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Doctors and patients use the 10-point pain scale to gauge the severity of pain, but there may be a better way. – Image: © EgudinKa/Getty Images You may remember being asked to describe your level of pain on a 10-point scale, with 0 meaning no pain and 10 meaning extreme pain. This scale was initially designed to help nurses and doctors better document and monitor how much pain you were experiencing and thereby offer the right treatment.

What is the metric for pain?

In a Numerical Rating Scale (NRS), patients are asked to circle the number between 0 and 10, 0 and 20 or 0 and 100 that fits best to their pain intensity. Zero usually represents ‘no pain at all’ whereas the upper limit represents ‘the worst pain ever possible’.

What is pain 1 to 10?

What Is a Pain Scale? – A pain scale is simply a way of rating or quantifying your pain so you can talk about it with your doctor, other health care professionals, or even your friends and family. There are many different kinds of pain scales, but a common one is a numerical scale from 0 to 10.

• Here, 0 means you have no pain; one to three means mild pain; four to seven is considered moderate pain; eight and above is severe pain.
• Pain scales are based on self-reported data — that means from you, the patient — so they are admittedly subjective.
• Your version of a seven could be someone else’s idea of a three.

But the idea is that they can help compare your own ratings over time. Is your pain improving or getting worse? Using a pain scale can also help you and your doctor analyze which factors — a change in physical activity, say, or a new medication regimen — could be responsible for those changes.

What is physical pain measured in?

Measurements in acute pain – Assessment of acute pain is crucial to ensure safe and effective management of patients with an acute surgical or medical illness, and as part of routine perioperative care. Most of the scales used in acute pain settings are one-dimensional and designed for the assessment of intensity of pain, degree of pain relief, or other aspects of pain.

The visual analogue scale (VAS) and numeric rating scale (NRS) are most commonly used to assess the present intensity of acute pain. They are reliable, valid, sensitive to change, and easy to administer for measurement of severity of pain. The NRS, using an 11-point scale (0—‘no pain’ to 10—‘worst pain’, or ‘pain as bad as it could be’), is often preferred due to its administration simplicity and reliability.1 VAS is considered the ‘gold standard’ technique and is used particularly in pain-related research.

It consists of a 100 mm unmarked line with standardized wording: ‘no pain’ on the left of the line, and ‘worst pain imaginable’ on the right—the patient then places a mark on the line corresponding to their level of pain. A disadvantage of this scale is that it does not give instant rating as measurement is needed and application of the scale requires explanation to the patient when the level of understanding may be decreased in the early post-anaesthetic period.

1. Categorical verbal rating scale (VRS) uses words to describe the magnitude of pain, for example, none, mild, moderate, severe.
2. VRS is a quick, simple tool with a high validity as an indicator of pain intensity; however, it may be less precise and sensitive than VAS.2 Language can be a barrier to effective administration.

Although neuropathic pain is commonly related to chronic conditions, it is present in about 3% of all patients with acute pain.3 The prevalence depends on the type of performed surgery—for example, almost all patients post-inguinal herniotomy describe features of neuropathic pain in the early postoperative period.

1. An awareness of this and early assessment of neuropathic component of acute pain is crucial for appropriate management.
2. One-dimensional scales are inadequate for neuropathic pain assessment which requires specialized scales.4 There is no consensus which scale is best for the assessment of acute post-surgical neuropathic pain.

In the acute setting, in a study by Sadler and colleagues, 5 LANSS identified five of 165 patients (3%) as experiencing acute neuropathic pain, whereas DN4 identified seven patients in the same group of 165 individuals (4.2%). Another study by Hayes and colleagues 6 showed that patients with acute neuropathic pain represented only 1.04% of studied group, showing 78% of them had pain at 6 months, and 55% at 12 months.

How do you quantify pain?

Numeric rating scales (NRS) – This pain scale is most commonly used. A person rates their pain on a scale of 0 to 10 or 0 to 5. Zero means “no pain,” and 5 or 10 means “the worst possible pain.” These pain intensity levels may be assessed upon initial treatment, or periodically after treatment.

Is there a pain scale?

The DVPRS pain scale is being rolled out across the Military Health System and in civilian health care organizations as an improved way to determine pain levels. If you receive care in a military hospital or clinic, you might notice your health care team is using a new method for assessing your pain.

The Military Health System uses a new pain management scale known as the Defense and Veterans Pain Rating Scale, or DVPRS. Most people know the traditional way pain has been assessed during a medical appointment. Patients were usually asked to “rate your pain on a scale of 0-10.” While this was common practice for many years, growing evidence showed neither patients nor providers were satisfied with this approach.

