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Open Access 01-12-2010 | Research

Comparison of numerical and verbal rating scales to measure pain exacerbations in patients with chronic cancer pain

Authors: Cinzia Brunelli, Ernesto Zecca, Cinzia Martini, Tiziana Campa, Elena Fagnoni, Michela Bagnasco, Luigi Lanata, Augusto Caraceni

Published in: Health and Quality of Life Outcomes | Issue 1/2010

Abstract

Background

Numerical rating scales (NRS), and verbal rating scales (VRS) showed to be reliable and valid tools for subjective cancer pain measurement, but no one of them consistently proved to be superior to the other. Aim of the present study is to compare NRS and VRS performance in assessing breakthrough or episodic pain (BP-EP) exacerbations.

Methods

In a cross sectional multicentre study carried out on a sample of 240 advanced cancer patients with pain, background pain and BP-EP intensity in the last 24 hours were measured using both a 6-point VRS and a 0-10 NRS. In order to evaluate the reproducibility of the two scales, a subsample of 60 patients was randomly selected and the questionnaire was administered for a second time three to four hours later. The proportion of "inconsistent" (background pain intensity higher than or equal to peak pain intensity) evaluations was calculated to compare the two scales capability in discriminating between background and peak pain intensity and Cohen's K was calculated to compare their reproducibility.

Results

NRS revealed higher discriminatory capability than VRS in distinguishing between background and peak pain intensity with a lower proportion of patients giving inconsistent evaluations (14% vs. 25%). NRS also showed higher reproducibility when measuring pain exacerbations (Cohen's K of 0.86 for NRS vs. 0.53 for VRS) while the reproducibility of the two scales in evaluating background pain was similar (Cohen's K of 0.80 vs. 0.77).

Conclusions

Our results suggest that, in the measurement of cancer pain exacerbations, patients use NRS more appropriately than VRS and as such NRS should be preferred to VRS in this patient's population.

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Dworkin RH, Turk DC, Farrar JT, Haythornthwaite JA, Jensen MP, Katz NP, Kerns RD, Stucki G, Allen RR, Bellamy N, Carr DB, Chandler J, Cowan P, Dionne R, Galer BS, Hertz S, Jadad AR, Kramer LD, Manning DC, Martin S, McCormick CG, McDermott MP, McGrath P, Quessy S, Rappaport BA, Robbins W, Robinson JP, Rothman M, Royal MA, Simon L, Stauffer JW, Stein W, Tollett J, Wernicke J, Witter J, IMMPACT: Core outcome measures for chronic pain clinical trials: IMMPACT recommendations. Pain 2005,113(1–2):9–19. 10.1016/j.pain.2004.09.012PubMedCrossRef

Turk DC, Dworkin RH, Burke LB, Gershon R, Rothman M, Scott J, Allen RR, Atkinson JH, Chandler J, Cleeland C, Cowan P, Dimitrova R, Dionne R, Farrar JT, Haythornthwaite JA, Hertz S, Jadad AR, Jensen MP, Kellstein D, Kerns RD, Manning DC, Martin S, Max MB, McDermott MP, McGrath P, Moulin DE, Nurmikko T, Quessy S, Raja S, Rappaport BA, Rauschkolb C, Robinson JP, Royal MA, Simon L, Stauffer JW, Stucki G, Tollett J, von Stein T, Wallace MS, Wernicke J, White RE, Williams AC, Witter J, Wyrwich KW, Initiative on Methods Measurement and Pain Assessment in Clinical Trials: Developing patient-reported outcome measures for pain clinical trials: IMMPACT recommendations. Pain 2006,125(3):208–215. 10.1016/j.pain.2006.09.028PubMedCrossRef

Caraceni A, Cherny N, Fainsinger R, Kaasa S, Poulain P, Radbruch L, De Conno F: Pain measurement tools and methods in clinical research in palliative care: recommendations of an Expert Working Group of the European Association of Palliative Care. J Pain Symptom Manage 2002,23(3):239–255. 10.1016/S0885-3924(01)00409-2PubMedCrossRef

Garcia SF, Cella D, Clauser SB, Flynn KE, Lad T, Lai JS, Reeve BB, Smith AW, Stone AA, Weinfurt K: Standardizing patient-reported outcomes assessment in cancer clinical trials: a patient-reported outcomes measurement information system initiative. J Clin Oncol 2007,25(32):5106–5112. 10.1200/JCO.2007.12.2341PubMedCrossRef

Gordon DB, Dahl JL, Miaskowski C, McCarberg B, Todd KH, Paice JA, Lipman AG, Bookbinder M, Sanders SH, Turk DC, Carr DB: American pain society recommendations for improving the quality of acute and cancer pain management: American Pain Society Quality of Care Task Force. Arch Intern Med 2005,165(14):1574–1580. 10.1001/archinte.165.14.1574PubMedCrossRef

