Identification of Complementary versus Comprehensive Baseline Patient-Reported Outcomes (PROs) in an Adult Peripheral Nerve Pain Specialty Clinic for Prospective Data Collection
Kate Wan-Chu Chang, MA, MS1; Shawn Brown, CMA1; Lynda Yang, MD, PhD1; David L. Brown, MD2; Srinivas Chiravuri, MD1
1University of Michigan, Ann Arbor, MI, 2Section of Plastic & Reconstructive Surgery, University of Michigan, Ann Arbor, MI
Complex regional pain syndrome (CRPS) affects around 5 per 100,000 person years in the United States. CRPS symptoms include sensory or temperature change, swollen, decreased range of motion/weakness, and pain. Common treatment combines medications, surgical interventions, and psychosocial support; therefore, a comprehensive evaluation should assess pain's impact on International Classification of Functioning, Disability and Health (ICF) body function and structure, activity, and participation to monitor progress and improvement. However, current clinical protocol mainly focuses on physician-driven physical measurements, while there is paucity in reporting patient reported outcomes (PROs) in pain, activity, and participation. We aimed to identify the most comprehensive pain PROs for baseline in an interdisciplinary adult peripheral nerve pain clinic.
This cross-sectional study recruited adult CRPS patients in a peripheral nerve pain clinic from 2017-2018. We administered pain PROs measures at patients' first clinic appointment (baseline). PROs for pain level/intensity included Wong-Baker Face Pain Scale (scale 0-10), Visual Analogue Scale (VAS, 0-10), and McGill Pain Short Form (0-10). Pain symptoms were assessed via Neuropathic Pain Diagnostic Questionnaire (DN4, 0-10). Patients reported how pain affected their psychosocial status and daily living in Katz Index of Independence in Activities of Daily Living (scale 0-6) and West Haven-Yale Multidimensional Pain Inventory (WHYMPI, 0-6). Standard statistical analysis was applied for pain PROs summaries; we reported Pearson's correlation to identify the most comprehensive and complementary pain PROs.
Sixty-eight CRPS patients completed baseline pain PROs measures; mean age was 47±16 years old with a majority of female (63%) and Caucasian (87%). Baseline pain level ranged from 6.1 to 6.6 with 5 out of 10 DN4 neuropathic pain symptoms. Katz Index showed patients were independent in daily living (5.8/6), while WHYMPI reported high pain severity (4.4/6), pain interference in daily activities (3.9/6), feeling somewhat supportive (4.4/6), decreased mood (3.2/6), and less control due to pain (3.7/6). WHYMPI pain severity score was significantly correlated with Wong-Baker, VAS, McGill, Katz Index, and WHYMPI subscales (P<0.05); DN4 did not correlate with any other PROs measures.
We suggest using WHYMPI to establish pain PROs baseline-- this easy-to-use PROs captures an overall picture of pain impact on patients' pain severity, pain inference in daily activities, psychosocial status, and quality of life. Although DN4 showed poor correlations, it could be a complementary pain PROs. This novel approach can provide clinically relevant information to monitor patients' progress and can guide physicians in optimal treatment options.
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