The 0-10 reporting of a person’s pain often contributed to a goal of getting the pain to zero. Military pain management leaders shared that this often led to an overreliance on prescription pain medications which can have side effects that negatively impact on patients’ quality of life.

• Military medicine played a prominent role in changing the nature and focus of pain conversations between patients and clinicians,” said U.S.
• Navy Capt.
• Dr.) Harold Gelfand, director of the Defense and Veterans Center for Integrative Pain Management, the Department of Defense’s center of excellence for pain management, aligned to the Uniformed Services University of the Health Sciences.

“Based on their collective clinical experiences and conversations with patients, military providers recognized the need to expand our pain assessments beyond the single measure of pain intensity,” Gelfand said. In response to this challenge, a DOD pain management task force developed the DVPRS, which combines several previously validated and familiar pain assessment tools with some important additions.

Gelfand explained that the DVPRS incorporates functional descriptions for each of the 0-10 levels of pain so that successful pain management is also tied to improved function rather than simply getting pain to zero. The DVPRS also includes an assessment of the patient-reported impact of pain on four specific quality of life indicators: activity, sleep, mood, and stress.

This provides clinicians with a deeper understanding of the patient’s pain condition and a better way to measure the progress and effectiveness of pain management treatments. The DVPRS was developed while the MHS focused on improving pain management outcomes.

Many Iraq and Afghanistan veterans were facing chronic pain conditions, and health experts were looking for strategies to minimize the unnecessary use of prescription pain medications. Beyond the MHS, the DVPRS has gained attention in numerous civilian health care organizations. For example, the West Virginia University Health System designated the DVPRS as its pain assessment tool in response to many of the same issues facing military medicine.

For more information, watch the DVPRS information video,

What is 7 10 pain level?

Types of pain scales – The most common type of pain scale measures how intense pain is. Here are some pain scales you may see in practice:

Numeric rating scale: This uses a 1 to 10 scale to allow patients to rate their pain. Zero is considered no pain; 1 to 3 is mild pain; 4 to 6 is moderate pain and 7 to 10 is severe pain. Visual analog scale: This uses a continuous line, with one end marked as “no pain” and the other end marked as “worst possible pain.” Patients then are asked to mark a spot on the line to show their pain intensity, and doctors then determine a pain score. Categorical scale: In place of numbers, this scale uses words to indicate their pain. One end of the scale is “no pain” to “mild pain,” with the other end of the scale marked with “very severe pain” and “worst possible pain.” A version of this scale, known as the Wong-Baker Faces Scale, is used for children that uses graphic faces; “no pain” has a smiling green face, with a red crying face for “hurts worst.”

An example of a pain scale. Credit: Getty Images. Other pain scales are considered multidimensional, as they incorporate factors other than intensity of pain. Multidimensional pain tools are less commonly used. They can include initial pain assessment tools, the brief pain inventory and the McGill pain questionnaire.

How do psychologists measure pain?

Measures of Pain Intensity and Quality – As already emphasized, self-report is the gold standard for assessing pain severity or intensity, and quality. Three specific pain severity measures have garnered the largest proportion of attention in the literature, and each has substantial evidence supporting its psychometric properties including reliability, validity, and responsivity to change.

The numeric rating scale (NRS) is the most commonly employed measure of pain severity. Typically respondents are asked to rate their level of pain on a zero (no pain) to 10 (worst pain imaginable) scale. The instructions may vary in terms of specific parameters for the report. For example, although it is most common to inquire about pain “now,” respondents may also be asked to report on average, least and worst pain over a specified period, for example, over the past day or week.

The visual analogue scale (VAS) typically involves a 100 cm scale with similar anchors to the NRS, and respondents are asked to make a mark on the line that best represents their pain intensity level. The verbal rating scale (VRS) typically uses a small list of adjectives that are intended to quantify the experience of pain severity, namely none, mild, moderate, and severe.

After careful consideration of the data on each of these options, IMMPACT recommended use of the NRS in most situations.10 Consistent with this recommendation, many healthcare organizations have adopted the NRS for routine screening for the presence and intensity of pain in clinical settings, often referring to “Pain as the fifth vital sign.”11 IMMPACT also noted that alternative approaches to assessing pain severity may be adopted when such measures exist for specific clinical conditions.

For instance, the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) is sometimes used to assess pain associated with osteoarthritis.12 Perhaps the most commonly used self-report measure of pain is the McGill Pain Questionnaire (MPQ), a more lengthy measure designed to assess the quality and affective component of the pain experience, not simply pain intensity.13 Respondents choose pain descriptors from a list of 78 potential descriptors that fall into 20 pain categories.

