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Several scales are commonly used for assessing pain intensity. Among them, the numerical rating scale (NRS), visual analog scale (VAS), and verbal rating scale (VRS) are often used in clinical practice. However, no study has performed psychometric analyses of their reliability and validity in the measurement of osteoarthritic (OA) pain. Therefore, the present study examined the test-retest reliability, validity, and minimum detectable change (MDC) of the VAS, NRS, and VRS for the measurement of OA knee pain. In addition, the correlations of VAS, NRS, and VRS with demographic variables were evaluated. The study included 121 subjects (65 women, 56 men; aged 40-80 years) with OA of the knee. Test-retest reliability of the VAS, NRS, and VRS was assessed during two consecutive visits in a 24 h interval. The validity was tested using Pearson's correlation coefficients between the baseline scores of VAS, NRS, and VRS and the demographic variables (age, body mass index [BMI], sex, and OA grade). The standard error of measurement (SEM) and the MDC were calculated to assess statistically meaningful changes. The intraclass correlation coefficients of the VAS, NRS, and VRS were 0.97, 0.95, and 0.93, respectively. VAS, NRS, and VRS were significantly related to demographic variables (age, BMI, sex, and OA grade). The SEM of VAS, NRS, and VRS was 0.03, 0.48, and 0.21, respectively. The MDC of VAS, NRS, and VRS was 0.08, 1.33, and 0.58, respectively. All the three scales had excellent test-retest reliability. However, the VAS was the most reliable, with the smallest errors in the measurement of OA knee pain.

The majority of previous research that has examined the validity of pain intensity rating scales has been conducted in western and developed countries. Research to evaluate the generalizability of previous findings in non-developed countries is necessary for identifying the scales that are most appropriate for use in international research. The aims of the current study were to (1) evaluate the validity and utility of four commonly used measures of pain intensity in a sample of patients with chronic pain from Thailand and (2) compare findings in the current sample with published findings from research conducted in other countries, in order to identify the measure or measures which might be most appropriate for cross-country research. Three hundred and sixty patients with chronic pain seen in a hospital in Bangkok, Thailand, were asked to rate their current pain and average, worst, and least pain intensity in the past week using the Visual Analogue Scale (VAS), 6-point Verbal Rating Scale (VRS-6), 0-10 Numerical Rating Scale (NRS-11), and Faces Pain Scale-Revised (FPS-R). We evaluated the utility and validity of each measure by examining the (1) rates of correct responding and (2) association of each measure with a factor score representing the variance shared across measures, respectively. We also evaluated the associations between incorrect response rates and both age and education level, and then compared the findings from this sample with the findings from research conducted in other countries. The results indicated support for the validity of all measures among participants who were able to use these measures. However, there was variability in the incorrect response rates, with the VAS having the highest (45%) and the NRS-11 having the lowest (15%) incorrect response rates. The VAS was also the least preferred (9%) and the NRS-11 the most preferred (52%) scale. Education and age were significantly associated with incorrect response rates, and education level with scale preference. The findings indicate that the NRS-11 has the most utility in our sample of Thai individuals with chronic pain. However, when considered in light of the findings from other countries, the results of this study suggest that the FPS-R may have the most utility for use in cross-cultural and international research. Research in additional samples in developing countries is needed to evaluate the generalizability of the current findings.

Purpose of Review It is essential to have validated and reliable pain measurement tools that cover a wide range of areas and are tailored to individual patients to ensure effective pain management. The main objective of this review is to provide comprehensive information on commonly used pain scales and questionnaires, including their usefulness, intended purpose, applicability to different patient populations, and associated advantages and disadvantages. Recent Findings Acute pain questionnaires typically focus on measuring the severity of pain and the extent of relief achieved through interventions. Chronic pain questionnaires evaluate additional aspects such as pain-related functional limitations, psychological distress, and psychological well-being. The selection of an appropriate pain scale depends on the specific assessment objectives. Additionally, each pain scale has its strengths and limitations. Understanding the differences among these pain scales is essential for selecting the most appropriate tool tailored to individual patient needs in different settings. Conclusion Medical professionals encounter challenges in accurately assessing pain. Physicians must be familiar with the different pain scales and their applicability to specific patient population.

