Visual Analog Scale pain reporting was standardized

doi:10.1016/j.jclinepi.2004.11.017

Journal of Clinical Epidemiology

Volume 58, Issue 6, June 2005, Pages 618-623

https://doi.org/10.1016/j.jclinepi.2004.11.017 Get rights and content

Abstract

Background and Objective

Whereas pain is frequently measured using a visual analog scale (VAS) that can examine change over short time intervals in the same subject, such ratings are not useful in analyzing differences across subjects. We created a method for normalizing VAS pain reporting to control for the variation between different populations due to the differences in subjective perception or objective evaluation of pain.

Methods

A list of 226 pains was gathered from a convenience sample of persons on the street and patients waiting at medical and orthopedic clinics. These pains were ranked according to severity by health professionals and 19 pains with the most stable rankings were selected. These 19 pains were then rated by a sample of community-dwelling persons and a method of VAS standardization was developed, based on six selected pains.

Results

Individual variations in pain ratings were found to be independent of respondent age and gender, but were correlated with experience of the event or behavior and with self-reported health status. A new scoring method that takes into account these correlations is proposed.

Conclusion

It is possible to standardize VAS pain ratings to compare pain between different populations.

Introduction

Pain is a universal experience, but reports of pain are hard to interpret. Much work has gone into characterizing and measuring pain. Our goal is to find a way to make the reporting of pain experience more comparable across individuals in a population. We focus our attention on developing a statistical adjustment process that can be applied to a widely used pain reporting device, the Visual Analog Scale (VAS).

The phenomenon of pain includes both subjective perception and actual experience, and the combination of the two. Excellent reviews of pain measurement are available [1], [2], [3], [4]. Different subjects may report different levels of pain as a result of the same physical stimulus, based presumably on a combination of physiological as well as psychosocial factors [5], [6], [7]. Given the complex networks for receiving and interpreting pain, the same level of injury may affect different people differently [2], [3], [8]. These observations raise the question about how useful self-reported pain data are for comparisons among people reporting pain, or even within the same individual over two different times.

Pain reporting may vary according to demographic factors [1], [9], [10], [11], [12], [13], [14], [15]. Physicians respond differently to reporting of pain by patients from different ethnic groups [16]. Moreover, evidence suggests that past pain experiences influence the rating of pain severity [17].

Pain is considered to be a multidimensional construct [18], [19], and simple pain measures are viewed with skepticism [20]. Nonetheless, many clinical investigators have used some variant of the VAS to generate a quantitative measure of pain. This method appears to be reliable in tracking changes in pain over time in the same subject, but, given the evidence regarding the subjective (psychosocial) component to the rating of pain, it does not permit any comparisons of pain experienced between populations (e.g., persons with Parkinson disease versus those with multiple sclerosis).

One attempt at developing a method for standardizing VAS reports by adjusting for reports of a predetermined standard set of pains was unable to improve the performance of the underlying VAS approach [21], but the problem may lie in choosing an arbitrary set of standard pains that were not necessarily familiar to the subjects. Ideally, the approach to norming individual pain reports or pain reports between populations would use pains that are consistently felt to represent different severity levels. Although such consistency is an ideal, little is known about the actual experience of pain in the general population in terms of either its prevalence or their perception of how painful it is [22], [23], [24], [25].

The present study explored people's ratings of various pains (whether experienced or not) and the relationship of those ratings to their actual pain experience, as a step toward creating a method that would permit norming responses across respondents and thus allow comparing pain ratings on a common metric.

Section snippets

Methods

A multistage approach was used, each with a different sample. These stages are presented in Table 1. The first three stages represent the work reported here; the fourth stage uses the tool developed in this study. In the first stage, a convenience sample of 313 persons was interviewed: 104 patients in orthopaedic surgery clinic waiting rooms, 100 patients from primary care medicine clinic waiting rooms, and 109 persons stopped on the street or in a shopping mall. Each person was asked to

Results

The average rating of the severity of pain by the community sample in the third stage was found to be similar to the rank ordering by health professionals in the prior step (Table 2). The Spearman correlation coefficient between ranks was .965 (P < .001).

Although 1,622 community respondents (81%) returned the questionnaires, not all respondents answered every question. Table 3 shows their mean ratings, organized by whether they had experienced the pain. In 11 of the 19 pains, those who had

Discussion

Several observations emerge from the present study. Few pains (more often minor ones) are universally experienced by men or women, nor do people universally agree about the severity of a given pain. These findings indicate the need for a way to normalize self-reported pain using VAS items that takes into account the differences that exist between individuals regarding not just experience but the perception of how much pain is associated with an event.

It is possible to identify candidate pains

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¹: Present address: Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA.

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Original ArticleVisual Analog Scale pain reporting was standardized

Abstract

Background and Objective

Methods

Results

Conclusion

Introduction

Section snippets

Methods

Results

Discussion

Pain

Soc Sci Med

Pain

Pain

Soc Sci Med

Pain

J Clin Epidemiol

J Pain Symptom Manage

J Clin Epidemiol

Pain

Pain

People in pain

Pain: the science of suffering

Psychological mechanisms of pain and analgesia

Original Article
Visual Analog Scale pain reporting was standardized