Pain Scores Show No Monotonic Upward or Downward Trend Over Time

BackgroundSelf-reported pain scales are commonly used in emergency departments (EDs). The 11-point (0–10) numerical rating scale is a commonly used scale for adults visiting EDs in the United States. Despite their widespread use, little is known about whether distribution of pain scores has remained consistent over time.ObjectivesThe objective of this study is to determine if there were upwards or downwards (monotonic) trends in pain scores over time at a single hospital.MethodsRetrospective chart review for the years 2003–2011. All pain scores for May 1st and 2nd of those years were collected. Multinomial logistic regression was used to model the probability of a patient rating their pain in each of 11 categories (scores 0 to 10) as a function of the calendar year. Additional analysis was carried out with pain scores grouped into four categories.ResultsData were collected from 2934 patient charts. Pain scores were recorded in 2136 charts, and 1637 of these pain scores were above zero (i.e., 1–10). The pain score distribution differed significantly over time (p = 0.001); however, there was no monotonic (single-direction) trend.ConclusionAlthough there were significant shifts in pain scores over time, there is not a significant monotonic trend. At this hospital, there was no “inflation” or “deflation” in pain scores over time. Shifts in distribution, even when not in a single direction, may be important for researchers examining pain scores in the ED.