Kaasa S, Loge JH, Fayers P, Caraceni A, Strasser F, Hjermstad MJ, Higginson I, Radbruch L, Haugen DF: Symptom assessment in palliative care: a need for international collaboration. J Clin Oncol 2008,26(23):3867–3873. 10.1200/JCO.2007.15.8881PubMedCrossRef

Hjermstad MJ, Gibbins J, Haugen DF, Caraceni A, Loge JH, Kaasa S, EPCRC, European Palliative Care Research Collaborative: Pain assessment tools in palliative care: an urgent need for consensus. Palliat Med 2008,22(8):895–903. 10.1177/0269216308095701PubMedCrossRef

Holen JC, Hjermstad MJ, Loge JH, Fayers PM, Caraceni A, De Conno F, Forbes K, Furst CJ, Radbruch L, Kaasa S: Pain assessment tools: is the content appropriate for use in palliative care? J Pain Symptom Manage 2006,32(6):567–580. 10.1016/j.jpainsymman.2006.05.025PubMedCrossRef

Ohnhaus EE, Adler R: Methodological problems in the measurement of pain: a comparison between the verbal rating scale and the visual analogue scale. Pain 1975,1(4):379–384. 10.1016/0304-3959(75)90075-5PubMedCrossRef

10.

Kremer E, Atkinson JH, Ignelzi RJ: Measurement of pain: patient preference does not confound pain measurement. Pain 1981,10(2):241–248. 10.1016/0304-3959(81)90199-8PubMedCrossRef

11.

Jensen MP, Karoly P, Braver S: The measurement of clinical pain intensity: a comparison of six methods. Pain 1986,27(1):117–126. 10.1016/0304-3959(86)90228-9PubMedCrossRef

12.

Jensen MP, Karoly P: Self-report scales and procedures for assessing pain in adults. Handbook of pain assessment 2001, 2: 15–34.

13.

De Conno F, Caraceni A, Gamba A, Mariani L, Abbattista A, Brunelli C, La Mura A, Ventafridda V: Pain measurement in cancer patients: a comparison of six methods. Pain 1994,57(2):161–166. 10.1016/0304-3959(94)90219-4PubMedCrossRef

14.

Briggs M, Closs JS: A descriptive study of the use of visual analogue scales and verbal rating scales for the assessment of postoperative pain in orthopedic patients. J Pain Symptom Manage 1999,18(6):438–446. 10.1016/S0885-3924(99)00092-5PubMedCrossRef

15.

Breivik EK, Bjornsson GA, Skovlund E: A comparison of pain rating scales by sampling from clinical trial data. Clin J Pain 2000,16(1):22–28. 10.1097/00002508-200003000-00005PubMedCrossRef

16.

Radbruch L, Sabatowski R, Loick G, Jonen-Thielemann I, Kasper M, Gondek B, Lehmann KA, Thielemann I: Cognitive impairment and its influence on pain and symptom assessment in a palliative care unit: development of a Minimal Documentation System. Palliat Med 2000,14(4):266–276. 10.1191/026921600672986600PubMedCrossRef

17.

Lara-Munoz C, De Leon SP, Feinstein AR, Puente A, Wells CK: Comparison of three rating scales for measuring subjective phenomena in clinical research. I. Use of experimentally controlled auditory stimuli. Arch Med Res 2004,35(1):43–48. 10.1016/j.arcmed.2003.07.007PubMedCrossRef

18.

Hartrick CT, Kovan JP, Shapiro S: The numeric rating scale for clinical pain measurement: a ratio measure? Pain Pract 2003,3(4):310–316. 10.1111/j.1530-7085.2003.03034.xPubMedCrossRef

19.

Lund I, Lundeberg T, Sandberg L, Budh CN, Kowalski J, Svensson E: Lack of interchangeability between visual analogue and verbal rating pain scales: a cross sectional description of pain etiology groups. BMC Med Res Methodol 2005, 5: 31. 10.1186/1471-2288-5-31PubMedCentralPubMedCrossRef

20.

Gagliese L: Assessment of pain in elderly people. Handbook of pain assessment 2001, 7: 119–133.

21.

Walsh D: Practical problems in pain measurements. Pain 1984,19(1):96–98. 10.1016/0304-3959(84)90070-8CrossRef

22.

Jensen MP, Turner JA, Romano JM: What is the maximum number of levels needed in pain intensity measurement? Pain 1994,58(3):387–392. 10.1016/0304-3959(94)90133-3PubMedCrossRef

23.

Caraceni A, Mendoza TR, Mencaglia E, Baratella C, Edwards K, Forjaz MJ, Martini C, Serlin RC, de Conno F, Cleeland CS: A validation study of an Italian version of the Brief Pain Inventory (Breve Questionario per la Valutazione del Dolore). Pain 1996,65(1):87–92. 10.1016/0304-3959(95)00156-5PubMedCrossRef

24.

