Establishing the patient acceptable symptom state for patient-reported pain outcomes 6 months after breast cancer surgery
Abstract. Introduction:. The patient-acceptable symptom state (PASS) is a threshold score on patient-reported outcome measures beyond which patients consider their symptoms unacceptable (PASS negative). The PASS may guide the interpretation of outcomes associated with persistent pain after breast ca...
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| Format: | Article |
| Language: | English |
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Wolters Kluwer
2025-08-01
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| Series: | PAIN Reports |
| Online Access: | http://journals.lww.com/painrpts/fulltext/10.1097/PR9.0000000000001297 |
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| author | Matthew Kang David Rice Nuala Helsby Andrew Somogyi Michal Kluger Daniel Chiang |
| author_facet | Matthew Kang David Rice Nuala Helsby Andrew Somogyi Michal Kluger Daniel Chiang |
| author_sort | Matthew Kang |
| collection | DOAJ |
| description | Abstract. Introduction:. The patient-acceptable symptom state (PASS) is a threshold score on patient-reported outcome measures beyond which patients consider their symptoms unacceptable (PASS negative). The PASS may guide the interpretation of outcomes associated with persistent pain after breast cancer surgery (PPBCS).
Objectives:. This study aimed to identify PASS cut-off values for the numerical rating scale (NRS) on the brief pain inventory (BPI) items for pain at 6 months after breast cancer surgery and describe functional and psychological outcomes associated with an unacceptable (PASS-negative) pain state.
Methods:. This prospective cohort study included patients undergoing primary breast cancer surgery. Patients were assessed preoperatively and postoperatively at 2 weeks and 6 months using validated questionnaires. Patient-acceptable symptom state was evaluated at 6 months after surgery. Patients were classified into PASS-positive (acceptable pain state) or PASS-negative groups using a pain-specific anchor question. Patient-acceptable symptom state thresholds for the BPI items were determined using the Youden index on a receiver operating characteristic curve.
Results:. Of the 140 included patients, 13.6% reported a PASS-negative state at 6 months after surgery. Compared to PASS-positive patients, PASS-negative patients reported greater pain severity, pain interference, psychological distress, upper limb disability, and neuropathic pain (all P < 0.008). Numerical rating scale patient-acceptable symptom state cut-off values for the BPI items were 1.5 (worst pain), 0.5 (average pain), and 0.8 (pain interference).
Conclusion:. The NRS scores for the BPI worst pain >1.5, average pain >0.5, and pain interference >0.8 delineated patients with “unacceptable” PPBCS. These values may define clinically meaningful PPBCS and offer pain cut-off values for research. |
| format | Article |
| id | doaj-art-318a1e9b7c5c418cbb7f7151c700ec0e |
| institution | DOAJ |
| issn | 2471-2531 |
| language | English |
| publishDate | 2025-08-01 |
| publisher | Wolters Kluwer |
| record_format | Article |
| series | PAIN Reports |
| spelling | doaj-art-318a1e9b7c5c418cbb7f7151c700ec0e2025-08-20T03:23:07ZengWolters KluwerPAIN Reports2471-25312025-08-01104e129710.1097/PR9.0000000000001297PR90000000000001297Establishing the patient acceptable symptom state for patient-reported pain outcomes 6 months after breast cancer surgeryMatthew Kang0David Rice1Nuala Helsby2Andrew Somogyi3Michal Kluger4Daniel Chiang5a Department of Anaesthesiology, Perioperative & Pain Medicine, Health New Zealand, Te Whatu Ora Waitemata, Auckland, New Zealanda Department of Anaesthesiology, Perioperative & Pain Medicine, Health New Zealand, Te Whatu Ora Waitemata, Auckland, New Zealandc Department of Molecular Medicine and Pathology, Faculty of Medicine and Health Science, University of Auckland, Auckland, New Zealandd Discipline of Pharmacology, Adelaide Medical School, University of Adelaide, South Australia, Australiaa Department of Anaesthesiology, Perioperative & Pain Medicine, Health New Zealand, Te Whatu Ora Waitemata, Auckland, New Zealanda Department of Anaesthesiology, Perioperative & Pain Medicine, Health New Zealand, Te Whatu Ora Waitemata, Auckland, New ZealandAbstract. Introduction:. The patient-acceptable symptom state (PASS) is a threshold score on patient-reported outcome measures beyond which patients consider their symptoms unacceptable (PASS negative). The PASS may guide the interpretation of outcomes associated with persistent pain after breast cancer surgery (PPBCS). Objectives:. This study aimed to identify PASS cut-off values for the numerical rating scale (NRS) on the brief pain inventory (BPI) items for pain at 6 months after breast cancer surgery and describe functional and psychological outcomes associated with an unacceptable (PASS-negative) pain state. Methods:. This prospective cohort study included patients undergoing primary breast cancer surgery. Patients were assessed preoperatively and postoperatively at 2 weeks and 6 months using validated questionnaires. Patient-acceptable symptom state was evaluated at 6 months after surgery. Patients were classified into PASS-positive (acceptable pain state) or PASS-negative groups using a pain-specific anchor question. Patient-acceptable symptom state thresholds for the BPI items were determined using the Youden index on a receiver operating characteristic curve. Results:. Of the 140 included patients, 13.6% reported a PASS-negative state at 6 months after surgery. Compared to PASS-positive patients, PASS-negative patients reported greater pain severity, pain interference, psychological distress, upper limb disability, and neuropathic pain (all P < 0.008). Numerical rating scale patient-acceptable symptom state cut-off values for the BPI items were 1.5 (worst pain), 0.5 (average pain), and 0.8 (pain interference). Conclusion:. The NRS scores for the BPI worst pain >1.5, average pain >0.5, and pain interference >0.8 delineated patients with “unacceptable” PPBCS. These values may define clinically meaningful PPBCS and offer pain cut-off values for research.http://journals.lww.com/painrpts/fulltext/10.1097/PR9.0000000000001297 |
| spellingShingle | Matthew Kang David Rice Nuala Helsby Andrew Somogyi Michal Kluger Daniel Chiang Establishing the patient acceptable symptom state for patient-reported pain outcomes 6 months after breast cancer surgery PAIN Reports |
| title | Establishing the patient acceptable symptom state for patient-reported pain outcomes 6 months after breast cancer surgery |
| title_full | Establishing the patient acceptable symptom state for patient-reported pain outcomes 6 months after breast cancer surgery |
| title_fullStr | Establishing the patient acceptable symptom state for patient-reported pain outcomes 6 months after breast cancer surgery |
| title_full_unstemmed | Establishing the patient acceptable symptom state for patient-reported pain outcomes 6 months after breast cancer surgery |
| title_short | Establishing the patient acceptable symptom state for patient-reported pain outcomes 6 months after breast cancer surgery |
| title_sort | establishing the patient acceptable symptom state for patient reported pain outcomes 6 months after breast cancer surgery |
| url | http://journals.lww.com/painrpts/fulltext/10.1097/PR9.0000000000001297 |
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