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== Purpose  ==
== Purpose  ==
 
The Numeric Pain Rating Scale (NPRS) (an [[Outcome Measures|outcome measure]]) that is a unidimensional measure of pain intensity in adults,<ref name="p9">Childs JD, Piva SR, Fritz JM. Responsiveness of the numeric pain rating scale in patients with low back pain. Spine 2005;30:1331–4.</ref><ref name="p0">Jensen MP, McFarland CA. Increasing the reliability and validity of pain intensity measurement in chronic pain patients. Pain 1993;55: 195–203.</ref><ref name="p3">Rodriguez CS. Pain measurement in the elderly: a review. Pain Manag Nurs 2001;2:38–46</ref>&nbsp;including those with [[Chronic Pain|chronic pain]] due to [[Rheumatoid Arthritis|rheumatic]] diseases.<ref name="p3" /><ref name="p8">Ferraz MB, Quaresma MR, Aquino LR, Atra E, Tugwell P, Goldsmith CH. Reliability of pain scales in the assessment of literate and illiterate patients with rheumatoid arthritis. J Rheumatol 1990;17:1022–4</ref> (man in pain, R)<br>  
The NRS for pain is a unidimensional measure of pain intensity in adults <ref name="19">Childs JD, Piva SR, Fritz JM. Responsiveness of the numeric pain rating scale in patients with low back pain. Spine 2005;30:1331–4.</ref>&nbsp;<ref name="20">Jensen MP, McFarland CA. Increasing the reliability and validity of pain intensity measurement in chronic pain patients. Pain 1993;55: 195–203.</ref>&nbsp;<ref name="3">Rodriguez CS. Pain measurement in the elderly: a review. Pain Manag Nurs 2001;2:38–46</ref>, including those with chronic pain due to rheumatic diseases&nbsp;<ref name="3">Downie WW, Leatham PA, Rhind VM, Wright V, Branco JA, Anderson JA. Studies with pain rating scales. Ann Rheum Dis 1978;37:378–81</ref>&nbsp;<ref name="8">Ferraz MB, Quaresma MR, Aquino LR, Atra E, Tugwell P, Goldsmith CH. Reliability of pain scales in the assessment of literate and illiterate patients with rheumatoid arthritis. J Rheumatol 1990;17:1022–4</ref>
<br>  


== Content  ==
== Content  ==


The NRS is a segmented numeric version of the visual analog scale (VAS) in which a respondent selects a whole number (0–10 integers) that best reflects the intensity of their pain <ref name="3" />. The common format is a horizontal bar or line. Similar to the pain VAS, the NRS is anchored by terms describing pain severity extremes.&nbsp;<ref name="main">HAWKER GA. Measures of Adult Pain. Arthritis Care &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp; Research 2011; 63,S240–S252</ref>
The NPRS is a segmented numeric version of the visual analog scale ([[Visual Analogue Scale|VAS]]) in which a respondent selects a whole number (0–10 integers) that best reflects the intensity of his/her pain.<ref name="p3" />  
<br>  
* The common format is a horizontal bar or line.  
* Similar to the VAS, the NPRS is anchored by terms describing pain severity extremes.<ref name="main">HAWKER GA. Measures of Adult Pain. Arthritis Care &amp; Research 2011; 63,S240–S252</ref> <br>


== Number of Items  ==
== Number of Items  ==


Although various iterations exist, the most commonly used is the 11-item NRS.<ref>Williamson A. Pain: a review of three commonly used pain rating scales. ISSUES IN CLINICAL NURSING 2005; 14: 798–804</ref>
Although various iterations exist, the most commonly used is the 11-item NPRS.<ref>Williamson A. Pain: a review of three commonly used pain rating scales. ISSUES IN CLINICAL NURSING 2005; 14: 798–804</ref> <br>  
<br>  


