Welcome back to Spine-IQ’s Back Blog! Last week, we discussed “HOW” to incorporate PROMIS Pain Interference scale in your practice. This week, we will focus on a different patient reported outcome measure (PROMs) that can be incorporated in your office to measure pain intensity. Some of you may be thinking “what a pain” these measures are, but on thoughtful review “PAIN” is usually the first indicator and/or symptom of why a patient decided to call your office to seek care.
PAIN is a challenge because we cannot SEE IT, MEASURE IT CORRECTLY, FEEL IT (except on ourselves), and IDENTIFYING THE ORIGIN is challenging. Another clinical challenge is, how do we really measure the patients pain objectively? PAIN can be a deceptive term since many patients have a high pain threshold and degree of PAIN disguises the severity of the condition. PROMIS is a critical way to measure the patient’s real pain tolerance and removing any and all bravado from the patients verbal description.
One of the most important parts of the clinical encounter is trying to find out how much a person hurts. This fact can lead to an honest and important conversation about the patient’s pain experience. That is where the value of the PROMIS Pain Intensity scale comes in. The PROMIS Pain Intensity scale1 uses 3 validated, reliable questions to assess how intense a patients pain is. Below we will describe the scale and how to interpret it:
PROMIS Pain Intensity Questions:
| Question | Answer scale |
| In the past 7 days, how intense was your pain at its worst? | No pain (1), Mild (2), Moderate (3), Severe (4), Very severe (5) |
| In the past 7 days, how intense was your average pain? | No pain (1), Mild (2), Moderate (3), Severe (4), Very severe (5) |
| What is your level of pain right now? | No pain (1), Mild (2), Moderate (3), Severe (4), Very severe (5) |
The significance of the PROMIS Pain Intensity scale is that it allows the patient to answer about the last 7 days along with their current pain to get a more complete picture of the patients’ pain experience. There are very few clinical indicators that can reveal as much about the patient, the condition and your approach than knowing about their PAIN.
PROMIS Pain Intensity Score Interpretation
The HealthMeasures website provides you with a free-to-use tool that automatically outputs the patients PROMIS-PI score for you. If you’d like to calculate the scores by yourself then it can be done in two steps:
Step one: calculate raw score by adding up all of the values. The answer scales range from 1 point for ‘No Pain’ to 5 points for ‘Very Severe’. This means that the raw score can be between 3 points and 15 points. Once you have the raw score calculated then you can use the following table to calculate what the T-Score is:
| Raw Score | T-Score | Raw Score (Cont.) | T-Score (Cont.) |
| 3 | 36.3 | 10 | 64.9 |
| 4 | 43.1 | 11 | 68.4 |
| 5 | 47.5 | 12 | 72.0 |
| 6 | 51.4 | 13 | 75.1 |
| 7 | 54.8 | 14 | 77.8 |
| 8 | 58.5 | 15 | 81.8 |
| 9 | 61.9 |
It’s important to remember that in PROMIS, higher scores indicate more of the measure. Therefore, higher scores indicate more pain intensity. The T-Score for the average general population is 50. Typically, PROMIS Pain Intensity T-scores from 20-55 are considered within normal limits, 55-60 is mild, 60-70 is moderate, and 70+ is severe. A score change of 2-3 points has been reported as clinically meaningful differences. 2
Summary
The amount of pain that a person is experiencing can be a helpful tool for you to understand the severity of the problem, the limitations of the patient, and the progress you are making with the care plan you have elected. Using evidence-based tools like PROMIS Pain Intensity is valuable along with your history and conversations with the patient to build confidence in the patient that you understand the problem and compliance with your intervention is essential. 3 Additionally, using validated outcome measures is a great way to make sure that your documentation is the best it can be when reviewing the progress with the patient as well as when your plan it is reviewed by others.
Stay tuned for next week’s blog when we dive into literature of ways to emphasize self-management in your clinic!
References:
- Stone AA, Broderick JE, Junghaenel DU, Schneider S, Schwartz JE. PROMIS fatigue, pain intensity, pain interference, pain behavior, physical function, depression, anxiety, and anger scales demonstrate ecological validity. J Clin Epidemiol. 2016;74:194-206. doi:10.1016/j.jclinepi.2015.08.029
- Chen CX, Kroenke K, Stump TE, et al. Estimating minimally important differences for the PROMIS pain interference scales: results from 3 randomized clinical trials. Pain. 2018;159(4):775-782. doi:10.1097/j.pain.0000000000001121
- Fuentes J, Armijo-Olivo S, Funabashi M, et al. Enhanced therapeutic alliance modulates pain intensity and muscle pain sensitivity in patients with chronic low back pain: an experimental controlled study. Phys Ther. 2014;94(4):477-489. doi:10.2522/ptj.20130118