Measuring

Pain

Measurement Of Pain

Tools for pain assessment include unidimensional scales and multidimensional tools. The unidimensional scales usually assess a single dimension of pain, patient self-report of pain intensity. Although useful for assessing acute pain of clear etiology (e.g., postoperative pain), rating scales may oversimplify the assessment of some types of pain. Therefore, experts recommend the use of multidimensional tools in the assessment of complex or persistent pain.¹

Numeric Rating Scale (NRS)

The NRS is the most commonly used rating scale. Patients rate their pain on a 0-to-10 scale or a 0-to-5 scale, with 0 representing “no pain at all” and 5 or 10 “the worst imaginable pain”. Pain intensity levels can be easily quantified at all visits or even at home.¹

Elaborated figure from text in (1).

Visual Analogue Scale (VAS)

The VAS consists of a 10-cm line, with anchors at either end (“no pain” and “the worst imaginable pain”). The patient marks the place on the line to indicate their pain. The clinician then measures the line with a ruler and assigns a score.¹

Elaborated figure from text in (1).

Verbal Rating Scale (VRS)

In a VRS adjectives are used to describe different levels of pain. The respondent is asked to mark the adjective which fits best to the pain intensity.²

Elaborated figure from text in (2).

Categorical Scales

Categorical scales provide an easy way for patients to rate their pain using either verbal or visual descriptors. One example is the commonly-used Faces Pain Scale for Adults and Children.²

Elaborated figure from text in (2).

Patient Global Assessment (PGA)

Is one of the most widely used Patient-reported outcomes (PRO). PGA is often assessed by a single question with a 0-10 or 0-100 response. The content can vary and relates either to global health or to disease activity. Higher scores represent a higher level of disease activity or a worse global health.³

Roland Morris Disability Questionnaire (RMDQ)

Is a 24-item patient-reported outcome measure that evaluates pain-related disability associated with low back pain. Each item is scored as 0 if left blank or 1 if endorsed, resulting in a total RMDQ score ranging from 0 to 24. Higher scores indicate higher levels of pain-related disability.⁴

Mild, Moderate And Severe Pain

Defining cut points for varying levels of pain intensity is important for assessing changes in a patient’s functional status, and to guide the development and evaluation of treatment options. Moreover, many treatment recommendations for patients with pain are based on this simple threefold classification (mild, moderate and severe pain).⁵

MC-I305-17-2024

Data preparation: January 2024

Pain: Current Understanding of Assessment, Management and Treatments. Developed by NPC as part of a collaborative project with JCAHO (2001)
Haefeli M and Elfering A. Eur Spine J (2006); 15: S17–S24
Nikiphorou E et al. Arthritis Research & Therapy (2016); 18:251
Hernandez‑Lucas P et al. BMC Complementary Medicine and Therapies (2023); 23:229
Woo A et al. Ann Palliat Med (2015);4(4):176-183