title: Studies comparing Numerical Rating Scales, Verbal Rating Scales, and Visual Analogue Scales for assessment of pain intensity in adults: a systematic literature review.
abstract: BACKGROUND
  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.
  
  
  OBJECTIVE
  To investigate the use and performance of unidimensional pain scales, with specific emphasis on the NRSs.
  
  
  METHODS
  A systematic search was performed, including citations through April 2010. All abstracts were evaluated by two persons according to specified criteria.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Regional Center for Excellence in Palliative Care, Department of Oncology, Oslo University Hospital-Ullevål, Oslo, Norway. m.j.hjermstad@medisin.uio.no
authors.forename: Marianne Jensen
authors.initials: MJ
authors.lastname: Hjermstad
authors.forename: Peter M
authors.initials: PM
authors.lastname: Fayers
authors.forename: Dagny F
authors.initials: DF
authors.lastname: Haugen
authors.forename: Augusto
authors.initials: A
authors.lastname: Caraceni
authors.forename: Geoffrey W
authors.initials: GW
authors.lastname: Hanks
authors.forename: Jon H
authors.initials: JH
authors.lastname: Loge
authors.forename: Robin
authors.initials: R
authors.lastname: Fainsinger
authors.forename: Nina
authors.initials: N
authors.lastname: Aass
authors.forename: Stein
authors.initials: S
authors.lastname: Kaasa
mesh_terms: D000328:Adult; D006801:Humans; D010146:Pain / Q000145:classification* / Q000175:diagnosis*; D010147:Pain Measurement / Q000379:methods* / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires