Postoperative pain assessment with three intensity scales in Chinese elders

Purpose: To evaluate the reliability and validity of the Faces Pain Scale Revised (FPS-R), the Numeric Rating Scale (NRS), and the Iowa Pain Thermometer (IPT) for pain assessment in Chinese elders who have had surgery. Design: A descriptive correlational design with repeated measures was used. A convenience sample of 180 Chinese elders (age range 65 to 95 years) undergoing scheduled surgery at a university-affiliated hospital was recruited. Methods: On the day before surgery, recalled pain and anticipated postoperative pain intensity were rated by patients with three scales presented in randomized order, and then cognitive function was measured. On the first 3 postoperative days, participants completed the three scales in random order to assess current, worst, and least pain on each day. On the 3rd postoperative day, single retrospective ratings on worst, least, and average pain over the 3 days for each scale were also obtained and scale preferences were investigated. Findings: The failure rates for all three scales were extremely low. The intraclass correlation coefficients across current, worst, and least pain on each postoperative day were consistently high (0.949 to 0.965), and all scales at each rating were strongly correlated (r=.833 to .962). Pain scores significantly decreased during the 3 postoperative days and all three scales were found to be sensitive in evaluating patient-controlled analgesia (PCA) efficacy. The scale mostly preferred was the IPT (54.7%), followed by the FPS-R (28.5%) and the NRS (15.6%). No significant differences were noted in participant preference by age and cognitive status, but preference for the IPT and the FPS-R were significantly related to gender and education level. Conclusions: Although all three scales show good reliability, validity, and sensitivity for assessing postoperative pain intensity in Chinese elders, the IPT appears to be a better choice based on patient preference. Clinical Relevance: The FPS-R, the NRS, and the IPT can be used confidently to assess postoperative pain in Chinese surgical elders.