== Response Options/Scale  ==
== Response Options/Scale  ==


An 11-point numeric scale (NRS 11) with 0 representing one pain extreme (e.g., “no pain”) and 10 representing the other pain extreme (e.g., “pain as bad as you can imagine” and “worst pain imaginable”)<ref name="20" />&nbsp;<ref name="3" /> <br>  
The 11-point numeric scale ranges from '0' representing one pain extreme (e.g. “no pain”) to '10' representing the other pain extreme (e.g. “pain as bad as you can imagine” or “worst pain imaginable”).<ref name="p0" /><ref name="p3" /> <br>  


[[Image:NRS pain.jpg|center]]
[[Image:NRS pain.jpg|center]]  


== Recall period for items ==
== Recall Period for Items ==


Varies, but most commonly respondents are asked to report pain intensity “in the last 24 hours” or average pain intensity.&nbsp;<ref name="7">Dworkin RH, Turk DC, Farrar JT, Haythornthwaite JA, Jensen MP, Katz NP, et al. Core outcome measures for chronic pain clinical trials: IMMPACT recommendations. Pain 2005;113:9–19.</ref>  
Recal varies, but respondents are most commonly asked to report pain intensity “in the last 24 hours” or an average pain intensity.<ref name="p7">Dworkin RH, Turk DC, Farrar JT, Haythornthwaite JA, Jensen MP, Katz NP, et al. Core outcome measures for chronic pain clinical trials: IMMPACT recommendations. Pain 2005;113:9–19.</ref>   
<br>
 
== Obtaining the Scale ==
 
Available from the web site: http://www.partnersagainstpain.com/printouts/A7012AS2.pdf.
<br>


== Administration  ==
== Administration  ==


The NRS can be adminis-tered verbally (therefore also by telephone) or graphically for self-completion<ref name="8">Jensen MP, Karoly P, Braver S. The measurement of clinical pain intensity: a comparison of six methods. Pain 1986;27:117–26.</ref>. The respondent is asked to indicate&nbsp;the numeric value on the segmented scale that best describes their pain intensity.&nbsp;<ref name="main" />  
The NPRS can be administered verbally (therefore also by telephone) or graphically for self-completion.<ref name="p8" /> As mentioned above, the respondent is asked to indicate the numeric value on the segmented scale that best describes their pain intensity.<ref name="main" /> <br>  
<br>


== Scoring and Interpretation  ==
== Scoring and Interpretation  ==


The number that the respondent indicates on the scale to rate their pain intensity is recorded. Scores range from 0–10. Higher scores indicate greater pain intensity.<ref name="main" />  
Scores range from 0-10 points, with higher scores indicating greater pain intensity.<ref name="main" /> <br>  
<br>


== Merits and Demerits  ==
== Merits and Demerits  ==


*The pain NRS takes &lt;1 minute to complete.
*The NPRS takes &lt;1 minute to complete
*The pain NRS is easy to administer and score.<ref name="8" />&nbsp;<ref name="25">Jensen MP, Karoly P, O’Riordan EF, Bland F Jr, Burns RS. The subjective experience of acute pain. Clin J Pain 1989;5:153–9</ref>  
*The NPRS is easy to administer and score<ref name="p8" /><ref name="p5">Jensen MP, Karoly P, O’Riordan EF, Bland F Jr, Burns RS. The subjective experience of acute pain. Clin J Pain 1989;5:153–9</ref>  
*Minimal language translation difficulties supports the use of the NRS&nbsp;across cultures and languages<ref name="26">Langley GB, Sheppeard H. The visual analogue scale: its use in pain measurement. Rheumatol Int 1985;5:145–8.</ref>  
*Minimal language translation difficulties supports the use of the NPRS&nbsp;across cultures and languages<ref name="p6">Langley GB, Sheppeard H. The visual analogue scale: its use in pain measurement. Rheumatol Int 1985;5:145–8.</ref>  
*Valid and reliable scale to measure pain intensity&nbsp;<ref name="main" /><br>  
*The NPRS is a valid and reliable scale to measure pain intensit&nbsp;<ref name="main" /><br>  
*Strengths of this measure over the pain VAS are the ability to be administered both verbally (therefore by telephone) and in writing, as well as its simplicity of scoring.<ref name="main" />  
*Strengths of this measure over the VAS are the ability to be administered both verballyand in writing, as well as its simplicity of scoring<ref name="main" />  
*However, pain NRS evaluates only 1 component of the pain&nbsp;experience, pain intensity, and therefore does not capture the complexity and idiosyncratic nature of the pain experience or improvements due to symptom fluctuations.
*One weakness is that the NPRS evaluates only 1 component of the pain&nbsp;experience and &nbsp;intensity, and therefore does not capture the complexity and idiosyncratic nature of the pain experience or improvements due to symptom fluctuations.<br>
<br>


