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.
To investigate the use and performance of unidimensional pain scales, with specific
emphasis on the NRSs.
A systematic search was performed, including citations through April 2010. All abstracts
were evaluated by two persons according to specified criteria.
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.
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.
Copyright © 2011 U.S. Cancer Pain Relief Committee. Published by Elsevier Inc. All
rights reserved.