Pain site and the effects of amputation pain: further clarification of themeaning of mild, moderate, and severe pain

Research among persons with cancer pain suggests that the association betwe en pain intensity and pain interference is non-linear. That is. pain begins to have a serious impact on functioning when it reaches a certain threshol d level (about 5 on 0-10 scales). Often, a second pain threshold can be ide ntified which, once reached. shows an even greater proportional negative im pact on functioning. This finding supports the potential clinical utility o f classifying pain as mild, moderate, and severe based on the impact of pai n on quality of life, and research among persons with cancer pain supports specific cutoffs (mild: 1-4, moderate: 5-6, severe: 7-10, see Pain 61 (1995 ) 277) for this classification. The current study sought to replicate the n on-linear association between pain and pain interference in a non-cancer pa in sample, determine whether the cutoffs that have been identified as optim al for cancer patients are also optimal for prisons with pain associated wi th amputation. and determine whether the optimal cutoffs replicate across p ain types (in this case, phantom limb, back, and general pain) within a sin gle sample. Two-hundred and five persons with acquired amputation and phant om limb pain, back pain, or both, rated their average pain intensity and de gree of pain interference for each type of pain. The results support a non- linear association between pain intensity and pain interference. However, t he optimal cutoffs for classifying mild, moderate and severe pain in the pr esent sample replicated the findings for persons with cancer pain only for back pain - different optimal cutoffs were found for phantom limb and gener al pain. Moreover, the degree of pain interference appeared to vary as a fu nction of pain type. The same level of back pain interfered more significan tly with daily function than phantom limb pain did after pain levels reache d file or more (on a 0-10 scale). These findings have implications for unde rstanding the meaning of pain intensity levels, as well as for the assessme nt of pain intensity in persons with amputation-related pain. (C) 2001 Inte rnational Association for the Study of Pain. Published by Elsevier Science B.V. All rights reserved.