Measuring acute postoperative pain using the visual analog scale: the minimal clinically important difference and patient acceptable symptom state

Myles, Paul S.; Myles, Daniel B.; Galagher, W; Boyd, David B.; Chew, Colleen; MacDonald, Neil; Dennis, A.T.

doi:10.1093/bja/aew466

Cited by 596 publications

(488 citation statements)

References 45 publications

Supporting

Mentioning

467

Contrasting

Unclassified

Order By: Relevance

“…Also, there was significant heterogeneity in study designs with respect to the analgesic regimen. The minimal clinically important difference (MCID) in pain score has been debated, and while some have suggested a cut-off of 20 mm on a 100 mm VAS, or 30% on the NRS,82 some have argued for 10 mm14 and others have advocated individualizing MCID to baseline pain 83. We chose 10 mm as our defined MCID in accordance with the recent study by Myles and colleagues,14 who postulated 10 mm to be the MCID, and an absolute score of 33 mm on a 100 mm VAS to signify “acceptable pain control.” Although most studies report pain at rest, studies reporting pain on activity would be more suited to judge recovery from surgery with respect to mobilization.…”

Section: Discussionmentioning

confidence: 99%

Pain management after laparoscopic hysterectomy: systematic review of literature and PROSPECT recommendations

Lirk

Thiry

Bonnet

et al. 2019

Reg Anesth Pain Med

View full text Add to dashboard Cite

Background and objectivesLaparoscopic hysterectomy is increasingly performed because it is associated with less postoperative pain and earlier recovery as compared with open abdominal hysterectomy. The aim of this systematic review was to evaluate the available literature regarding the management of pain after laparoscopic hysterectomy.Strategy and selection criteriaRandomized controlled trials evaluating postoperative pain after laparoscopic hysterectomy published between January 1996 and May 2018 were retrieved, according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, from the EMBASE and MEDLINE databases and the Cochrane Register of Controlled Trials. Efficacy and adverse effects of analgesic techniques were assessed.ResultsOf the 281 studies initially identified, 56 were included. Of these, 31 assessed analgesic or anesthetic interventions and 25 assessed surgical interventions. Acetaminophen, non-steroidal anti-inflammatory drugs, and dexamethasone reduced opioid consumption. Limited evidence hindered recommendations on alpha-2-agonists. Inconsistent evidence was found in the studies investigating pregabalin and transversus abdominis plane block, and no evidence was found for intraperitoneal local anesthetics, port site infiltration, or single-port laparoscopy. Measures to lower peritoneal insufflation pressure or humidify or heat insufflated gas seem to reduce the incidence of shoulder pain, but not abdominal pain.ConclusionsThe baseline analgesic regimen for laparoscopic hysterectomy should include acetaminophen, a non-steroidal anti-inflammatory drug, dexamethasone, and opioids as rescue analgesics.

show abstract

Section: Discussionmentioning

confidence: 99%

Pain management after laparoscopic hysterectomy: systematic review of literature and PROSPECT recommendations

Lirk

Thiry

Bonnet

et al. 2019

Reg Anesth Pain Med

View full text Add to dashboard Cite

show abstract

“…Despite its status as a gold standard to measure pain intensity, the VAS has the limitation that a reduction in a VAS score itself may not equate to improvement in the patient’s experience [6, 14]. Whether the difference in VAS score between groups reached the MCID and the value of VAS score fulfilled patient acceptable symptom state (PASS) were also assessed.…”

Section: Methodsmentioning

confidence: 99%

“…The MCID is the smallest difference in an outcome score that a patient perceives as beneficial [6]. The PASS is the score below which patients consider themselves well [14, 19]. The VAS score at the recovery room was assessed to fulfill the prescribed VAS score published by Myles et al [14].…”

Section: Methodsmentioning

confidence: 99%

“…The PASS is the score below which patients consider themselves well [14, 19]. The VAS score at the recovery room was assessed to fulfill the prescribed VAS score published by Myles et al [14]. Myles et al concluded analgesic interventions that provided a change of 10 for the 100-mm pain VAS signified a clinically important improvement, and a VAS of 33 or less signified acceptable pain control after surgery [14].…”

