AbstractsMedical & Health Science

Many patients experience pain after surgery. Adequate pain treatment begins with a reliable pain assessment. The Numeric Rating Scale (NRS) is often used for this purpose; patients are asked to score their pain on a scale from 0 to 10, where 0 indicates no pain and 10 indicates the worst imaginable pain. Patients’ NRS scores are the leading indicators for postoperative pain treatment. The Dutch guideline for pain treatment recommend professionals to administer additional analgesics at an NRS score higher than 3. However, patients and professionals differ in how they interpret the NRS scores. Most postoperative patients who report NRS scores between 4 and 6 consider their pain bearable and do not desire additional opioids. A risk of overtreatment might arise when healthcare professionals rigidly follow guidelines for pain treatment. Therefore, rigid cut-off scores in guidelines for postoperative pain treatment should not be used for individual patients. A discussion about the cut-off score for a particular patient can possibly improve mutual understanding, leading to individualized interventions (pharmacologic and/or non-pharmacologic) and superior postoperative care. Educating patients with a film about pain assessment and treatment was not effective in postoperative patients about the use of the NRS, because many continued to give high NRS scores while not expressing a desire for analgesics. In a qualitative study, postoperative patients told us that they had their own ideas about the meaning of the different numbers of the pain scale.We propose a conceptual model for the relationship between factors that influence the pain rating process.When assigning a NRS score to their pain, patients process the first two themes in stages: They first weigh score-related factors and intrapersonal factors, and a preliminary pain score is “internally” set. Some patients undergo a last stage before reporting to the professional: Weighing the judgments by healthcare professionals and the anticipated consequences of reporting a particular NRS score against their actual desire for more or less analgesics.The proposed model can help professionals to understand the factors that influence a given NRS score and suggest the most appropriate questions for clarification.In this way, patients and professionals can arrive at a shared understanding of the pain score, resulting in a tailored decision regarding the most appropriate treatment for current postoperative pain. In addition, we found that 79% of the patients and 51% of the nurses were neutral or agreed with the false statement that people become addicted to pain medication easily. Concerns about analgesics have been cited as one of the major barriers to adequate pain management.