As chronic pain patients, we dream of complete relief from pain.  However, the sad fact for most of us is that total freedom from pain is probably an unrealistic goal.  If that's the case, what then is a realistic goal?  Just how much pain relief is it reasonable to expect?  And a perhaps equally important question is, what outcomes other than a decrease in pain intensity are important to us? 

For the past seven years, a multidisciplinary group of international experts has been meeting and working to develop recommendations for improving clinical trials of pain treatments.  One important focus of this group – called the Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials (IMMPACT) – has been on how effective treatments for chronic pain can be defined, measured and translated into meaningful outcomes for patients. 

Measuring Improvement in Pain Intensity

Not surprisingly, the primary measure of a treatment's effectiveness has been pain intensity.  The most frequently used tools to evaluate a patient's pain are:

•  Numerical Rating Scale (NRS) – Patients are asked to rate their pain by a number between 0 (no pain) to 10 (worst pain imaginable).  This is the scale most often used in doctors' offices and hospitals.  (See Using the Pain Scale Effectively.) 
•  Visual Analog Scale (VAS) – Patients are asked to mark their pain intensity along a line 100 mm long, with 0 (no pain) at one end and 100 (worst pain imaginable) at the other end.

The IMMPACT group reviewed several studies and found that patients evaluate the success of a treatment by the following criteria:

•  Substantial improvement – 4 or more points reduction on the NRS, or 50% or more reduction on the VAS;
•  Moderately important improvement – 2 points NRS reduction, or 30 – 36% VAS reduction;
•  Mimimally important change – 1 point NRS reduction, or 10-20% VAS reduction.

From that it was surmised that most patients consider a treatment satisfactory or successful if they experience at least a 50% reduction in the level of their pain. 

How These Studies Apply to You

Before beginning any pain management plan, I think it's important for the doctor and patient to discuss expectations and agree on realistic goals.  If the patient is expecting complete pain relief but the doctor considers the treatment a success if there is a 50% reduction in pain, both are going to be dissatisfied.  The patient will end up feeling like the doctor doesn't care about her pain and the doctor may start to think the patient is just looking for more drugs. 

It's also a good idea to periodically reassess your pain management plan, evaluating your progress (or lack of it) and possibly setting new goals.  When you first began pain management, you were probably happy with any degree of pain relief you could get.  But after a while, you may feel that a 30% reduction in pain is just not enough to allow you to function as you need to and you want to try for better pain control.  You doctor needs to know if your goals have changed so you both are aiming for the same target.