Page 90 Guide to Pain Management in Low-Resource Settings

78 Richard A. Powell et al.

Adult pain intensity scales

Scale Advantages Disadvantages
Cognitively Unimpaired
(i) Visual analogue scale Th e tool is quick and simple to administer, Th e tool is highly sensitive to changes
is easy to score and compare to previ- in pain levels, which can hinder its use.
ous ratings, is easily translated into other Some adults can fi nd the tool too abstract
languages, has been validated extensively, to understand, especially among patients
and is considered one of the best tools for with cognitive dysfunction, non-English-
assessing variations in pain intensity. speaking patients, postoperative patients
(whose levels of consciousness and atten-
tion may be altered after receiving general
anesthesia or certain analgesics), and
patients with physical disability such as
reduced visual acuity or manual dexterity
(the health practitioner marking the scale
can introduce bias).
(ii) Numeric rating scale Th e tool is quick and simple to use, and it Some patients are unable to complete the
is easy to score and document the results tool with only verbal instructions. Conse-
and compare with previous ratings. Th e quently, there is decreased reliability at the
tool is well validated, can be translated age extremes and with nonverbal patients
into other languages, and can be used to and the cognitively impaired.
detect treatment eff ects.
It is easy to teach patients its correct use.
Unlike the VAS, the scale can be ad-
ministered verbally, thereby overcoming
problems for those with physical or visual
impairments and enabling those who are
physically and visually disabled to quantify
their pain intensity over the telephone.
(iii) Verbal descriptor scale Th e tool is quick and simple to use, easily Based on the use of language to describe
comprehended, well validated and sensi- pain, the tool depends upon a person’s
tive to treatment eff ects, and intuitively interpretation and understanding of the
preferred by some patients instead of descriptors; which can prove to be a
attempting to express their pain intensity challenge in diff erent cultures. Th e tool is
numerically. problematic for use among the very young
or old, the cognitively impaired, and the
illiterate.
(iv) APCA African Palliative Th e tool is quick and simple to use, and Th is tool, which only addresses pain as
Outcome Scale provides three scales in one (i.e. numbers, a single domain in addition to others af-
words, and the physical hand). fecting a patient’s life, requires a degree of
staff training to ensure its consistent ap-
plication. Additional research is ongoing
to validate the tool in diff erent popula-
tions and settings.
Cognitively Impaired
(v) Pain Assessment in Advanced Th is tool is useful among adults who are Relies upon proxy indicators of pain
Dementia Scale unable to report pain; it is quick to use rather than verbal self-reporting.
and easily reproducible.

Note: Th e table above draws on McLaff erty and Farley (2008).