• These descriptors assess four pain domains: sensory, affective, evaluative, and miscellaneous.
• Within each category, the individual descriptors reflect varying degrees of intensity and are assigned corresponding numerical values that reflect this difference.
• Respondents also highlight the location of their pain on a figure drawing and provide information about the factors that alleviate and aggravate their pain intensity.

The MPQ generates three scores: (1) the Pain Rating Index, which is the sum of all words chosen in the available categories (the sum of the value of each subclass can be obtained also); (2) Number of Words Chosen, a score that reflects the number of words chosen from each of the four categories; and (3) the Present Pain Intensity, a rating of current pain on a scale from 0 (no pain) to 5 (excruciating).

Can pain be measured by its intensity?

1. Introduction – Pain intensity is a common outcome domain assessed in pain clinical trials 1, 14, 21, 25, 31, 34, 38, 45 and most often targeted in pain treatment.34, 42 Different domains of pain intensity such as current pain intensity, 24-hour average pain intensity, worst pain, and least pain are assessed regularly in clinical practice and research studies.

Although an individual’s average pain is arguably the more important outcome domain to target in pain treatment, research comparing average and worst pain ratings indicate that worst pain is more strongly associated with disability.30 Thus, both average and worst pain remain important intensity domains to assess, and knowledge regarding the validity and utility of both is important.

Pain intensity is commonly assessed using measures such as the Visual Analogue Scale (VAS), Numerical Rating Scale (NRS), Verbal Rating Scale (VRS), and Faces Pain Scale-Revised (FPS-R).29, 31 Consensus groups recommend using NRS for clinical research 12 given its strengths as found in research in samples of individuals from western countries.4, 6 – 8, 15, 16, 18, 31, 38, 39 Thus, it might be reasonable to conclude that the NRS should be the measure of choice in most settings.

However, each scale has important strengths and weakness, and no one scale is recommended for use in all situations and with all patient groups.14, 25, 31 Faces scales (ie, pain scales that illustrate different levels of pain intensity through different facial expressions), for example, were developed for use in children and people with low literacy levels.

However, there are concerns that such scales may also be influenced by, or assess, emotional reactions in addition to pain intensity.22, 34, 35 Moreover, there are inconsistencies in the way different individuals interpret measurement scales, 13 and the most useful measure may vary between populations as a function of age, literacy levels, and cultural background.34, 38 For example, the VRS and the FPS-R (or the scale on which the FPS-R is based, the FPS 24 ) are often preferred over other measures, 33, 34, 43, 47 especially by individuals with lower education levels.9, 21, 46 There is also evidence that the NRS and VRS may not provide reliable measures of pain intensity in individuals from developing countries who have less than 7 years of education.28 Although studies report no differences in scale preference based on age, 21, 34, 43 the VAS is known to be more difficult to use than other scales, 23 especially among the elderly 12, 34, 38 and individuals with cognitive deficits.10, 21 Pain perception and expression is influenced by culture and ethnicity as well.11, 32 Studies performed in samples from the USA and Europe report a higher preference for the NRS, 15, 38 whereas the FPS or the FPS-R tend to be preferred by Turkish, and Chinese individuals.33, 34, 47 In addition, one study of individuals from Ghana found that a colored circle pain scale was preferred over both the FPS and NRS.2 Based on these findings, and in light of the fact that most research in this area have been performed in samples from western countries, it seems necessary to evaluate the psychometric properties of pain intensity measures in developing countries, before the NRS can be recommended over other scales for cross-cultural research.

Unlike in western societies where citizens are exposed to a variety of response scales as the part of day-to-day life (eg, online or paper feedback forms for customer feedback in banks and medical facilities), the population in Nepal is rarely exposed to or asked to complete such measures, due in part to the low literacy rates in Nepal.17 Although a majority of the population are able to count to 10 and perform simple calculations associated with money handling, patients frequently fail to understand and use pain scales such as NRS in clinical settings.

Given these considerations, the aim of this study was to evaluate the utility and validity of 4 pain intensity measures in a sample of individuals from a non-western and low literacy country (in this case, Nepal). We also sought to understand the role of age and education on the utility and validity of the measures.

Based on research findings cited previously, and given the relatively low literacy rates in Nepal, we hypothesized that the study participants would prefer the verbal (VRS) and pictorial (FPS-R) scales over the numerical (NRS) or analogue (VAS) scales. We also hypothesized that while preference rates would not be affected by age, participants with less education would prefer the FPS-R and VRS over the NRS and VAS.

Third, we hypothesized there would be more errors in the NRS and VAS, relative to the FPS-R and VRS. Fourth, we hypothesized that older participants would have more incorrect responses to all measures, but error rates will not vary as a function of education level.