Cut-off points for mild, moderate, and severe pain on the visual analogue scale for pain in patients with chronic musculoskeletal pain
Abstract
The aim of this study was to find the cut-off points on the visual analogue scale (VAS) to distinguish among mild, moderate, and severe pain, in relation to the following: pain-related interference with functioning; verbal description of the VAS scores; and latent class analysis for patients with chronic musculoskeletal pain. A total of 456 patients were included. Pain was assessed using the VAS and verbal rating scale; functioning was assessed using the domains of the Short Form (36) Health Survey (SF-36). Eight cut-off point schemes were tested using multivariate analysis of variance (MANOVA), ordinal logistic regression, and latent class analysis. The study results showed that VAS scores ⩽ 3.4 corresponded to mild interference with functioning, whereas 3.5 to 6.4 implied moderate interference, and ⩾ 6.5 implied severe interference. VAS scores ⩽ 3.4 were best described for patients with chronic musculoskeletal pain as mild pain, 3.5 to 7.4 as moderate pain, and ⩾ 7.5 as severe pain. Latent class analysis found that a 3-class solution fitted best, resulting in the classes 0.1 to 3.8, 3.9 to 5.7, and 5.8 to 10 cm. Findings from our study agree with those of some other studies, although many other studies found different optimal cut-off point schemes. As there appear to be no universally accepted cut-off points, and in view of the low-to-moderate associations between VAS scores and functioning and between VAS and verbal rating scale scores, the correct classification of VAS sc…
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
The median average pain score at baseline was 5.4 cm (4.3-6.6) on a 10 cm visual analogue scale, which equates to moderate severity pain.
“The median average pain score at baseline was 5.4 cm (4.3-6.6) on a 10 cm visual analogue scale, which equates to moderate severity pain, 52”
From Management of chronic pain secondary to temporomandibular disorders: a systematic review and network meta-analysis of randomised trials (2023) · cites this paper as [52]
Cites
The validation of visual analogue scales as ratio scale measures for chronic and experimental pain
Price, D. D., McGrath, P. A., Rafii, A., & Buckingham, B. (1983) · Pain · doi:10.1016/0304-3959(83)90126-4 · Cited by 3,921 · see citing works
Core outcome measures for chronic pain clinical trials: IMMPACT recommendations
Dworkin, R. H., Turk, D. C., Farrar, J. T., Haythornthwaite, J. A., Jensen, M. P., Katz, N. P., Kerns, R. D., Stucki, G., Allen, R. R., Bellamy, N., et al. (2005) · Pain · doi:10.1016/j.pain.2004.09.012 · Cited by 3,732 · see citing works
Core outcome domains for chronic pain clinical trials: IMMPACT recommendations
Turk, D. C., Dworkin, R. H., Allen, R. R., Bellamy, N., Brandenburg, N., Carr, D. B., Cleeland, C., Dionne, R., Farrar, J. T., Galer, B. S., et al. (2003) · Pain · doi:10.1016/j.pain.2003.08.001 · Cited by 3,510 · see citing works
Flagged first, then by citations
Cited by
Sorted by citations
Hajihasani, A., Rouhani, M., Salavati, M., Hedayati, R., & Kahlaee, A. H. (2019) · PM&R · doi:10.1016/j.pmrj.2018.09.029 · Cited by 125 · see citing works
Dal Farra, F., Risio, R. G., Vismara, L., & Bergna, A. (2021) · Complementary Therapies in Medicine · doi:10.1016/j.ctim.2020.102616 · Cited by 123 · see citing works
Inoue, S., Kamiya, M., Nishihara, M., Arai, Y.-C. P., Ikemoto, T., & Ushida, T. (2017) · Journal of Pain Research · doi:10.2147/jpr.s129295 · Cited by 84 · see citing works
Measuring public speaking anxiety: Self-report, behavioral, and physiological
Gallego, A., McHugh, L., Penttonen, M., & Lappalainen, R. (2022) · Behavior Modification · doi:10.1177/0145445521994308 · Cited by 82 · see citing works
“According to Boonstra et al. (2014), a score ≤3.8 indicates mild symptoms, between 3.9 and 5.7 moderate, and scores ≥5.8 severe.”
BackgroundInfluentialPhysiotherapy management of patients with chronic pelvic pain (CPP): a systematic review
Klotz, S. G. R., Schön, M., Ketels, G., Löwe, B., & Brünahl, C. A. (2019) · Physiotherapy Theory and Practice · doi:10.1080/09593985.2018.1455251 · Cited by 66 · see citing works
Yao, L., Sadeghirad, B., Li, M., Li, J., Wang, Q., Crandon, H. N., Martin, G., Morgan, R., Florez, I. D., Hunskaar, B. S., et al. (2023) · BMJ · doi:10.1136/bmj-2023-076226 · Cited by 57 · see citing works
Gorinelli, S., Gallego, A., Lappalainen, P., & Lappalainen, R. (2023) · Journal of Contextual Behavioral Science · doi:10.1016/j.jcbs.2023.05.004 · Cited by 28 · see citing works
Elzeky, M. E., Salameh, B., Reshia, F. A. A., Sabry, A. A., Shahine, N. F., & Mohamed, E. A. (2024) · Journal of Research in Nursing · doi:10.1177/17449871241252005 · Cited by 11 · see citing works
- Authors
- Boonstra, A. M., Schiphorst Preuper, H. R., Balk, G. A., & Stewart, R. E.
- Affiliations
- University Medical Center Groningen (NL)
- Corresponding author
- Boonstra, Anne M.
- Venue
- Pain
- Published
- 2014-12
- Volume
- 155
- Issue
- 12
- Pages
- 2545-2550
- ISSN
- 0304-3959 (ISSN-L)
- OpenAlex
- W2170369624
- Cited by
- 691
- References
- 3
- Citations by year
- 2026: 61 · 2025: 97 · 2024: 84 · 2023: 76 · 2022: 70 · 2021: 80 · 2020: 78 · 2019: 55 · 2018: 33 · 2017: 34 · 2016: 16 · 2015: 6 · 2012: 1
- FWCI
- 13.61
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Pain (publishedVersion)
- PubMed (publishedVersion)
- University of Groningen research database (University of Groningen / Centre for Information Technology) (submittedVersion)
- Topics
- Health Sciences › Medicine › Pharmacology › Musculoskeletal pain and rehabilitation
- Health Sciences › Medicine › Anesthesiology and Pain Medicine › Pain Management and Opioid Use
- Health Sciences › Medicine › Surgery › Anesthesia and Pain Management
- Keywords
- visual analogue scale, pain intensity, cut-off values, chronic musculoskeletal pain, verbal rating scale, SF-36, latent class analysis, pain assessment
- MeSH terms
- Adult, Cross-Sectional Studies, Female, Persons with Disabilities, Disabled Persons, Humans, Male, Middle Aged, Surveys and Questionnaires, Severity of Illness Index, Multivariate Analysis, Logistic Models, Chronic Pain, Musculoskeletal Pain, Visual Analog Scale
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
