Abstract
Assessing if an individual patient has achieved clinically meaningful changes in pain
intensity is a core aspect in the evaluation of pain treatments. The aim of the present
study was to define minimally clinically significant differences (MCSDs) for the numerical
rating scale (0–10 NRS) in adolescents with chronic pain. Data from 153 adolescents
who completed an inpatient treatment were analyzed. MCSDs were defined as those cut
points that yielded an optimal balance between sensitivity and specificity with regard
to patients' global impression of change. The variability of the empirically defined
cut points was quantified using bootstrapping. Our results show that raw changes of
1 NRS point and percent changes of 12.5% can be considered MCSDs both within the full
sample and within various subsamples of patients. Applying the MCSDs developed for
adults to pediatric patients yielded extremely low sensitivities; for example, only
22% of the children who described global improvement met the 50% decrease in pain
criterion. Studies evaluating chronic pain treatments for adolescents should use MCSDs
that are specifically developed for this group of patients. Raw changes of 1 point
and 12.5% on the 0 to 10 NRS should be considered clinically meaningful. On a methodological
level, we call for more systematic studies aimed at defining MCSDs that also address
the variability of cut point estimates so as to foster the integration of findings.
Perspective
Many studies are aimed at empirically defining cut points for clinically relevant
pain using receiver operating characteristic-based methods. For the first time, we
apply these methods to children and show that even when taking into account the variability
of the method, cut points specific for children are needed.
Key words
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Article info
Publication history
Published online: November 22, 2013
Accepted:
September 13,
2013
Received in revised form:
August 1,
2013
Received:
February 15,
2013
Footnotes
No funding was received for this study.
The authors declare that they have no conflict of interest, including specific financial interests, relationships, or affiliations relevant to the study.
Identification
Copyright
© 2014 American Pain Society. Published by Elsevier Inc. All rights reserved.
