Health Services Research & Development

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2007 HSR&D National Meeting Abstract

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National Meeting 2007

3077 — Relationship of Reported Pain Severity to Perceived Effect on Function

Saliba D (VA COE, UCLA, RAND) , Orlando M (RAND), Cadogan M (UCLA School of Nursing), Lorenz K (VA COE), Jones M (RAND), Yosef J (VA COE), Hascall T (UCLA), Simon B (VA COE), Harker J (VA GRECC)

Objectives:
Pain self-report is the accepted gold-standard for identifying pain presence and severity. Repeated severity assessment provides insight into individual clinical change. However, providers question the usefulness of this metric for understanding function. This study tested whether 4 questions addressing the effect of pain on day-to-day functions added unique information that could improve standardized pain assessment.

Methods:
We conducted pain interviews with 125 post-acute and long-stay residents in 2 VA nursing homes (NHs). Residents were asked about pain presence, severity (mild, moderate, severe, very severe/horrible), and bother (not at all, a little, moderate, a great deal). Residents were also asked if they “limited activities because of pain” and whether pain made it “hard to get out of bed,” “hard to sleep,” or “hard to spend time with other people.”

Results:
51% of residents (n=63) reported pain. For residents with pain, the modal severity response was “moderate” (43%) and “great deal” for bother (32%). Correlation between pain severity report and overall count of functional interference was significant (Spearman’s rho=.449, p=.001). In general, for each item, the proportion reporting interference increased as severity increased. However, residents reported interference with function at all levels of severity, and Fischer’s exact test showed significant association only for “hard to get out of bed” (p=.0175) ) and “interfered with sleeping” (p=.0211). Examination of frequency tables indicates that the strength of association was primarily among residents reporting extreme (“mild” or “very severe”) pain; whereas among residents reporting “moderate” or “severe” the association was minimal. Similar patterns were seen for bother.

Implications:
The lack of perfect association implies that questions addressing the effect of pain on day-to-day functions are an important addition to standardized pain assessments, particularly for persons with moderate or severe pain.

Impacts:
These analyses led to the addition of these 4 functional items to a large national test revising the Minimum Data Set, a mandated assessment completed on everyone admitted to VA NHs. These findings therefore stand to improve pain assessment in VA NHs across the US. These items should also be tested in other populations.