== Psychometric Information  ==
== Psychometric Information  ==


===== Development  =====
=== Development  ===


To improve discrimination for detecting relatively small changes, an NRS comprised of numbers along a scale was used in a population of 100 patients with a variety of rheumatic diseases. Variations in pain descriptors used as anchors for end points on the pain NRS have been reported in the literature. However, the methodology used to develop these various anchor terms is unknown.<ref>Downie WW, Leatham PA, Rhind VM, Wright V, Branco JA, Anderson JA. Studies with pain rating scales. Ann Rheum Dis 1978;37:378–81.</ref>&nbsp;<ref>Jensen MP, Karoly P, Braver S. The measurement of clinical pain intensity: a comparison of six methods. Pain 1986;27:117–26.</ref>  
To improve discrimination for detecting relatively small changes, an NPRS comprised of numbers along a scale was used in a population of 100 patients with a variety of rheumatic diseases. Variations in pain descriptors used as anchors for end points on the NPRS have been reported in the literature. However, the methodology used to develop these various anchor terms is unknown.<ref>Downie WW, Leatham PA, Rhind VM, Wright V, Branco JA, Anderson JA. Studies with pain rating scales. Ann Rheum Dis 1978;37:378–81.</ref><ref>Jensen MP, Karoly P, Braver S. The measurement of clinical pain intensity: a comparison of six methods. Pain 1986;27:117–26.</ref>  


===== Acceptability  =====
=== Acceptability  ===


Chronic pain patients prefer the NRS over other measures of pain intensity, including the pain VAS, due to comprehensibility and ease of completion<ref>De C Williams AC, Davies HT, Chadury Y. Simple pain rating scales hide complex idiosyncratic meanings. Pain 2000;85:457–63</ref>. However, focus groups of patients with chronic back pain and symptomatic hip and knee osteoarthritis (OA) have found that the pain NRS is inadequate in capturing the complexity and idiosyncratic nature of the pain expe-rience or improvements due to symptom fluctuations.<ref>Hawker GA, Davis AM, French MR, Cibere J, Jordan JM, March L, et al. Development and preliminary psychometric testing of a new OA pain measure: an OARSI/OMERACT initiative. Osteoarthritis CartilagefckLR2008;16:409–14</ref>&nbsp;<ref>Hush JM, Refshauge KM, Sullivan G, De Souza L, McAuley JH. Do numerical rating scales and the Roland-Morris Disability Question-naire capture changes that are meaningful to patients with persistent back pain? Clin Rehabil 2010;24:648–57.</ref>  
Chronic pain patients prefer the NPRS over other measures of pain intensity, including the VAS, due to comprehensibility and ease of completion.<ref>De C Williams AC, Davies HT, Chadury Y. Simple pain rating scales hide complex idiosyncratic meanings. Pain 2000;85:457–63</ref> However, focus groups of patients with chronic back pain and symptomatic hip and knee osteoarthritis (OA) have found that the NPRS is inadequate in capturing the complexity and idiosyncratic nature of the pain experience or improvements due to symptom fluctuations.<ref>Hawker GA, Davis AM, French MR, Cibere J, Jordan JM, March L, et al. Development and preliminary psychometric testing of a new OA pain measure: an OARSI/OMERACT initiative. Osteoarthritis Cartilage 2008;16:409–14</ref><ref>Hush JM, Refshauge KM, Sullivan G, De Souza L, McAuley JH. Do numerical rating scales and the Roland-Morris Disability Question-naire capture changes that are meaningful to patients with persistent back pain? Clin Rehabil 2010;24:648–57.</ref>  


