The Patient Acceptable Symptom State of Chronic Musculoskeletal Pain Measured on a Visual Analog Scale in Moroccan Patients

Abstract

Objectives: The patient acceptable symptom state (PAccSS) is the value beyond which patients consider themselves well. Our aim was to determine the PAccSS of chronic pain in Moroccan outpatients suffering from chronic rheumatic diseases and to identify contributors to PAccSS. Methods: A 4-week prospective study of 387 outpatients suffering from chronic rheumatic diseases was carried out. Pain level was evaluated using a 0-100mm visual analog scale. An anchoring method based on patient's opinion was used. The PAccSS was defined as the 75th percentile of the score for patients who considered their state satisfactory. Pearson's chi-square and binary logistic regression were used to analyze the data. Results: The underlying disease of the patients (mean age 50±13 years; female sex 70%) was rheumatoid arthritis (N=102), ankylosing spondylitis (N=100), peripheral osteoarthritis (N=100), and degenerative back pain (N=85). The mean disease duration was 7.4±6.7 years. At the time of the study, the level of pain was 44±23mm. One hundred ninety (49%) patients considered their state as satisfactory, and the PAccSS threshold was 50mm. Significant contributors to PAccSS were high educational level, high socioeconomic status, higher functional status scores, and shorter term disease duration. Conclusion: Half of patients were satisfied of their disease state, while the PAccSS threshold of pain was unexpectedly high. This could be explained by an overestimation of the pain intensity or a Moroccan patients' high tolerance to pain. The main protective factors that contribute to achieving the PAccSS were high educational level, high socioeconomic status, higher functional status, and shorter term disease duration. © 2013 Wiley Periodicals, Inc.