Background Various pain assessment scales, including the Visual Analog Scale (VAS), Numerical Rating Scale (NRS), Verbal Rating Scale (VRS), and Wong-Baker Faces Scale (WBS), are commonly used, yet their comparative effectiveness in maxillofacial pain remains unclear. Aim This study aims to compare four commonly used pain scales—VAS, NRS, VRS, and WBS—and evaluate their correlation and agreement in adult patients presenting with acute maxillofacial pain. Methods This prospective cross-sectional study included 197 adult patients who presented to the emergency department with acute maxillofacial pain and were subsequently referred to the maxillofacial surgery clinic. Pain intensity was assessed using all four scales in randomized sequence. Spearman correlation analysis was performed to evaluate relationships between scales, while Bland-Altman analysis was used to assess agreement. Patient preferences were analyzed based on age, sex, and educational level. Results All four pain scales demonstrated strong correlations, with the highest correlation between NRS and VRS and the lowest between VAS and WBS. Bland-Altman analysis revealed the strongest agreement between VAS and NRS, while the weakest agreement was observed between VAS and WBS. NRS emerged as the most reliable and preferred scale, especially among younger and highly educated patients. WBS was preferred by older adults and those with lower education levels. Conclusion While NRS appears to be the most reliable and broadly applicable assessment scale, VAS and VRS can serve as alternatives for patients with strong numerical or verbal comprehension skills. WBS remains valuable for elderly or less-educated populations due to its intuitive visual representation.

Background and Importance: Pain is one of the most reasons for a visit to an emergency department (ED). Pain scores as the verbal rating scale (VRS) or numerical rating scale (NRS) are used to determine pain management. While it is crucial to measure pain levels, it is equally important to identify patients who desire pain medication, so that adequate provision of analgesia can occur. Objective: To establish the association between pain scores on the NRS and VRS, and the desire for, and provision of, pain medication. Design, settings and participants: Retrospective monocentric observational cohort study of ED patients presenting with painful conditions. Outcomes measure and analysis: The primary outcome was to establish for each pain score (NRS and/or VRS), those patients who desired, and were ultimately provided with, pain medication, and those who did not. Secondary outcomes included establishing the prediction of pain scores to determine desire of pain medication, and the correlation between NRS and VRS when both were reported. Main Results: 130,279 patients were included for analysis. For each patient who desired pain medication, pain medication was provided. Proportion of patients desiring pain medication were 4.1–17.8% in the pain score range 0.5–3.5, 31.9–63.4% in the range 4–6.5, and 65–84.6% in the range 7–10. The prediction probability of pain scores to determine desire for pain medication was represented with an AUROC of 0.829 (95% CI 0.826–0.831). The optimal threshold predicting the desire for pain medication would be a pain score of 4.25, with sensitivity 0.86, and specificity 0.68. For the 7835 patients with both NRS and VRS scores available, the Spearman-Rho coefficient assessing correlation was 0.946 (p < 0.001). Conclusions: Despite guidelines currently recommending pain medication in patients with a NRS score > 4, we found a discrepancy between pain scores and desire for pain medication. Results of this large retrospective cohort support that the desire for pain medication in the ED might not be derived from a pain score alone.

Since the analgesic effect of acupuncture stimulation is derived from different mechanisms depending on the type of pain, it is important to know which acupuncture points to stimulate. In this study, to confirm the effect of acupuncture stimulation on acute pain from a neurological point of view, somatosensory evoked potential and sensory threshold changes were evaluated to identify the nerve range that is affected by acupuncture stimulation on LI4 (Hapgok acupuncture point, of the radial nerve) during acute pain. The subjects were 40 healthy men and women aged 19-35 years. The study was designed as a randomly controlled, crossover trial with acupuncture stimulation at LI4 as the intervention. The washout period for acupuncture stimulation was 2 weeks, and the subjects were divided into two groups, i.e., an acupuncture stimulation group and a non-stimulation group, with 10 men and 10 women in each group. somatosensory evoked potential measurement was carried out for 5 minutes by alternately applying 2 HZ-pulse electrical stimulation to the thumb and the little finger of the hand acupunctured with a 64-channel electroencephalogram. The verbal rating scale was used before and after each acupuncture stimulation session. The results of the study confirmed that the somatosensory evoked potential amplitude value of the thumb was significantly decreased and that the intensity of sensory stimulation corresponding to a verbal rating scale score of 6 was significantly increased only in the thumb after acupuncture stimulation. Therefore, the results show that acupuncture treatment for acute pain is more effective when direct acupuncture stimulation is applied to the painful area.

