Does pain intensity measured on a scale from 0 to 10, in Chinese and Australian Caucasian patients increase unpredictably and if so do the unpredictable levels vary between the two ethnicities? A comparison using the relationships between pain intensity, and pain related functional interference, pain related beliefs and attitudes, pain management satisfaction and opioid related side effects

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There are several established methods in Pain Medicine where a patient is able to describe the intensity of their pain. The most popular involve scoring pain intensity using a numeric scale comprising numbers from 1 to 10 and a visual scale which is 10 cm long and allows a clinician to measure the visual rating out of 10. Both these methods of pain intensity measurement carry the assumption that pain intensity increases in a predictable way as the numbers on these two measurement scales might indicate. The truth is that this is not likely to be true. The World Health Organization, for example, places great significance on a cancer pain rating that is higher than 3 out of 10, recommending that treatment for pain greater than 3 out of 10 be escalated. The most likely reason for changes in pain intensity not being even and predictable is that pain intensity is only a small part of overall pain experience. Pain intensity is influenced by many other factors, including the context of the pain (its effect on movement, sleep, mood), side effects of medications, anticipation of pain severity prior to pain experience, attitudes and beliefs relating to pain experience and satisfaction with the experience of pain management just to mention a few. There are statistical methods that can help us to explore how pain intensity changes as it increases. These complex methods can be applied though analysis of various measurements from patients, which can be easily collected in observational studies. The results of these analyses can then be used to look for steep “steps” in the pain intensity scale among populations of patients which indicate that pain level has increased to a greater degree than the gaps between the numbers on the pain rating scale might indicate. It is the numeric value where these steps occur, for example at a pain level of 3 out of 10 where recommendations to escalate pain treatment might be appropriate. Such points have already been identified in populations of patients affected by cancer pain, chronic pain as well as patients after surgery. There is only one study which examined a multiethnic population, the study involving cancer pain. A group of researchers that I have been working with have identified several factors that are very different in patients of Chinese ethnicity compared with patients of Caucasian ethnicity after major surgery. Many of these factors (Chinese people were more likely to defer analgesic management to their managing doctors, had greater expectation of severe postoperative pain, greater susceptibility to itch with morphine, lesser satisfaction with pain management) are likely to create “steps” in pain intensity scales that may differ significantly between these two races. We hope to compare two populations of 450 patients after surgery from China and Australia in order to confirm this belief as pain treatment escalation may need to be set at different levels in accordance with ethnicity.

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