The visual analog scale for pain - Clinical significance in postoperative patients

Background: The visual analog scale is widely used in research studies, but its connection with clinical experience outside the research setting and t he best way to administer the VAS forms are not well established. This stud y defines changes in dosing of intravenous patient-controlled analgesia as a clinically relevant outcome and compares it with VAS measures of postoper ative pain. Methods: Visual analog scale measurements were obtained from 150 patients o n the morning after intraabdominal surgery. On the same afternoon, 50 of th e patients provided a VAS score on the same form used in the morning, 50 on a new form, and 50 were not asked for a second VAS measurement. Results: Visual analog scale values and changes in value were similar for p atients who were given a new VAS form in the afternoon and those who used t he form that showed the morning value. The proportions of patients requesti ng additional analgesia were 4, 43, and 80%, corresponding to afternoon VAS Scores Of 30 or less, 31-70, and greater than 70, respectively. Change fro m morning VAS score had no apparent in-fluence on patient-controlled analge sic dosing for patients with afternoon values of 30 or less or greater than 70, but changes in VAS scores of at least 10 did discriminate among patien ts whose afternoon values were between 31 and 70. Conclusions: When pain is an outcome measure in research studies, grouping final VAS scores into a small number of categories provides greater clinica l relevance for comparisons than using the full spectrum of measured values or changes in value. Seeing an earlier VAS form has no apparent influence on later values.