A new study published in The Spine Journal examines the characteristics of patients reporting maximum pain on the visual analog scale.
The study included 6,779 patients who sought care for spinal disorders and measured their pain on the VAS scale. The patients presented with lumbar degenerative disc disease with and without spinal stenosis. There were patients in both groups reporting VAS pain scores of 10/10.
The researchers found:
1. There were 160 individuals who reported 10/10 pain on the VAS scale at their initial presentation — 2.9 percent of the patients.
2. Among the patients who reported 10/10 pain on the VAS, most reported an improvement of three points on average in the VAS pain score between their first visit and their last follow-up appointment.
3. When compared with patients who reported submaximal pain, there were 1.5 odds that patients who reported 10/10 VAS pain scores would improve by at least 40 percent.
4. The patients with identifiable secondary gain were more common in the group that reported submaximal pain.
5. The biggest improvement in VAS pain scores — four points or more — was among older patients, non-smokers and those who didn't report secondary gain from their disease.
6. The patients who continued to report 10/10 pain on the VAS were those who smoked more frequently.
The study authors concluded, "Our analysis supports the need to consider the influence of secondary gain on the patients' reported VAS pain scores. Maximum pain seems to be a more acute phenomenon with some likelihood to significantly improve."