Measuring Pain Impact Versus Pain Severity Using a Numeric Rating Scale

Abstract

Tools that measure the impact of pain may be a more valuable screening instrument than the NRS. Further research is now needed to determine if measuring the impact of pain in clinical practice is more effective at triggering appropriate management than more restricted measures of pain such as the NRS.

The Numeric Scoring of Pain: This Practice Rates a Zero Out of Ten

“…Multiple studies from diverse settings have consistently found that patient-reported scores do not accurately predict the desire for analgesic therapy. [5][6][7][8][9][10][11] In their article, Chang et al 1 corroborate these previous findings, with 51% of their subjects declining further analgesics at least once despite reporting a pain score of 5 or greater and 21% similarly declining analgesics despite a score of 7 or greater. The authors observe that "the large variability.reinforces the necessity of asking patients if they want additional medication rather than basing treatment decisions on patients' reported level of pain."…”

“…Indeed, the numeric rating scale is only moderately predictive of more robust measures of pain. [9][10][11][12][13] Pain is neither a vital sign nor a disease. Pain is a symptom-a subjective condition affected by a multitude of clinical, emotional, cultural, and psychological factors.…”

Initial development of patient-reported instrument assessing harm, efficacy, and misuse of long-term opioid therapy

“…We then removed items that were not written in patient-reported format if the item’s content was covered by a similar, patient-reported item. Since interpreting the clinical significance of single time-point numeric ratings can be challenging,[17] we removed items relying on numeric scales in the response if similar items not requiring use of a numeric rating scale were available. Finally, in recognition that three of the instruments identified in the systematic review were designed for clinical research on opioid-induced constipation (the Bowel Function Index, the Patient Assessment of Constipation Symptoms, and the Bowel Function Diary) and contained a level of detail on constipation unnecessary for primary care-based screening, we chose three items that adequately covered the concept of opioid-induced constipation rather than including all the constipation-related items.…”

Best evidence in multimodal pain management in spine surgery and means of assessing postoperative pain and functional outcomes

“…The numeric rating scale (NRS) and VAS are each validated tools to measure pain intensity [60,61]. These metrics are completed by having the patient rate the severity of their current pain on a scale of 0 to 10.…”