SCORING SYSTEMS IN PAIN
DR.SAIRAH SADAF
CONTENT
• QUANTIFY PAIN INTENSITY/ SEVERITY
• QUALITY OF PAIN
QUANTIFY PAIN SEVERITY
1) Uni-dimensional 2) Multi-dimensional
– Verbal Rating scale (VRS) – McGill pain Questionnaire (MPQ)
– Binary scale – Brief pain inventory (BPI)
– Numerical rating scale (NRS) – Medical outcome study 36-item
– Faces rating scale short form (SF-36) health survey
– Visual analog scale (VAS)
Uni-dimensional Tools
Verbal Rating scale (VRS) Binary scale
• pain is described as none, mild, • Do you have a 60% relieve in your
moderate, or severe. pain? "Yes or No".
• Pros: • Pros:
– Short – Short
– Easy to understand – Easy to understand
• Cons: • Cons:
– Not helpful in Research – Not helpful in Research
Uni-dimensional Tools
Numerical rating scale (NRS) Faces rating scale
• has a numerical scale between "no pain" • The patient is asked to point at various
and "worst pain imaginable". facial expressions ranging from a smiling
• The two extreme experiences of the pain is face (no pain) to an extremely unhappy one
noted (the worst possible pain).
• "Zero" corresponds to no pain and "10"
corresponds to the worst pain imaginable
• A reduction of 30% or 2 points and more
from baseline in patient's treatment
indicates a positive response for treatment.
Visual analog scale (VAS)
•A straight line, typically 10 cm (or 100 mm) long, is presented to the patient.
•One end represents "no pain" or "none at all".
•The other end represents the "worst possible pain" or "extreme pain
•patient marks a point on the line
•examiner measures the distance in centimeters (or millimeters) from the "no pain" end to the
patient's mark
McGill pain Questionnaire (MPQ)
• It’s a checklist of words describing symptoms.
• it attempts to define the pain in 3 major dimensions by 20 sets of descriptive
words divided as:
– 10 sets describe sensory-discriminative (nociceptive pathway).
– 5 sets describe motivational-affective (reticular and limbic structures).
– 1 set describes cognitive-evaluative (cerebral cortex).
– 4 sets describe miscellaneous dimensions
Short-form McGill Pain Questionnaire (SF-MPQ)
• This version, which takes 2–5 minutes to complete, consists of three sections:
• 15 descriptive words. Possible score range: 0–45
• Patients use a 4-point intensity scale (0 = none, 1 = mild, 2 = moderate, 3 =
severe) to rate descriptors from two pain dimensions:
– Sensory (11 words): Describes the qualities of pain. Possible score range: 0–33
– Affective (4 words): Describes the emotional impact of pain. Possible score
range: 0–12
– PPI stands for Present Pain Intensity. It is a verbal rating scale that asks
patients to select a word
QUALITY OF PAIN
• Leeds assessment of neuropathic symptoms and sign (LANSS)
• Neuropathic pain Questionnaire (NPQ)
• Douleur neuropathique en 4 (DN4 questions)
• Pain Detect
• Pain ID
Leeds assessment of neuropathic symptoms and sign
(LANSS)
•Two components
•5 symptoms addressing pain quality
and triggers
•Second is sensory testing which
consists of 2 signs
•Sensitivity and specificity ranging
from 82 to 91 % and 80 to 94%
respectively.
•Score <12/24 indicates that the pain
is unlikely to be neuropathic in origin
and score 2..12/24 indicates that the
pain is likely to be neuropathic in
origin
•It is a self-questionnaire consisting of 12 items: 10 related to sensations and 2 related to affect
•Each item is scored on a scale of O ( no pain) to 100 (worst possible pain).
•The sensitivity and specificity have been reported to be 66-75% respectively
•It consists of 7 items related to symptoms and 3 items related to physical examination
•Each item is scored 1 (yes) or 0 (no) and sum of all ten items is taken as total score with a score
of > or equal to 4 as neuropathic pain.
•The sensitivity and specificity of 83 and 90% have been reported
•Self report questionnaire consisting
of 9 items: 7 sensory descriptors and
2 related to spatial (radiating) and
temporal characteristics
•The sensory descriptors are scored
on a scale of 0 (no) to 5 (very
strongly)
•Radiating pain as 1 (yes) or 0 (no).
•Score of >19 indicates neuropathic
pain likely and < 12 neuropathic pain
unlikely.
•It is a self questionnaire consisting of 5 sensory descriptors and 1 item regarding pain
located in the joints
•Scoring is from -1 to 5
•Higher scores indicating neuropathic pain
