Impact of pain question modifiers on spine augmentation outcome

Purpose: To determine whether the reported pain severity changed significantly on the basis of specific types of pain questions posed to patients with spine augmentation. Materials and Methods: Institutional review board approval and patient consent were obtained for this HIPAA-compliant, prospective study. Patients presenting for consideration of spine augmentation between November 2008 and May 2009 were enrolled. Twenty-four patients were asked at initial presentation and at 30 days to grade their severity of back pain on a 10-point numeric rating scale in response to nine pain questions modified by the relative severity (most vs least severe), by activity (at rest vs with activity), and over time (previous day vs previous week). Statistical analysis included paired t tests to detect any differences in responses to the questions at both time points. Results: Of the 24 patients, 15 (63%) underwent spine augmentation. For patients undergoing spine augmentation, baseline mean numeric rating score for "worst pain with activity over the past week" was 8.9 6 1.5 (standard deviation), compared with 2.9 6 2.7 for "least pain at rest over the past day" (P =.001). Interval change between baseline and 30-day assessments was relatively small for all nine questions (mean, 1.6;range, 0.2-2.2); the mean difference for eight of the nine questions did not reach statistical significance. The modifiers worst versus least and with activity versus at rest had a significant impact on the reported severity, while previous week versus previous day had minimal impact. Conclusion: Wide variation in the reported pain can be achieved simply by modifying specific pain questions to patients with spine augmentation.