Abstract
Introduction
Several tools for pain measurement including a Visual Analogue Scale (VAS) and a Verbal Rating Scale (VRS) are currently used in patients with chronic pain. The aim of the present study was to determine which of these two pain tests performs optimally in patients following groin hernia repair.
Patients and methods
A questionnaire identified pain level in a cohort of patients that had previously undergone corrective groin hernia surgery. Current pain intensity was graded on a four-point VRS scale (no pain, mild, moderate or severe pain) and on a 100-mm VAS scale (0 = no pain, 100 = unbearable). “Scale failure” (one or both tests not completed correctly) was determined, and cut-off points for the VAS test were calculated by creating the optimum kappa coefficient between both tools.
Results
The response rate was 78.2% (706/903). Scale failure was present in VAS tests more than VRS (VAS: 12.5%, 88/706 vs. VRS: 2.8%, 20/706; P < 0.001). Advanced age was a risk factor for scale failure (P < 0.001). The four categories of VRS corresponded to mean VAS scores of 1, 20, 42, and 78 mm, respectively. VAS categories associated with the highest kappa coefficient (k = 0.78) were as follows: 0–8 = no pain, 9–32 = mild, 33–71 = moderate, >71 = severe pain. VAS scores grouped per VRS category showed considerable overlap. Age and sex did not significantly influence cut-off points.
Conclusions
Because of lower scale failure rates and overlapping VAS scores per VRS category, the VRS should be favored over the VAS in future postherniorrhaphy pain assessment. If VAS is preferred, the presented cut-off points should be utilized.
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References
Melzack R (1975) The McGill pain questionnaire: major properties and scoring methods. Pain 1:277–299
Daut RL, Cleeland CS, Flanery RC (1983) Development of the Wisconsin brief pain questionnaire to assess pain in cancer and other diseases. Pain 17:197–210
Briggs M, Closs JS, Phil M (1999) A descriptive study of the use of visual analogue scales and verbal rating scales for the assessment of postoperative pain in orthopaedic patients. J Pain Symptom Manage 18:438–446
Herr KA, Spratt K, Mobily PR, Richardson G (2004) Pain intensity assessment in older adults. Use of experimental pain to compare psychometric properties and usability of selected pain scales with younger adults. Clin J Pain 20:207–219
Page B, Paterson D, Young D, O’Dwyer PJ (2002) Pain from primary inguinal hernia and the effect of repair on pain. Br J Surg 89:1315–1318
Nienhuijs SW, Boelens O, Strobbe LJA (2005) Pain after anterior hernia repair. J Am Coll Surg 200:885–889
Loos MJA, Roumen RMH, Scheltinga MRM (2007) Chronic sequelae of common elective groin hernia repair. Hernia 11:169–173
Cunningham J, Temple WJ, Mitchell P, Nixon JA, Preshaw RM, Hagen NA (1996) Cooperative hernia study: pain in the postrepair patient. Ann Surg 224:598–602
Callesen T, Bech K, Kehlet H (1999) Prospective study of chronic pain after groin hernia repair. Br J Surg 86:1528–1531
Bay-Nielsen M, Perkins FM, Kehlet H (2001) Pain and functional impairment 1 year after inguinal herniorraphy: a nationwide questionnaire study. Ann Surg 233:1–7
Poobalan AS, Bruce J, King PM, Chambers WA, Krukowski ZH, Smith WC (2001) Chronic pain and quality of life following open inguinal hernia repair. Br J Surg 88:1122–1126
Courtney CA, Duffy K, Serpell MG, O’Dwyer PJ (2002) Outcome of patients with severe chronic pain following repair of groin hernia. Br J Surg 89:1310–1314
Kumar S, Wilson RG, Nixon SJ, Macintyre IM (2002) Chronic pain after laparoscopic and open mesh repair of groin hernia. Br J Surg 89:1476–1479
Lau H, Patil NG, Yuen WK, Lee F (2003) Prevalence and severity of chronic groin pain after endoscopic totally extraperitoneal inguinal hernioplasty. Surg Endosc 17:1620–1623
Grant AM, Scott NW, O’Dwyer PJ, on behalf of the MRC Laparoscopic Groin Hernia Trial Group (2004) Five year follow-up of a randomized trial to assess pain and numbness after laparoscopic or open repair of groin hernia. Br J Surg 91:1570–1574
O’Dwyer PJ, Kingsnorth AN, Molloy RG, Small PK, Lammers B, Horeyseck G (2005) Randomized clinical trial assessing impact of a lightweight or heavyweight mesh on chronic pain after inguinal hernia repair. Br J Surg 92:166–170
Franneby U, Sandblom G, Nordin P, Nyren O, Gunnarsson U (2006) Risk factors for long-term pain after hernia surgery. Ann Surg 244:212–219
Mikkelsen T, Werner MU, Lassen B, Kehlet H (2004) Pain and sensory dysfunction 6 to 12 months after inguinal herniotomy. Anesth Analg 99:146–151
Jönsson A-C, Lindgren I, Hallström B, Norrving B, Lindgren A (2006) Prevalence and intensity of pain after stroke: a population based study focusing on patients’ perspectives. J Neurol Neurosurg Psychiatr 77:590–595
Collins SL, Moore RA, McQuay HJ (1997) The visual analogue pain intensity scale: what is moderate pain in millimetres? Pain 72:95–97
Jensen MP, Chen C, Brugger AM (2003) Interpretation of visual analog scale ratings and change scores: a reanalysis of two clinical trial of postoperative pain. J Pain 4:407–414
Lund I, Lundeberg T, Sandberg L, Norrbrink Budh, Kowalski J, Svensson E (2005) Lack of interchangeability between visual analogue and verbal rating pain scales: a cross sectional description of pain etiology groups. BMC Med Res Methodol 5:31
Loos MJA, Roumen RMH, Scheltinga MRM (2007) Classifying postherniorrhaphy pain syndromes following elective inguinal hernia repair. World J Surg 31:1760–1765
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Loos, M.J.A., Houterman, S., Scheltinga, M.R.M. et al. Evaluating postherniorrhaphy groin pain: Visual Analogue or Verbal Rating Scale?. Hernia 12, 147–151 (2008). https://doi.org/10.1007/s10029-007-0301-9
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DOI: https://doi.org/10.1007/s10029-007-0301-9