title: The verbal numeric pain scale: effects of patient education on self-reports of pain.
abstract: BACKGROUND
  Emergency department (ED) patients are frequently asked to provide a self-report of the level of pain experienced using a verbal numeric rating scale.
  
  
  OBJECTIVE
  To determine the effects of patient education regarding the verbal numeric rating scale on self-reports of pain among ED patients.
  
  
  METHODS
  In this prospective, interventional study, 310 eligible ED patients with pain, aged 18 years and older, were randomized to view either a novel educational video (n = 155) or a novel print brochure (n = 155) as an educational intervention, both developed to deliver educational information about the verbal numeric pain scale and its use. Participants initially rated their pain on a scale from 0 to 10 and then were administered the educational intervention. Following the educational intervention, participants completed a survey that included demographic information, postinterventional pain score, prior pain experience, and subjective rating of the helpfulness of the educational intervention. Fifty-five consecutive participants were enrolled as controls and received no educational intervention but gave a self-reported triage pain score and a second pain score at an equivalent time interval. Clinical significance was defined as a decrease in pain of 2 or more points following the education.
  
  
  RESULTS
  Following the educational interventions, there were statistically significant, although not clinically significant, decreases in mean pain scores within each intervention group (video: mean change, 1 point [95% confidence interval [CI] = 0.7 to 1.2]; printed brochure: mean change, 0.6 points [95% CI = 0.4 to 0.8]). For participants in the control group (no intervention), there was no significant change (mean change, 0.2 points [95% CI = -0.2 to 0.5]). A clinically significant decrease in pain was seen in 28% of the video group, 23% of the brochure group, and 5% of controls. Most patients had no change (71% of the video group, 73% of the brochure group, and 89% of controls). Participants rated the helpfulness of the video educational intervention as 7.1 (95% CI = 6.7 to 7.5) and the print educational intervention as 6.7 (95% CI = 6.2 to 7.1) on a scale from 0 (least effective) to 10 (most helpful).
  
  
  CONCLUSIONS
  Among ED participants with pain, both educational interventions (video and printed brochure) resulted in statistically and clinically significant decreased self-reported pain scores by 2 or more points in 26% of participants compared with 5% of controls. The educational interventions were rated as helpful by participants, with no appreciable difference between the two intervention groups.
authors.affiliation: Department of Emergency Medicine, St. Vincent Mercy Medical Center, Toledo, OH 43608-2691, USA. cmarco2@aol.com
authors.forename: Catherine A
authors.initials: CA
authors.lastname: Marco
authors.forename: Alan P
authors.initials: AP
authors.lastname: Marco
authors.forename: Michael C
authors.initials: MC
authors.lastname: Plewa
authors.forename: Nancy
authors.initials: N
authors.lastname: Buderer
authors.forename: Jameson
authors.initials: J
authors.lastname: Bowles
authors.forename: Jennifer
authors.initials: J
authors.lastname: Lee
mesh_terms: D000328:Adult; D000368:Aged; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000175:diagnosis*; D010147:Pain Measurement / Q000295:instrumentation* / Q000379:methods*; D010174:Pamphlets; D010353:Patient Education as Topic / Q000379:methods*; D017060:Patient Satisfaction; D011446:Prospective Studies; D012737:Sex Factors; D014741:Video Recording