===== Reliability.  =====
=== Reliability ===


High test–retest reliability has been observed in both literate and illiterate patients with rheumatoid arthritis (r = 0.96 and 0.95, respectively) before and after medical consultation.&nbsp;<ref name="8">Ferraz MB, Quaresma MR, Aquino LR, Atra E, Tugwell P, Goldsmith CH. Reliability of pain scales in the assessment of literate and illiterate patients with rheumatoid arthritis. J Rheumatol 1990;17:1022–4.</ref>  
High test–retest reliability has been observed in both literate and illiterate patients with rheumatoid arthritis (r = 0.96 and 0.95, respectively) before and after medical consultation.<ref name="p8" />  


===== Validity  =====
=== Validity  ===


For construct validity, the NRS was shown to be highly correlated to the VAS in patients with rheumatic and other chronic pain conditions (pain&gt;6 months): cor-relations range from 0.86 to 0.95.<ref name="8">Ferraz MB, Quaresma MR, Aquino LR, Atra E, Tugwell P, Goldsmith CH. Reliability of pain scales in the assessment of literate and illiterate patients with rheumatoid arthritis. J Rheumatol 1990;17:1022–4.</ref>  
For construct validity, the NPRS was shown to be highly correlated with the VAS in patients with rheumatic and other chronic pain conditions (pain&gt;6 months): correlations range from 0.86 to 0.95.<ref name="p8" />  


===== Ability to detect change.<br> =====
=== Minimal Clinically Important Difference (MCID) ===


In clinical trials of pregabalin for diabetic neuropathy, postherpetic neuralgia, chronic low back pain, fibromyalgia, and OA, analyses of the relationships between changes in pain NRS scores and patient&nbsp;reports of overall improvement, measured using a stan-dard 7-point patient global impression of change, demonstrated a reduction of 2 points, or 30%, on the pain NRS scores to be clinically important <ref>Farrar JT, Young JP Jr, LaMoreaux L, Werth JL, Poole RM. Clinical importance of changes in chronic pain intensity measured on an 11-point numerical pain rating scale. Pain 2001;94:149–58.</ref>. Similar results were found in low back pain patients when changes in pain&nbsp;NRS scores were compared to patient improvements in pain after physical therapy, using a 15-point Global Rating of Change scale&nbsp;<ref>Childs JD, Piva SR, Fritz JM. Responsiveness of the numeric pain rating scale in patients with low back pain. Spine 2005;30:1331–4</ref>  
In clinical trials of pregabalin (also known as Lyrica) for diabetic neuropathy, postherpetic neuralgia, chronic low back pain, fibromyalgia, and OA, analyses of the relationships between changes in NPRS scores and patient&nbsp;reports of overall improvement (measured using a standard 7-point patient Global Impression of Change), demonstrated a reduction of 2 points, or 30%, on the NPRS scores to be clinically important.<ref>Farrar JT, Young JP Jr, LaMoreaux L, Werth JL, Poole RM. Clinical importance of changes in chronic pain intensity measured on an 11-point numerical pain rating scale. Pain 2001;94:149–58.</ref>&nbsp;Similar results were found in low back pain patients when changes in NPRS scores were compared to patient improvements in pain after physical therapy using a 15-point Global Rating of Change scale.<ref>Childs JD, Piva SR, Fritz JM. Responsiveness of the numeric pain rating scale in patients with low back pain. Spine 2005;30:1331–4</ref> In another study, the MCID was found to be 2 points in patients with shoulder pain.<ref name="mich">Michener LA, Snyder AR, Leggin BG. Responsiveness of the numeric pain rating scale in patients with shoulder pain and the effect of surgical status. Journal of sport rehabilitation. 2011 Feb 1;20(1):115.</ref>


== References  ==
== References  ==


<references />
<references />  


<br>
<br>  


[[Category:Outcome_Measures]] [[Category:Pain]] [[Category:Musculoskeletal/Orthopaedics|Orthopaedics]]
[[Category:Outcome_Measures]]  
[[Category:Pain]]  
[[Category:Musculoskeletal/Orthopaedics]]
[[Category:Primary Contact]]
[[Category:Assessment]]
[[Category:Older People/Geriatrics]]
[[Category:Pain Screening Tools]]
[[Category:Older People/Geriatrics - Outcome Measures]]
[[Category:Older People/Geriatrics - Assessment and Examination]]
[[Category:Thoracic Spine - Outcome Measures]]
[[Category:Pain - Outcome Measures]]

Latest revision as of 10:32, 26 July 2023

Original Editor - Venus Pagare

Top Contributors - Venus Pagare, Tomer Yona, Kim Jackson, Evan Thomas, Claire Knott, Lauren Lopez, Lucinda hampton, Vanessa Rhule, Melissa Coetsee, 127.0.0.1 and WikiSysop

Purpose[edit | edit source]

The Numeric Pain Rating Scale (NPRS) (an outcome measure) that is a unidimensional measure of pain intensity in adults,[1][2][3] including those with chronic pain due to rheumatic diseases.[3][4] (man in pain, R)

Content[edit | edit source]

The NPRS is a segmented numeric version of the visual analog scale (VAS) in which a respondent selects a whole number (0–10 integers) that best reflects the intensity of his/her pain.[3]

  • The common format is a horizontal bar or line.
  • Similar to the VAS, the NPRS is anchored by terms describing pain severity extremes.[5]

Number of Items[edit | edit source]

Although various iterations exist, the most commonly used is the 11-item NPRS.[6]

Response Options/Scale[edit | edit source]

The 11-point numeric scale ranges from '0' representing one pain extreme (e.g. “no pain”) to '10' representing the other pain extreme (e.g. “pain as bad as you can imagine” or “worst pain imaginable”).[2][3]

NRS pain.jpg

Recall Period for Items[edit | edit source]

Recal varies, but respondents are most commonly asked to report pain intensity “in the last 24 hours” or an average pain intensity.[7]

Administration[edit | edit source]

The NPRS can be administered verbally (therefore also by telephone) or graphically for self-completion.[4] As mentioned above, the respondent is asked to indicate the numeric value on the segmented scale that best describes their pain intensity.[5]

Scoring and Interpretation[edit | edit source]

Scores range from 0-10 points, with higher scores indicating greater pain intensity.[5]

Merits and Demerits[edit | edit source]

  • The NPRS takes <1 minute to complete
  • The NPRS is easy to administer and score[4][8]
  • Minimal language translation difficulties supports the use of the NPRS across cultures and languages[9]
  • The NPRS is a valid and reliable scale to measure pain intensit [5]
  • Strengths of this measure over the VAS are the ability to be administered both verballyand in writing, as well as its simplicity of scoring[5]
  • One weakness is that the NPRS evaluates only 1 component of the pain experience and  intensity, and therefore does not capture the complexity and idiosyncratic nature of the pain experience or improvements due to symptom fluctuations.

Psychometric Information[edit | edit source]

Development[edit | edit source]

To improve discrimination for detecting relatively small changes, an NPRS comprised of numbers along a scale was used in a population of 100 patients with a variety of rheumatic diseases. Variations in pain descriptors used as anchors for end points on the NPRS have been reported in the literature. However, the methodology used to develop these various anchor terms is unknown.[10][11]

Acceptability[edit | edit source]

Chronic pain patients prefer the NPRS over other measures of pain intensity, including the VAS, due to comprehensibility and ease of completion.[12] However, focus groups of patients with chronic back pain and symptomatic hip and knee osteoarthritis (OA) have found that the NPRS is inadequate in capturing the complexity and idiosyncratic nature of the pain experience or improvements due to symptom fluctuations.[13][14]

Reliability[edit | edit source]

High test–retest reliability has been observed in both literate and illiterate patients with rheumatoid arthritis (r = 0.96 and 0.95, respectively) before and after medical consultation.[4]

Validity[edit | edit source]

For construct validity, the NPRS was shown to be highly correlated with the VAS in patients with rheumatic and other chronic pain conditions (pain>6 months): correlations range from 0.86 to 0.95.[4]

Minimal Clinically Important Difference (MCID)[edit | edit source]

