Measuring pain intensity in older patients: a comparison of five scales.

BACKGROUND AND AIMS: Pain is common in older individuals. In order to understand and treat pain in this group, reliable and valid measures are needed. This study aimed to evaluate: (1) the validity, utility, incorrect response rates and preference rates of 5 pain rating scales in older individuals; and (2) the associations between age, education level, and cognitive function and both (a) incorrect response and (b) preference rates. METHODS: Two hundred and one orthopedic clinic outpatients ≥ 65 years old were asked to rate their current pain, and least, average, and worst pain intensity in the past week using 5 scales: Verbal Numerical Rating Scale (VNRS), Faces Pain Scale - Revised (FPS-R), Verbal Rating Scale (VRS), Numerical Rating Scale (NRS), and Visual Analogue Scale (VAS). Participants were also asked to indicate scale preference. We computed the associations between each measure and a factor score representing the shared variance among the scales, the incorrect response and scale preference rates, and the associations between incorrect response and preference rates and age, education level, and cognitive function. The incorrect responses included being unable to respond, providing more than one response, responses outside a range, providing range answers rather than fixed answers, and responses indicating 'least > average,' 'least > worst,' and 'average > worst'. RESULTS: The findings support validity of all 5 scales in older individuals who are able to use all measures. The VNRS had the lowest (2%) and the VAS had the highest (6%) incorrect response rates. The NRS was the most (35%) and the VAS was the least (5%) preferred. Age was associated with the incorrect response rates of the VRS and VAS, such that older individuals were less likely to use these scales correctly. Education level was associated with the incorrect response rates of the FPS-R, NRS and VAS, such that those with less education were less likely to use these measures correctly. Cognitive function was not significantly associated with incorrect response rates. Age, education level and cognitive function were not significantly associated with scale preference. CONCLUSIONS: Although all five scales are valid, the VNRS evidences the best overall utility in this sample of older individuals with pain. The NRS or FPS-R would be fine alternatives if it is not practical or feasible to use the VNRS.

Cost-Effectiveness and Cost-Utility Analyses in Thailand of Continuous Intrathecal Morphine Infusion Compared with Conventional Therapy in Cancer Pain: A 10-year Multicenter Retrospective Study.

Background: Because of the high initial cost of intrathecal drug delivery (ITDD) therapy, this study investigated the cost-effectiveness and cost-utility of ITDD therapy in refractory cancer pain management in Thailand over the past 10 years. Methods: The retrospective study was conducted in patients with cancer pain who underwent ITDD therapy from January 2011 to 2021 at three university hospitals. Clinical outcomes included the numerical rating scale (NRS), Palliative Performance Scale, and the EQ-5D. The direct medical and nonmedical as well as indirect costs were also recorded. Cost-effectiveness and cost-utility analyses were performed comparing ITDD therapy with conventional therapy (extrapolated from costs of the same patient before ITDD therapy) from a societally oriented economic evaluation. Results: Twenty patients (F:M: 10:10) aged 60 ± 15 years who underwent implantation of an intrathecal percutaneous port (IT port; n = 15) or programmable intrathecal pump (IT pump; n = 5) were included. The median survival time was 78 (interquartile range = 121-54) days after ITDD therapy. At 2-month follow-up, the incremental cost-effectiveness ratio (ICER)/pain reduction of an IT port (US$2065.36 (CA$2829.54)/2-point NRS reduction/lifetime) was lower than for patients with an IT pump (US$5479.26 (CA$7506.58)/2-point NRS reduction/lifetime) compared with continued conventional therapy. The ICER/quality-adjusted life years (QALYs) gained for an IT port compared with conventional treatment was US$93,999.31(CA$128,799.06)/QALY gained, which is above the cost-effectiveness threshold for Thailand. Conclusion: The cost-effectiveness and cost-utility of IT port therapy for cancer pain was high relative to the cost of living in Thailand, above the cost-effectiveness threshold. Prospective cost analysis studies enrolling more patients with diverse cancers that investigate the benefit of early ITDD therapy with devices over a range of prices are warranted.

Contexte: En raison du coût initial élevé du traitement par administration intrathécale de médicaments (AIM), cette étude a étudié le rapport coût-efficacité et le rapport coût-utilité du traitement par AIM dans la prise en charge de la douleur cancéreuse réfractaire en Thaïlande au cours des 10 dernières années.Méthodes: L'étude rétrospective a été menée auprès de patients souffrant de douleur cancéreuse ayant subi un traitement par AIM de janvier 2011 et 2021 dans trois hôpitaux universitaires. Les résultats cliniques comprenaient l'échelle d'évaluation numérique (EEN), l'échelle de performance palliative et l'EQ-5D. Les coûts médicaux et non médicaux directs et indirects ont également été consignés. Les analyses coûts-efficacité et coût-utilité ont été effectuées en comparant le traitement par AIM au traitement conventionnel (extrapolé à partir des coûts pour le même patient avant le traitement par AIM) à partir d'une évaluation économique sociétale.Résultats: Vingt patients (F : M : 10 : 10) âgés de 60 ± 15 ans ayant subi l'implantation d'un port percutané intrathécal (port IT; n = 15) ou d'une pompe intrathécale programmable (pompe IT; n = 5) ont été inclus. Le temps de survie médian était de 78 jours (intervalle interquartile = 121­54) après le traitement par AIM. À deux mois de suivi, le ratio coût-efficacité incrémental (RCEI/réduction de la douleur d'un port IT (2 065,36 $ US (2 829,54 $ CA) /réduction de 2 points sur l'EEN/durée de vie) était inférieur à celui des patients avec une pompe IT (5479,26 $ US (7506,58 $ CA) /réduction de 2 points sur l'EEN/durée de vie) comparativement au traitement conventionnel en continu. Le RCEI/année de vie pondérée par la qualité (AVPQ) gagnée pour un port IT comparativement au traitement conventionnel était de 93 999,31 $ US (128 799,06 $ CA) /AVPQ gagné, ce qui est au-dessus du seuil de rentabilité pour la Thaïlande.Conclusion: Le rapport coût-efficacité et le rapport coût-utilité du traitement par port IT pour la douleur cancéreuse étaient élevés par rapport au coût de la vie en Thaïlande, soit au-dessus du seuil de rentabilité. Les études d'analyse de coût prospectives portant sur un plus grand nombre de patients atteints de divers cancers qui étudient les avantages des traitements par AIM précoces à l'aide d'appareils de prix différents sont justifiées.