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described (traditional VAS,101-point NRS, 11-point box scale, 6-point behavioral
rating scale, 4-point VRS, and 5-point VRS) were compared based on the following
criteria: ease of administration of scoring, rates of correct responding, sensitivity (as
defined by the number of available response categories), and responsiveness to
change, as well as in terms of the predictive relationship between each scale and a
linear combination of pain intensity indices.
The tools produced similar results concerning their predictive validity and the pro-
portion of patients not responding as instructed (e.g. leaving response blank, marking
between two categories, marking two answers, etc.). Indeed, according to [25], sev-
eral similar problems exist with the use of the aforementioned tools. Despite their
apparent simplicity, approximately 7-11% of adults and up to 25% of the aged fails to
complete it. Specifically, VAS methods are sometimes criticized that are being diffi-
cult to understand, with 7−16% higher failure rates being reported for VASs than for
the VRSs and NRSs. The problem is found in individuals with physical or cognitive
impairment and in the elderly. The VAS is also less reliable in illiterate patients [30].
When considering the remaining criteria (responsiveness to change, ease of ad-
ministration, sensitivity) the 101-point NRS proved to be the most practical tool. In
practice, patients prefer the NRS to the VAS since only 2% fail to complete it [25],
and the feasibility of its use, as well as that it is easily possible to administer it e.g.
verbally, have been proven [17]. However, in patients with a chronic disease such as
osteoarthritis, “VAS and VRS responses were shown to be highly correlated (
r
≈ 0.7-
0.8) and the tools produced similar effect sizes after treatment; thus, the VRS was
easier to administer and interpret, and at the end the VRS emerged as the overall scale
of choice in both younger and older cohorts” [30].
To this end, evidence from literature indicates that VRS, as well as NRS are the
most reliable tools that patients also feel more comfortable using, however, they are
not as appropriate to detect changes over time as are VAS and GRS [17]. Since pain is
a disorder that in order to understand it you need to look at its development over time,
VAS and/or GRS are the pain measurement tools that are going to be adopted in this
work for the purpose intended.
B)
Pain Affect Assessment tools
Accordingly, [17] also present in their review the available tools used to assess pain
affect. Based on their study, the aforementioned tools (VRS, NRS, etc.) could also be
used to assess affect, however, due to the fact that measuring pain affect is multi-
dimensional in nature, that is intensity and affect are both considered in the assess-
ment, the results show that these tools have also the same disadvantages as when
measuring pain intensity alone. For that reason, more sophisticated tools have been
developed for the purpose intended, specifically the
Pain-O-Meter
, and the
McGill
Pain Questionnaire
.
•
Pain-O-Meter
. As described in their review, this tool “consists of a mechani-
cal VAS and two lists of terms describing the pain affect. Each of these
terms has an associated intensity value ranging from one to five. The respon-
dents must decide, which of the 11 possible words best describe their pain.
Then the associated intensity values are summed together to build the Pain-
O-Meter-affective scale.
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