The utility and validity of pain intensity rating scales for use in developing countries

Abstract

Introduction:Pain intensity is the domain most often assessed in pain research. Although the Numerical Rating Scale is recommended for use in western countries, the utility and validity of this scale, relative to others, has not been established in non–western developing countries, such as Nepal.Objectives:Here, we sought to (1) identify which of 4 commonly used pain scales is most preferred by Nepalese, (2) compare error rates, (3) determine whether preference and error rates are influenced by age or education level, and (4) evaluate construct validity of each scale using factor analysis.Methods:Two hundred two adults with musculoskeletal pain from Nepal rated their worst and average pain intensity using all 4 scales and selected their most preferred scale.Results:The results indicate that the Faces Pain Scale-Revised is the most preferred scale, followed by a Verbal Rating Scale. The Numerical Rating Scale and Visual Analogue Scale were both least preferred and had higher rates of incorrect responses, especially among the older participants. However, all the scales demonstrated adequate construct validity as measures of pain intensity among those participants who could accurately use all 4 scales.Conclusion:The findings indicate that the Faces Pain Scale-Revised should be the first choice for assessing pain intensity in Nepalese adults. Research is needed to determine whether these findings replicate in other non–western and developing countries, to identify the pain intensity measure that would be the best choice for use in cross-cultural pain research.

Sensory-Discriminative Three-Dimensional Body Pain Mobile App Measures Versus Traditional Pain Measurement With a Visual Analog Scale: Validation Study

“…Nonetheless, patients are frequently asked to represent their overall pain by giving a single number (numerical rating scale, NRS), verbally state its level (verbal rating scale, VRS), or similarly mark on a 10 cm line their pain level (visual analog scale, VAS). Despite being considered the gold standard in clinical trials for pain, traditional measurement tools have huge disadvantages, including low precision and higher rates of incorrect responses [ 6 , 7 ]. Perhaps, the most important aspect is the assumption that overall pain is a unidimensional experience that can be measured with a single-item scale [ 8 , 9 ].…”

Does Assessment of Pain Vary Across Age Groups?

“…Whilst there are some suggestions that these modified scales could be used with the older population, they are not really appropriate. Although, a recent study with Nepalese adults found that the faces scale (revised) and the verbal rating scale were the most popular with adults, particularly older adults (12). Thus, suggesting some cross cultural differences.…”

Combined analysis of 3 cross-sectional surveys of pain in 14 countries in Europe, the Americas, Australia, and Asia: impact on physical and emotional aspects and quality of life

“…The 3 factors in the Physical category assessed the percentage of respondents with each of the following: pain frequency of at least weekly, pain duration of at least several hours, and more severe pain intensity, defined as a score of 7-10 on the 10-point Faces Pain Scale-Revised. The Faces Pain Scale-Revised is a widely used pain scale considered appropriate for use across many populations, including developing countries and low-literacy populations [12,13]. The 3 factors in the Emotional category assessed the percentage of respondents who agreed with each (separately) of the following: that pain impacts their self-esteem, is associated with anxiety, and reduces their ability to be happy.…”