6/11/2023 0 Comments Numeric pain scale17 Although a majority of the population are able to count to 10 and perform simple calculations associated with money handling, patients frequently fail to understand and use pain scales such as NRS in clinical settings. Unlike in western societies where citizens are exposed to a variety of response scales as the part of day-to-day life (eg, online or paper feedback forms for customer feedback in banks and medical facilities), the population in Nepal is rarely exposed to or asked to complete such measures, due in part to the low literacy rates in Nepal. 2 Based on these findings, and in light of the fact that most research in this area have been performed in samples from western countries, it seems necessary to evaluate the psychometric properties of pain intensity measures in developing countries, before the NRS can be recommended over other scales for cross-cultural research. 33, 34, 47 In addition, one study of individuals from Ghana found that a colored circle pain scale was preferred over both the FPS and NRS. 11, 32 Studies performed in samples from the USA and Europe report a higher preference for the NRS, 15, 38 whereas the FPS or the FPS-R tend to be preferred by Turkish, and Chinese individuals. Pain perception and expression is influenced by culture and ethnicity as well. 28 Although studies report no differences in scale preference based on age, 21, 34, 43 the VAS is known to be more difficult to use than other scales, 23 especially among the elderly 12, 34, 38 and individuals with cognitive deficits. 9, 21, 46 There is also evidence that the NRS and VRS may not provide reliable measures of pain intensity in individuals from developing countries who have less than 7 years of education. 34, 38 For example, the VRS and the FPS-R (or the scale on which the FPS-R is based, the FPS 24) are often preferred over other measures, 33, 34, 43, 47 especially by individuals with lower education levels. 22, 34, 35 Moreover, there are inconsistencies in the way different individuals interpret measurement scales, 13 and the most useful measure may vary between populations as a function of age, literacy levels, and cultural background. However, there are concerns that such scales may also be influenced by, or assess, emotional reactions in addition to pain intensity. 14, 25, 31 Faces scales (ie, pain scales that illustrate different levels of pain intensity through different facial expressions), for example, were developed for use in children and people with low literacy levels. However, each scale has important strengths and weakness, and no one scale is recommended for use in all situations and with all patient groups. 4, 6– 8, 15, 16, 18, 31, 38, 39 Thus, it might be reasonable to conclude that the NRS should be the measure of choice in most settings. 29, 31 Consensus groups recommend using NRS for clinical research 12 given its strengths as found in research in samples of individuals from western countries. Pain intensity is commonly assessed using measures such as the Visual Analogue Scale (VAS), Numerical Rating Scale (NRS), Verbal Rating Scale (VRS), and Faces Pain Scale-Revised (FPS-R). 30 Thus, both average and worst pain remain important intensity domains to assess, and knowledge regarding the validity and utility of both is important. Although an individual's average pain is arguably the more important outcome domain to target in pain treatment, research comparing average and worst pain ratings indicate that worst pain is more strongly associated with disability. 34, 42 Different domains of pain intensity such as current pain intensity, 24-hour average pain intensity, worst pain, and least pain are assessed regularly in clinical practice and research studies. Pain intensity is a common outcome domain assessed in pain clinical trials 1, 14, 21, 25, 31, 34, 38, 45 and most often targeted in pain treatment.
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