Evaluating pain in survivors of critical illness: the correlation between the EQ-5D-5L and the Brief Pain Inventory

Abstract

IntroductionPain is a common and debilitating symptom in survivors of critical illness. The ‘Core Outcome Set for Survivors of Acute Respiratory Failure’ proposes that the pain and discomfort question of the EuroQol 5 Dimension 5 Level (EQ-5D-5L) could be used to assess pain in this group, however, it was recognised that further research is required to evaluate how this single question compares to other more detailed pain tools. This study aims to evaluate the relationship between the pain and discomfort question of the EQ-5D-5L and the Brief Pain Inventory (BPI) in survivors of critical illness.MethodsThis study retrospectively analysed paired EQ-5D-5L and BPI data extracted from a prospective, multicentre study evaluating the impact of a critical care recovery programme. 172 patients who received a complex recovery intervention and 108 patients who did not receive this intervention were included. Data were available for the intervention cohort at multiple time points, namely, baseline, 3 months and 12 months. While, data were available for the usual care cohort at a single time point (12 months). We assessed the correlation between the pain and discomfort question of the EQ-5D-5L and two separate components of the BPI: severity of pain and pain interference.ResultsCorrelation coefficients comparing the pain and discomfort question of the EQ-5D-5L and the BPI pain severity score ranged between 0.73 (95% CI 0.63 to 0.80) and 0.80 (95% CI 0.72 to 0.86). Correlation coefficients comparing the pain and discomfort question of the EQ-5D-5L and the BPI pain interference score ranged between 0.71 (95% CI 0.62 to 0.79) and 0.83 (95% CI 0.76 to 0.88) across the various time points.ConclusionsThe pain and discomfort question of the EQ-5D-5L correlates moderately well with a more detailed pain tool and may help to streamline assessments in survivorship studies. More in-depth tools may be of use where pain is the primary study outcome or a patient-reported concern.

Validation of general pain scores from multidomain assessment tools in stroke

“…Our dataset comprised more than 10,000 participants from 10 studies and took place across different stroke settings, thereby increasing overall generalisability of results when compared to studies based on single centres or settings. Similar work has established the moderate relationship between the EQ-5D pain domain and the Brief Pain Inventory, but was based on a much smaller sample size in a different health condition ( 40 ). Our population included people with language impairment due to stroke, thereby providing information on populations in whom measurement of pain can be particularly challenging.…”

“…Additionally, the NPRS showed high test–retest ability and is highly correlated with the pain Visual Analogue Scale (VAS) ( 39 ). Docherty et al ( 40 ) reported moderate correlation between the EQ-5D-5L pain and discomfort domain with the Brief Pain Inventory (BPI). A separate study in adult burn patients reported Spearman correlation of 0.468 between the EQ-5D-5L pain and discomfort domain and the Patient and Observer Scar Assessment Scale (POSAS) ( 41 ).…”

“…Nevertheless, in the absence of consensus on pain measurement in stroke populations ( 1 , 2 ), the widespread use and international applicability of the EQ-5D could lend itself to use in future studies where it is of interest to describe pain, but where pain is not the primary goal of the study. The EQ-5D pain domain should not replace more detailed pain assessment but may permit post-stroke pain to be described where resources and assessment burden hinder the implementation of additional, pain-specific assessments ( 40 ).…”

Understanding the Value of Alleviating Health-Related Suffering and Palliative Care Centered in Lived Experience: The SAVE Toolkit

“…The use of the EQ-5D-5L for the SAVE study is based on several considerations and criteria. Specifically, this quality-of-life assessment tool: 1) correlates well in comparison to instruments focused on symptoms amenable to palliative care such as pain, 72 2) strong psychometric properties and validation 73,74 across conditions and populations, 3) serves as a standard tool for comparison across study countries, 4) is available in multiple languages following standardized translation protocol in accordance with international guidelines for use across study sites worldwide, 75 and 5) poses low respondent burden. Any descriptive information provided by participants in administration of the EQ-5D-5L can be captured to further link with dominant qualitative arm of the study.…”