In clinical trials of pregabalin (also known as Lyrica) for diabetic neuropathy, postherpetic neuralgia, chronic low back pain, fibromyalgia, and OA, analyses of the relationships between changes in NPRS scores and patient reports of overall improvement (measured using a standard 7-point patient Global Impression of Change), demonstrated a reduction of 2 points, or 30%, on the NPRS scores to be clinically important.[15] Similar results were found in low back pain patients when changes in NPRS scores were compared to patient improvements in pain after physical therapy using a 15-point Global Rating of Change scale.[16] In another study, the MCID was found to be 2 points in patients with shoulder pain.[17]

References[edit | edit source]

  1. ↑ Childs JD, Piva SR, Fritz JM. Responsiveness of the numeric pain rating scale in patients with low back pain. Spine 2005;30:1331–4.
  2. ↑ 2.0 2.1 Jensen MP, McFarland CA. Increasing the reliability and validity of pain intensity measurement in chronic pain patients. Pain 1993;55: 195–203.
  3. ↑ 3.0 3.1 3.2 3.3 Rodriguez CS. Pain measurement in the elderly: a review. Pain Manag Nurs 2001;2:38–46
  4. ↑ 4.0 4.1 4.2 4.3 4.4 Ferraz MB, Quaresma MR, Aquino LR, Atra E, Tugwell P, Goldsmith CH. Reliability of pain scales in the assessment of literate and illiterate patients with rheumatoid arthritis. J Rheumatol 1990;17:1022–4
  5. ↑ 5.0 5.1 5.2 5.3 5.4 HAWKER GA. Measures of Adult Pain. Arthritis Care & Research 2011; 63,S240–S252
  6. ↑ Williamson A. Pain: a review of three commonly used pain rating scales. ISSUES IN CLINICAL NURSING 2005; 14: 798–804
  7. ↑ Dworkin RH, Turk DC, Farrar JT, Haythornthwaite JA, Jensen MP, Katz NP, et al. Core outcome measures for chronic pain clinical trials: IMMPACT recommendations. Pain 2005;113:9–19.
  8. ↑ Jensen MP, Karoly P, O’Riordan EF, Bland F Jr, Burns RS. The subjective experience of acute pain. Clin J Pain 1989;5:153–9
  9. ↑ Langley GB, Sheppeard H. The visual analogue scale: its use in pain measurement. Rheumatol Int 1985;5:145–8.
  10. ↑ Downie WW, Leatham PA, Rhind VM, Wright V, Branco JA, Anderson JA. Studies with pain rating scales. Ann Rheum Dis 1978;37:378–81.
  11. ↑ Jensen MP, Karoly P, Braver S. The measurement of clinical pain intensity: a comparison of six methods. Pain 1986;27:117–26.
  12. ↑ De C Williams AC, Davies HT, Chadury Y. Simple pain rating scales hide complex idiosyncratic meanings. Pain 2000;85:457–63
  13. ↑ Hawker GA, Davis AM, French MR, Cibere J, Jordan JM, March L, et al. Development and preliminary psychometric testing of a new OA pain measure: an OARSI/OMERACT initiative. Osteoarthritis Cartilage 2008;16:409–14
  14. ↑ Hush JM, Refshauge KM, Sullivan G, De Souza L, McAuley JH. Do numerical rating scales and the Roland-Morris Disability Question-naire capture changes that are meaningful to patients with persistent back pain? Clin Rehabil 2010;24:648–57.
  15. ↑ Farrar JT, Young JP Jr, LaMoreaux L, Werth JL, Poole RM. Clinical importance of changes in chronic pain intensity measured on an 11-point numerical pain rating scale. Pain 2001;94:149–58.
  16. ↑ Childs JD, Piva SR, Fritz JM. Responsiveness of the numeric pain rating scale in patients with low back pain. Spine 2005;30:1331–4
  17. ↑ Michener LA, Snyder AR, Leggin BG. Responsiveness of the numeric pain rating scale in patients with shoulder pain and the effect of surgical status. Journal of sport rehabilitation. 2011 Feb 1;20(1):115.


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