Cited by 2,697Pain Management and Opioid UseAnesthesia and Pain ManagementPediatric Pain Management Techniques

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Studies Comparing Numerical Rating Scales, Verbal Rating Scales, and Visual Analogue Scales for Assessment of Pain Intensity in Adults: A Systematic Literature Review

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Hjermstad, Marianne Jensen, Fayers, Peter M., Haugen, Dagny F., Caraceni, Augusto, Hanks, Geoffrey W., Loge, Jon H., Fainsinger, Robin, Aass, Nina, Kaasa, Stein·2011·Journal of Pain and Symptom Management

DOI 10.1016/j.jpainsymman.2010.08.016

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Abstract

Context The use of unidimensional pain scales such as the Numerical Rating Scale (NRS), Verbal Rating Scale (VRS), or Visual Analogue Scale (VAS) is recommended for assessment of pain intensity (PI). A literature review of studies specifically comparing the NRS, VRS, and/or VAS for unidimensional self-report of PI was performed as part of the work of the European Palliative Care Research Collaborative on pain assessment.Objectives To investigate the use and performance of unidimensional pain scales, with specific emphasis on the NRSs.Methods A systematic search was performed, including citations through April 2010. All abstracts were evaluated by two persons according to specified criteria.Results Fifty-four of 239 papers were included. Postoperative PI was most frequently studied; six studies were in cancer. Eight versions of the NRS (NRS-6 to NRS-101) were used in 37 studies; a total of 41 NRSs were tested. Twenty-four different descriptors (15 for the NRSs) were used to anchor the extremes. When compared with the VAS and VRS, NRSs had better compliance in 15 of 19 studies reporting this, and were the recommended tool in 11 studies on the basis of higher compliance rates, better responsiveness and ease of use, and good applicability relative to VAS/VRS. Twenty-nine studies gave no preference. Many studies showed wide distributions of NRS scores within each category of the VRSs. Overall, NRS and VAS scores corresponded, with a few exceptions of systematically higher VAS scores.Conclusion NRSs are applicable for unidimensional assessment of PI in most settings. Whether the variability in anchors and response options directly influences the numerical scores needs to be empirically tested. This will aid in the work toward a consensus-based, standardized measure.

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Authors: Hjermstad, M. J., Fayers, P. M., Haugen, D. F., Caraceni, A., Hanks, G. W., Loge, J. H., Fainsinger, R., Aass, N., & Kaasa, S.
Affiliations: Oslo University Hospital (NO)
University of Aberdeen (GB)
Norwegian University of Science and Technology (NO)
Fondazione IRCCS Istituto Nazionale dei Tumori (IT)
University of Alberta (CA)
Corresponding author: Hjermstad, Marianne Jensen
ORCID: Hjermstad, Marianne Jensen
Fayers, Peter M.
Haugen, Dagny F.
Caraceni, Augusto
Loge, Jon H.
Aass, Nina
Kaasa, Stein
Venue: Journal of Pain and Symptom Management
Publisher: Elsevier BV
Published: 2011-06
Volume: 41
Issue: 6
Pages: 1073-1093
ISSN: 0885-3924 (ISSN-L)
DOI: 10.1016/j.jpainsymman.2010.08.016
OpenAlex: W2107153119
Cited by: 2,697
References: 88
Citations by year: 2026: 204 · 2025: 249 · 2024: 239 · 2023: 234 · 2022: 262 · 2021: 277 · 2020: 210 · 2019: 203 · 2018: 203 · 2017: 174 · 2016: 151 · 2015: 117 · 2014: 73 · 2013: 67 · 2012: 26
FWCI: 10.11
Type: journal article
Language: en
Open access: bronze
doi.org
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
www.elsevier.com/legal/tdmrep-license (tdm)
www.elsevier.com/open-access/userlicense/1.0/ (vor, 3148 d)
Locations: Journal of Pain and Symptom Management (publishedVersion)
PubMed (publishedVersion)
Archivio Istituzionale della Ricerca (Universita Degli Studi Di Milano) (submittedVersion, other-oa)
Funders: Sixth Framework Programme (LSHC-CT-2006-037777)
Topics: Health Sciences › Medicine › Anesthesiology and Pain Medicine › Pain Management and Opioid Use
Health Sciences › Medicine › Anesthesiology and Pain Medicine › Anesthesia and Pain Management
Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Pediatric Pain Management Techniques
Keywords: pain intensity assessment, numerical rating scale, verbal rating scale, visual analogue scale, scale comparison, response options, postoperative pain, cancer pain, scale standardization
MeSH terms: Adult, Humans, Pain, Pain Measurement, Surveys and Questionnaires

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Studies Comparing Numerical Rating Scales, Verbal Rating Scales, and Visual Analogue Scales for Assessment of Pain Intensity in Adults: A Systematic Literature Review

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