You are leaving Medscape Education
Cancel Continue
Log in to save activities Your saved activities will show here so that you can easily access them whenever you're ready. Log in here CME & Education Log in to keep track of your credits.

Box 1.  

The Visual Analogue Scale and Graphic Rating Scale

Box 2.  

The Verbal Rating Scale

Box 3.  

The Numeric Rating Scale

Box 4.  

Key Psychometric Properties Of Outcome Instruments: the Basics

Box 5.  

Core Outcome Measures Complementing the Assessment of Pain Intensity in Low Back Pain.

Pain Measurement in Patients With Low Back Pain

Authors: Anne F. Mannion, MD ; Federico Balagué, MD ; Ferran Pellisé, MD ; Christine Cedraschi, MDFaculty and Disclosures


Summary and Introduction


Pain is a multidimensional experience that is a prominent feature of many musculoskeletal disorders. Despite its subjective nature, pain is a highly relevant complaint; hence, nothing should deter physicians from attempting to formally assess it. This Review summarizes the main aspects of pain measurement from a practical standpoint, with a specific focus on low back pain. On balance, for the assessment of pain intensity, categorical scales with verbal descriptors or numerical rating scales seem to be preferable to traditional visual analogue scales, although no single best measure can be recommended. Pain per se should be assessed, rather than surrogate measures such as analgesic use. Back and leg pain should be evaluated separately in patients in whom these conditions coexist. For assessing change, prospective measurements are preferable to retrospective reports. Pain is not synonymous with function or quality of life, and other tools covering these important outcome dimensions should complement the assessment of pain, especially in patients with chronic symptoms. Clinicians should be aware of the psychometric properties of the tool to be used, including its level of imprecision (random measurement error) and its minimum clinically important difference (score difference indicating meaningful change in clinical status).


Pain is a major cause of morbidity, with the low back being one of the most common locations of symptoms. Low back pain (LBP) has a considerable impact on both the individual sufferer and society at large. The accurate assessment of pain is a prerequisite for its effective management,[1] yet the systematic quantification of this common symptom is rare in clinical practice.[2] It is difficult for the busy clinician to keep abreast of the continually emerging scientific literature on pain assessment; the intention of this article is to provide a clear and practical overview of the current information. This Review is not exhaustive, but it is based on an extensive search of the literature and the knowledge and experience of a multidisciplinary group of authors. We aim to provide recommendations for daily clinical practice. The main focus of this Review is LBP, but many of the principles discussed and tools recommended are applicable to other musculoskeletal conditions.

  • Print