyment of life	0.593

Sociedade Brasileira para o Estudo da Dor Av. Conselheiro Rodrigues Alves, 937 Cj2 - Vila Mariana, CEP: 04014-012, São Paulo, SP - Brasil, Telefones: , (55) 11 5904-2881/3959 - São Paulo - SP - Brazil
E-mail: dor@dor.org.br

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[1] Correspondence to: Av. Professor Ascendino Reis, 724 - Reabilitação Hospitalar, 04027-000 São Paulo, SP, Brasil. E-mail: mallsp@hotmail.com

	BPI variables	Kappa	Inferior CI	Superior CI	Significance	Accordance
NVS pre	Total of areas pre	-0.0159	-0.1333	0.1015
	Most intense pain pre	0.2504	0.0489	0.452	^* * - the p-value for this test is 0.05. The data presented in the accordance column correspond to the classification of the Kappa correlation value (absent, poor, weak, moderate, almost complete, substantial).	Weak
	Most mild pain pre	0.4069	0.1836	0.6303	^* * - the p-value for this test is 0.05. The data presented in the accordance column correspond to the classification of the Kappa correlation value (absent, poor, weak, moderate, almost complete, substantial).	Moderate
	Mean of pain pre	0.2424	0.0387	0.4461	^* * - the p-value for this test is 0.05. The data presented in the accordance column correspond to the classification of the Kappa correlation value (absent, poor, weak, moderate, almost complete, substantial).	Weak
	Amount of pain in the moment	0.9537	0.8648	1.0426	^* * - the p-value for this test is 0.05. The data presented in the accordance column correspond to the classification of the Kappa correlation value (absent, poor, weak, moderate, almost complete, substantial).	Almost complete
	Improvement % pre	-0.0081	-0.0081	-0.0081	^* * - the p-value for this test is 0.05. The data presented in the accordance column correspond to the classification of the Kappa correlation value (absent, poor, weak, moderate, almost complete, substantial).	Inconclusive
	General activity pre	0.1243	-0.0473	0.296
	Mood pre	0.0854	-0.0711	0.2418
	Walking pre	0.1637	-0.0205	0.3479
	Work pre	0.0017	-0.1137	0.1171
	Relationship pre	0.1788	-0.0219	0.3796
	Sleep pre	0.0489	-0.1138	0.2116
	Enjoyment of life pre	0.0196	-0.1223	0.1615
NVS post	Total of areas post	0.0054	-0.1385	0.1494
	Most intense pain post	0.2133	0.021	0.4056	^* * - the p-value for this test is 0.05. The data presented in the accordance column correspond to the classification of the Kappa correlation value (absent, poor, weak, moderate, almost complete, substantial).	Weak
	Most mild pain post	0.1968	-0.0394	0.4329
	Mean of pain post	0.4455	0.2192	0.6717	^* * - the p-value for this test is 0.05. The data presented in the accordance column correspond to the classification of the Kappa correlation value (absent, poor, weak, moderate, almost complete, substantial).	Moderate
	Amount of pain in the moment	0.6735	0.4683	0.8787	^* * - the p-value for this test is 0.05. The data presented in the accordance column correspond to the classification of the Kappa correlation value (absent, poor, weak, moderate, almost complete, substantial).	Substantial
	Improvement % post	-0.0196	-0.0196	-0.0196	^* * - the p-value for this test is 0.05. The data presented in the accordance column correspond to the classification of the Kappa correlation value (absent, poor, weak, moderate, almost complete, substantial).	Inconclusive
	General activity post	0.0575	-0.1038	0.2187
	Mood post	-0.0142	-0.213	0.1846
	Walking post	0.1171	-0.0774	0.3116
	Work post	0.0614	-0.0744	0.1973
	Relationship post	0.0625	-0.1667	0.2917
	Sleep post	0.0865	-0.1147	0.2878
	Enjoyment of life post	0.0036	-0.1406	0.1479