New Outcomes Instrument--S-TOPS--Developed to Assess Chronic Pain

A new brief outcomes instrument will soon be available for assessing pain in individual patients that can also be used in the research setting, those attending the Pharmacotherapy Special Interest Group (SIG) meeting at the American Pain Society's 29th Annual Scientific Meeting learned.

Originally published on MPR - Monthly Prescribing Reference.

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Called S-TOPS—for Short Form Outcomes Treatment of Pain System—the instrument is expected to replace the existing TOPS (Total Outcomes of Pain Survey). Created in the late 1990s, TOPS incorporates all of the domains of the Medical Outcomes Study Short Form 36-item questionnaire (SF-36). The SF-36 is considered the clinical trial gold standard to determine health-related quality-of-life (HRQoL), or the effects of health issues on a patient's ability to live normally and enjoy life. However, SF-36 is not validated for use in chronic pain patients; therefore, TOPS includes additional domains relevant to managing patients with chronic pain.

However, TOPS is cumbersome: it has 14 domains and takes 25-40 minutes for patients to complete—if they complete it. Recognizing TOPS was becoming unwieldy and that not all domains were necessary to capture HRQoL, development of S-TOPS began approximately 1.5 years ago, said Arthur G. Lipman, PharmD, of the University of Utah, Salt Lake City.

Four requirements were established for the new instrument: high construct validity, high clinical impact, enhanced sensitivity to change, and brevity. Data from 980 patients who had completed from two to seven TOPS questionnaires were used to validate S-TOPS and measure the survey's sensitivity to change, he said. Among the 980 patients, the most common diagnosis was back pain (31.1%).

S-TOPS has seven scales: pain symptom, physical function-lower body, physical function-upper body, family/social disability, emotional function, patient satisfaction with outcomes and patient satisfaction with care. In addition, recognizing that patients with chronic pain often complain of sleep disruption, a new sleep scale was created. The new questionnaire is brief, taking 9 to 13 minutes to complete.

"Pain severity is not always indicative of overall functional status," Dr. Lipman said, adding that the new instrument can clearly delineate pretreatment and post-treatment patient scores on each of the seven scales. S-TOPS is now in use in Hebrew at the Hadassah University Hospital Pain Relief Unit in Jerusalem, Israel. Translation into other languages is planned.

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