Activity-Based Checks (ABCs) of Pain: A Functional Pain Scale Used by Surgical Patients

Abstract

Introduction. Increased rates of surgery, combined with concerns about high-risk pain medications, have highlighted the need for improved methods of meaningfully assessing pain. In response to lack of medical context and functional data in existing scales, the Activity-Based Checks (ABCs) was developed. Methods. This prospective, cohort study was deployed at a single-institution, academic center. The primary outcome was to correlate the ABCs to the 0-10 numeric rating scale (NRS) in postoperative general surgery patients. Secondary outcomes included assessing the impact of patient factors and prescribing patterns on opioid consumption, in milligrams of morphine equivalents (MME) after discharge. Results. The function that correlated most to the NRS at discharge was “Out of Bed to Chair”. Indicators of better mental health were inversely correlated with MME consumption. Interestingly, the largest predictor of MME taken was MME prescribed. Over 40% of prescribed opioids goes unused. Conclusions. Functional pain scales, like the ABCs, may be useful adjuncts to evaluate pain. Individual functions, e.g., “Out of Bed to Chair” may be of particular importance. Clinicians must be aware that the strongest predictor of MMEs taken by patients was MMEs prescribed, highlighting the importance of better pain assessments and opioid stewardship.