The following is a summary of “Could we use the comfort score instead of the numeric rating pain score? A proof of concept pilot study,” published in the June 2023 issue of Emergency Medicine by Dorp, et al.
When assessing pain in the Emergency Department (ED), asking patients about their pain may inadvertently worsen their perception of pain due to the nocebo effect. Cognitive reframing, a strategy to mitigate the nocebo effect, could be achieved using a comfort score (CS) instead of the frequently used pain score (PS). For a study, researchers sought to determine if the CS and PS are interchangeable and whether the CS can be safely used in ED patients.
In the prospective pilot study, ED patients with pain were enrolled. Participants were randomly asked to provide both PS and CS. The CS scores were then inverted (ICS) and compared to PS using the Wilcoxon signed-rank test. Additionally, patient score preferences were evaluated.
A total of 100 patients were included in the study. The median PS for these participants was 6 (IQR 4–7), and the median ICS was 5 (IQR 3–6). Of all the PS and ICS scores, 15% were identical. There was no significant difference in medians (P = .115) between PS and ICS. However, in 33% of the participants, the total difference between PS and ICS was greater than 2. Interestingly, participants preferred to be asked for PS over CS (43% vs. 15%, P < .00).
The proof-of-concept study suggested that PS and ICS may be interchangeable in ED patients with pain. However, around one-third of patients had a possible clinically significant difference in score outcome, potentially leading to over- or underestimation of their pain. Whether the CS can be utilized as a tool for cognitive reframing to reduce pain perception and medication consumption requires further investigation.