A Dichotomous Pain Scale Reduces Post-Operative Opioid Consumption in Outpatient ACL Surgery: Results from a Prospective Randomized Controlled Study

Background/ Aim This study is a prospective, randomized controlled clinical study investigating the effect of using a dichotomous pain scale on post-operative opioid use in patients undergoing anterior cruciate ligament (ACL) reconstruction compared with the standard of using a 10-pt VAS scale. The primary objective was to determine whether the use of a dichotomous pain scale would reduce the consumption of opioids within the first two weeks after surgery. Methods Twenty-nine patients undergoing outpatient ACL reconstruction were randomly assigned to either the Binary (n=14) or Scale (n=15) group and completed a survey every day for two weeks after surgery. The Binary group was asked whether their pain was “tolerable” or “intolerable.” The Scale group was asked to rate their pain on a scale from zero to ten, as per standard of care. Results Patients in the Scale group on average consumed approximately twice the number of morphine milligram equivalents per day than the Binary group (p=0.03). Two weeks after surgery, there was no significant difference between patient satisfaction nor average knee range of motion between groups (p=0.63, p=0.08). Conclusions The results from this study suggest that using a dichotomous tolerability-based pain scale instead of the NPRS could serve as one strategy to reduce opioid use in the post-operative period.