Case Report
Volume 11 Issue 10 - 2020
Pain Assessed Using the Visual Analog Scale Differs between Initial Clinic Visit and the Day of Surgery in Orthopedic Patients and is Associated with Several Demographic Variables
Bradley S Lambert*, David Dong, Thomas C Sullivan, Patrick C McCulloch and Joshua D Harris
Orthopedic Biomechanics Research Laboratory, Department of Orthopedics and Sports Medicine, Houston Methodist Hospital, Houston, Texas, USA
*Corresponding Author: Bradley S Lambert, Director of Human Subjects Research, Orthopedic Biomechanics Research Laboratory, Department of Orthopedics and Sports Medicine, Houston Methodist Hospital Outpatient Center, Houston, TX, USA.
Received: August 26, 2020; Published: September 30, 2020




Abstract

Background: Pain assessment using the visual analog scale (VAS) is common during patient evaluation in orthopedic settings. However, several factors contribute to variability in patient pain scoring when only assessed in clinic. As a subjective psychological measure, we hypothesized that patient VAS scores would differ between the time of initial clinic visit (CV) and the day of surgery (DOS) and that the change in VAS scores (ΔVAS) would be associated with patient demographics, time of day and time between VAS recordings.

Methods: One-hundred-fourteen [m = 54, 42 ± 17yr | f = 60, 45 ± 16yr] orthopedic patients were recruited during their initial CV prior to surgery. Pain VAS was recorded using a handwritten mark on a 100-millimeter (mm) line representing a spectrum of no pain to worst pain at two time-points: CV and DOS. A ΔVAS of 14 mm was considered as a minimum clinically important difference (MCID) between measures. Demographics, time of day, time between CV and DOS measures and injury diagnoses were recorded. Student’s t-test and analysis of covariance were used to detect differences in VAS between CV and DOS. Pearson correlation analysis was used to detect relationships between independent variables and ΔVAS. Type-I error set at α = 0.05 for all analyses.

Results: VAS scores decreased on average when examining all patients (-4.86 ± 2.42 mm, p < 0.05) with 46% having a ΔVAS (increase or decrease) that exceeded the MCID (> 14 mm) and 24% with ΔVAS exceeding twice the MCID (> 28 mm). Patients with a body mass index ≥ 30 kg/m2 were found to have elevated VAS scores at DOS compared to < 30 kg/m2 (p < 0.05). Decreases in VAS were observed in patients < 35 years of age (-8.8 ± 3.7 mm), patients with knee (-15.5 ± 3.7 mm) rather than hip or upper body injuries, and patients who had morning CV appointments (-7.4 ± 3.2 mm) (p < 0.05). Age (R = 0.19) and initial VAS score during CV (R = -0.39) were found to be correlated with ΔVAS (p < 0.05).

Conclusion: Visual Analogue Scale scores vary considerably between CV and DOS in this patient population with the variance being partially attributable to several independent factors.

Level of Evidence: Level III, Retrospective.

Keywords: Pain; Pain Management; Visual Analog Scale; Orthopedic Surgery

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Citation: Bradley S Lambert., et al.. “Pain Assessed Using the Visual Analog Scale Differs between Initial Clinic Visit and the Day of Surgery in Orthopedic Patients and is Associated with Several Demographic Variables”. EC Orthopaedics 11.10 (2020): 83-93.

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