Section: Methodsmentioning

confidence: 99%

See 1 more Smart Citation

Early stage periarticular injection during total knee arthroplasty may provide a better postoperative pain relief than late-stage periarticular injection: a randomized-controlled trial

Tsukada

Kurosaka

Maeda

et al. 2018

Knee Surg Sports Traumatol Arthrosc

View full text Add to dashboard Cite

PurposeThis study was performed to determine whether periarticular injection performed in the early stage of total knee arthroplasty (TKA) could provide a better postoperative pain relief than periarticular injection performed in the late stage of TKA. The hypothesis was based on the concept that analgesic intervention before the onset of noxious stimuli would be associated with less postoperative pain.MethodsA total of 105 participants were randomly assigned to receive superficial injection just prior to arthrotomy (early stage periarticular injection group) or superficial injection after implanting the prosthesis (late-stage periarticular injection group) in patients undergoing unilateral TKA with 1:1 treatment allocation. In both groups, deep injection was performed according to the same schedule (just prior to implanting prosthesis). The solution consisted of 300 mg of ropivacaine, 8 mg of morphine, 40 mg of methylprednisolone, 50 mg of ketoprofen, and 0.3 mg of epinephrine mixed with normal saline to a final volume of 60 mL. All surgeries were managed under general anesthesia without any regional blocks. Registry-specified primary outcome was postoperative pain score at rest measured at the recovery room using a 100-mm visual analog scale (VAS). The VAS score was compared between two groups and assessed to reach the reported threshold values for the minimal clinically important difference (MCID) of 10 mm for the postoperative VAS score.ResultsThe VAS score at the recovery room was significantly lower in the early stage periarticular injection group than the late-stage periarticular injection group (23 ± 25 mm versus 39 ± 34 mm, respectively; 95% confidence interval 4–28 mm; p = 0.0078). The mean difference in the primary outcome fulfilled the MCID value.ConclusionsBringing forward the timing of periarticular injection may provide significant and clinically meaningful improvement in pain following TKA under general anesthesia.Level of evidenceI.

show abstract

“…The patient was questioned about his perception of vibratory stimuli applied from the left and right, and his perception of increased weight bearing in each session after completion of the post-test. We used a visual analog scale (VAS) to measure anxiety after the pre-test, and after the weight-shift training [45]. The VAS is frequently used to measure pain intensity.…”

Section: Examination Of the Test Validity In Patientsmentioning

confidence: 99%

Development of an implicit method for directing weight shifting to the affected side in patients with stroke: a proof of concept study

et al. 2017

View full text Add to dashboard Cite

Weight-shift training during stroke rehabilitation requires patient effort, potentially causing leg spasticity and anxiety, which disturb motor learning. The purpose of this study was (1) to devise an implicit guidance method for weight bearing that uses vibratory cues (and is therefore low exertion) and (2) to determine if the implicit guidance method is feasible. The first experiment included 12 healthy subjects. We conducted an experiment to produce a Weber's fraction capable of calculating a just-noticeable difference during a weight-shifting task. We then applied this Weber's fraction to a weight-shifting task in a patient with stroke. Using the implicit guidance method, the patient did not perceive an increase in weight bearing while weight shifting. Furthermore, the implicit guidance method appeared to reduce anxiety during training. This implicit guidance system warrants further investigation.

show abstract

Measuring acute postoperative pain using the visual analog scale: the minimal clinically important difference and patient acceptable symptom state

Abstract: Analgesic interventions that provide a change of 10 for the 100 mm pain VAS signify a clinically important improvement or deterioration, and a VAS of 33 or less signifies acceptable pain control (i.e. a responder), after surgery.

Cited by 596 publications

References 45 publications

Pain management after laparoscopic hysterectomy: systematic review of literature and PROSPECT recommendations

Pain management after laparoscopic hysterectomy: systematic review of literature and PROSPECT recommendations

Early stage periarticular injection during total knee arthroplasty may provide a better postoperative pain relief than late-stage periarticular injection: a randomized-controlled trial

Development of an implicit method for directing weight shifting to the affected side in patients with stroke: a proof of concept study

Contact Info

Product

Resources

About