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      Pain: a review of three commonly used pain rating scales : Pain rating scales

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      Journal of Clinical Nursing
      Wiley

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          Abstract

          This review aims to explore the research available relating to three commonly used pain rating scales, the Visual Analogue Scale, the Verbal Rating Scale and the Numerical Rating Scale. The review provides information needed to understand the main properties of the scales. Data generated from pain-rating scales can be easily misunderstood. This review can help clinicians to understand the main features of these tools and thus use them effectively. A MedLine review via PubMed was carried out with no restriction of age of papers retrieved. Papers were examined for methodological soundness before being included. The search terms initially included pain rating scales, pain measurement, Visual Analogue Scale, VAS, Verbal Rating Scale, VRS, Numerical/numeric Rating Scale, NRS. The reference lists of retrieved articles were used to generate more papers and search terms. Only English Language papers were examined. All three pain-rating scales are valid, reliable and appropriate for use in clinical practice, although the Visual Analogue Scale has more practical difficulties than the Verbal Rating Scale or the Numerical Rating Scale. For general purposes the Numerical Rating Scale has good sensitivity and generates data that can be statistically analysed for audit purposes. Patients who seek a sensitive pain-rating scale would probably choose this one. For simplicity patients prefer the Verbal Rating Scale, but it lacks sensitivity and the data it produces can be misunderstood. In order to use pain-rating scales well clinicians need to appreciate the potential for error within the tools, and the potential they have to provide the required information. Interpretation of the data from a pain-rating scale is not as straightforward as it might first appear.

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          Most cited references36

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          A comparison of pain measurement characteristics of mechanical visual analogue and simple numerical rating scales.

          Numerical rating scales and mechanical visual analogue scales (M-VAS) were compared for their capacity to provide ratio scale measures of experimental pain. Separate estimates of experimental pain sensation intensity and pain unpleasantness were obtained by each method, as were estimates of clinical pain. Orofacial pain patients made numerical scale and VAS ratings in response to noxious thermal stimuli (45-51 degrees C) applied for 5 sec to the forearm by a contact thermode. The derived stimulus-response function was well fit as a power function only in the case of sensory M-VAS. The power function derived from sensory M-VAS ratings predicted temperatures chosen as twice as intense as standard temperatures of 47 degrees C and 48 degrees C, thereby providing evidence for ratio scale characteristics of M-VAS. The stimulus-response function derived from sensory numerical ratings differed from that obtained with M-VAS and did not provide accurate predictions of temperatures perceived as twice intense at 47 degrees C or 48 degrees C. Both M-VAS and numerical rating scales produced reliably different stimulus response functions for pain sensation intensity as compared to pain unpleasantness and both provided consistent measures of experimental and clinical pain intensity. Finally, both mechanical and pencil-and-paper VAS produced very similar stimulus-response functions. The ratio scale properties of M-VAS combined with its ease of administration and scoring in clinical settings offer the possibility of a simple yet powerful pain measurement technology in both research and health care settings.
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            Methodological problems in the measurement of pain: a comparison between the verbal rating scale and the visual analogue scale.

            The effect of analgesics on pathological pain in a double-blind, complete cross-over design was assessed by means of two rating scales, a verbal rating scale (VRS) and visual analogue scale (VAS). The VRS is widely used, but has several disadvantages as compared to the VAS. The results obtained by means of the VRS showed higher F-ratios (analysis of variance and Kruskall-Wallis H-test) than those obtained by means of the VAS. The VRS, which transfers a continuous feeling into a digital system, seems to augment artificially the measurement of effects produced by analgesics, and the VAS seems to assess more closely what a patient actually experiences with respect to change in pain intensities. The correlation between the two scales was highly significant (r = 0.81, P less than 0.001). The calculated regression line (y=-29.6 + 0.55-x) was not similar to the line of identity and showed much lower values for the VAS, supporting our interpretation. The distribution of the variances of the values obtained by means of both scales was not homogenous. This indicates that the homogeneity of the distribution of variances should always be checked and a Kruskall-Wallis H-test used, if they are inhomogenously distributed.
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              What is the maximum number of levels needed in pain intensity measurement?

              An important issue that has yet to be resolved in pain measurement literature concerns the number of levels needed to assess self-reported pain intensity. An examination of treatment outcome literature shows a large variation in the number of levels used, from as few as 4 (e.g., 4-point Verbal Rating scales (VRS)) to as many as 101 (e.g., 101-point Numerical Rating scales (NRS)). The purpose of this study was to provide an empirically derived guideline for determining the number of levels needed. Chronic pain patients (n = 124) provided pre- and post-treatment measures of pain intensity using 101-point NRS for least, most, current, and average pain. The patients' responses to the measures were examined closely to determine the actual number of levels used. In addition, their responses to the 101-point scales were recorded to form 7 scales of varying levels (2- to 101-point scales). The sensitivity of the 7 recorded scales was examined. The results indicated that little information is lost if 101-point scales are coded as 11- or 21-point scales. Moreover, examination of the actual responses to the 101-point measure showed that almost all patients treated it as a 21-point scale by providing responses in multiples of 5 or 10, while a substantial number of patients treated it as an 11-point scale, providing responses in multiples of 10 only. The results suggest that 10- and 21-point scales provide sufficient levels of discrimination, in general, for chronic pain patients to describe pain intensity.
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                Author and article information

                Journal
                Journal of Clinical Nursing
                Wiley
                09621067
                August 2005
                August 2005
                June 30 2005
                : 14
                : 7
                : 798-804
                Article
                10.1111/j.1365-2702.2005.01121.x
                16000093
                efa79107-1550-42f1-9109-d6140460aa41
                © 2005

                http://doi.wiley.com/10.1002/tdm_license_1.1

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