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Simple pain rating scales hide complex idiosyncratic meanings.
Amanda C de Williams1, Huw Talfryn Oakley Davies, Yasmin Chadury
1King's, Guy's and St. Thomas' Medical School, University of London, London, UK INPUT Pain Management Unit, Guy's and St. Thomas' Hospital NHS Trust, London SE1 7EH, UK Department of Management, University of St. Andrews, St. Katharines West, The Scores, St. Andrews Fife, KY16 9AL, UK.
Pain
|April 27, 2000
Summary
Patients
Area of Science:
- Pain Management
- Psychometrics
- Patient Reported Outcomes
Background:
- Visual Analogue Scales (VAS) and Numerical Rating Scales (NRS) are commonly used for pain assessment.
- Assumptions of reliability and consistency in self-reported pain using VAS and NRS may be overly simplistic.
- Sources of error in pain reporting require deeper investigation.
Purpose of the Study:
- To examine patients' self-reported use of VAS and NRS.
- To investigate how patients rate multiple pains and different pain dimensions.
- To understand patients' interpretation and use of scale endpoints and increments.
Main Methods:
- A semi-structured interview was administered to 78 chronic pain patients.
- The interview included forced-choice and free-response questions.
- Data focused on patients' descriptions of their rating process.
Main Results:
- Lack of concordance between patients and inconsistency within patients' ratings were observed.
- Pain ratings appear to incorporate multiple, partially differentiated pain dimensions, with a strong emphasis on function/mobility.
- Patients' interpretation of scale labels (lexical or numerical) influenced their use, with evidence of covert relabeling.
Conclusions:
- The process of pain rating is better understood as meaning construction rather than a simple stimulus-matching task.
- Patient-reported pain ratings are influenced by internal and external factors, and personal meanings.
- Current psychometric assumptions for VAS and NRS may not fully capture the complexity of patient pain reporting.