Background: Dentinal hypersensitivity (DH) is common problem in dentistry. Traditional agents along with alternative therapies have been researched. Aim: To study the efficacy of a diode laser (DL) and electrode application with and without hydroxyapatite (HAP) and strontium chloride (SrCl2) powder. Materials and Methods: 60 Patients with mild cervical abrasion in at least two quadrant with two teeth per quadrant were selected and randomly divided into four groups: (i) Group 1- DL versus DL with HAP (ii) Group 2 - electrode application versus electrode application with HAP (iii) Group 3 - DL versus DL with SrCl2 (iv) Group 4 - electrode application versus electrode application with SrCl2 and were subjected to tactile stimulus and air blast test and scores were recorded on verbal rating scale (VRS) and visual analogues scale (VAS) at different time for 3 months. The data was statistically evaluated by one way ANOVA and paired t test. Results: In group 1 and 3, DL alone had a short term reduction of hypersensitivity (P = 0.001). Synergistic effect of DL and HAP (group 1) showed a prolonged reduction on both scales (P < 0.001) whereas the additive effect of SrCl2 with DL (group 3) showed statistically significant reduction on both scales at all time (p< 0.001). In group 2 there is insignificant difference on both scales at all time (P > 0.05) however group 4 showed significant reduction only in VAS score (p>0.05). Conclusion: DL alone had a short lived effect however with adjunctive sustained results were obtained whereas electrode application was neither beneficial nor did cause any adverse effect.

Purpose To assess the variation in the interpretation of common verbal descriptors (VDs) used in response scales and examine factors associated with those interpretations. Methods Subjects were recruited through MediGuard and they assigned interpretation scores (11-point scale; 0 = lowest possible, 10 = highest possible) to five common sets of VDs: set one (none, mild, moderate, severe, very severe); set two (never, rarely, sometimes, often, always); set three (poor, fair, good, very good, excellent); set four (not at all, a little bit, moderately, quite a bit, extremely); and set five (not at all, a little bit, somewhat, quite a bit, very much). One-sample test for proportions and T-tests examined equality of proportions (anchors) and means scores (non-anchors) with the fixed intervals (0.0, 2.5, 5.0, 7.5, and 10.0). Ordinal regression examined adjusted associations between demographic/clinical factors and VD scores. Results Of the 350 subjects, 68 % were females and mean (SD) age was 56.9 (12.1). Two sets had two VDs with mean (95 % CI) scores not different than the fixed intervals. Set one had mild = 2.50 (2.33; 2.66) and moderate = 5.01 (4.89; 5.13) with 98.8 % (97.3 %; 100 %) assigning none = 0. Set five had a little bit = 2.35 (2.17; 2.53) and quite a bit = 7.65 (7.43; 7.87) with 95.0 % (95 % CI 91.7; 98.2) assigning not at all = 0. Significant associations (p ≤ 0.05) included age and education with somewhat and income and comorbidities with very severe. Age, sex, and education showed associations with other VDs albeit in nonsignificant models. Conclusions Sets one and five yielded data closest to the fixed intervals. Demographic and clinical factors are associated with the interpretation of some VDs and should be adjusted for in analyses of non-randomized data.

The article describes a general two-step procedure for the numerical translation of vague linguistic terms (LTs). The suggested procedure consists of empirical and model components, including (1) participants’ estimates of numerical values corresponding to verbal terms and (2) modeling of the empirical data using fuzzy membership functions (MFs), respectively. The procedure is outlined in two studies for data from N = 89 and N = 109 participants, who were asked to estimate numbers corresponding to 11 verbal frequency expressions (e.g., sometimes ). Positions and shapes of the resulting MFs varied considerably in symmetry, vagueness, and overlap and are indicative of the different meanings of the vague frequency expressions. Words were not distributed equidistantly across the numerical scale. This has important implications for the many questionnaires that use verbal rating scales, which consist of frequency expressions and operate on the premise of equidistance. These results are discussed for an exemplar questionnaire (COPSOQ). Furthermore, the variation of the number of prompted LTs (5 vs. 11) showed no influence on the words’ interpretations.

Total knee arthroplasty (TKA) is highly associated with post-operative pain. The present randomized trial aimed to explore the possible post-operative pain management by a different combination of analgesics or opioids (ketamine and bupivacaine) following TKA. A total of 84 patients were randomly divided into four groups. All subjects were anesthetized for TKA surgery and received post-operative pain management via intra-articular saline (control group; n=23), ketamine (2 mg/kg) infused with saline (ket group; n=21) bupivacaine (0.5 mg/kg) infused with saline (bupi group; n=20) or ketamine (2 mg/kg)+bupivacaine (0.5 mg/kg) infused with saline (ket+bupi group; n=20) at the end of the surgery. Additional, post-operative analgesia was infused with the aid of patient-controlled analgesia with morphine. A reduction in the levels of pain score (verbal rating scale and visual analog scale), opioid consumption, time of ambulation, hospital stay and adverse events were observed in the ket+bupi group compared with the other groups. Meanwhile, the satisfaction score and knee flexion degree were improved following treatment with the ket+bupi regimen. Therefore, the multimodal analgesic regimen (ket+bupi) may be useful in mitigating post-operative pain as and improving knee mobilization following TKA.