Bonett DG: Sample size requirements for estimating intraclass correlations with desired precision. Stat Med 2002,21(9):1331–1335. 10.1002/sim.1108PubMedCrossRef

25.

Landis JR, Koch GG: The measurement of observer agreement for categorical data. Biometrics 1977,33(1):159–174. 10.2307/2529310PubMedCrossRef

26.

Peters ML, Patijn J, Lame I: Pain assessment in younger and older pain patients: psychometric properties and patient preference of five commonly used measures of pain intensity. Pain Med 2007,8(7):601–610. 10.1111/j.1526-4637.2007.00311.xPubMedCrossRef

27.

Collins SL, Moore RA, McQuay HJ: The visual analogue pain intensity scale: what is moderate pain in millimetres? Pain 1997,72(1–2):95–97. 10.1016/S0304-3959(97)00005-5PubMedCrossRef

28.

Paul SM, Zelman DC, Smith M, Miaskowski C: Categorizing the severity of cancer pain: further exploration of the establishment of cutpoints. Pain 2005,113(1–2):37–44. 10.1016/j.pain.2004.09.014PubMedCrossRef

29.

Serlin RC, Mendoza TR, Nakamura Y, Edwards KR, Cleeland CS: When is cancer pain mild, moderate or severe? Grading pain severity by its interference with function. Pain 1995,61(2):277–284. 10.1016/0304-3959(94)00178-HPubMedCrossRef

30.

Rosier EM, Iadarola MJ, Coghill RC: Reproducibility of pain measurement and pain perception. Pain 2002,98(1–2):205–216. 10.1016/S0304-3959(02)00048-9PubMedCrossRef

31.

Cleeland CS, Ryan KM: Pain assessment: global use of the Brief Pain Inventory. Ann Acad Med Singapore 1994,23(2):129–138.PubMed

32.

Jensen MP: The validity and reliability of pain measures in adults with cancer. J Pain 2003,4(1):2–21. 10.1054/jpai.2003.1PubMedCrossRef

33.

Caraceni A, Galbiati A, Brunelli C, Gorni G, Martini C, Zecca E, De Conno F: Cancer patient compliance in the self-administration of a pain assessment tool. J Pain Symptom Manage 2004,27(5):417–424. 10.1016/j.jpainsymman.2004.01.002PubMedCrossRef

34.

Herr KA, Spratt K, Mobily PR, Richardson G: Pain intensity assessment in older adults: use of experimental pain to compare psychometric properties and usability of selected pain scales with younger adults. Clin J Pain 2004,20(4):207–219. 10.1097/00002508-200407000-00002PubMedCrossRef

35.

Ponce de Leon S, Lara-Munoz C, Feinstein AR, Wells CK: A comparison of three rating scales for measuring subjective phenomena in clinical research. II. Use of experimentally controlled visual stimuli. Arch Med Res 2004,35(2):157–162.PubMedCrossRef

36.

Price DD, Bush FM, Long S, Harkins SW: A comparison of pain measurement characteristics of mechanical visual analogue and simple numerical rating scales. Pain 1994,56(2):217–226. 10.1016/0304-3959(94)90097-3PubMedCrossRef

37.

Zelman DC, Dukes E, Brandenburg N, Bostrom A, Gore M: Identification of cut-points for mild, moderate and severe pain due to diabetic peripheral neuropathy. Pain 2005,115(1–2):29–36. 10.1016/j.pain.2005.01.028PubMedCrossRef

38.

Cepeda MS, Africano JM, Polo R, Alcala R, Carr DB: Agreement between percentage pain reductions calculated from numeric rating scores of pain intensity and those reported by patients with acute or cancer pain. Pain 2003,106(3):439–442. 10.1016/j.pain.2003.09.006PubMedCrossRef

39.

Gracely RH, McGrath F, Dubner R: Ratio scales of sensory and affective verbal pain descriptors. Pain 1978,5(1):5–18. 10.1016/0304-3959(78)90020-9PubMedCrossRef

Title: Comparison of numerical and verbal rating scales to measure pain exacerbations in patients with chronic cancer pain
Authors: Cinzia Brunelli
Ernesto Zecca
Cinzia Martini
Tiziana Campa
Elena Fagnoni
Michela Bagnasco
Luigi Lanata
Augusto Caraceni
Publication date: 01-12-2010
Publisher: BioMed Central
Published in: Health and Quality of Life Outcomes / Issue 1/2010
Electronic ISSN: 1477-7525
DOI: https://doi.org/10.1186/1477-7525-8-42

At a glance: The STEP trials

Springer Medicine

Comparison of numerical and verbal rating scales to measure pain exacerbations in patients with chronic cancer pain

Abstract

Background

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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