Concordance Among Different Pain Scales in Patients with Dental Pain

Aims: To evaluate the concordance among different pain scales for evaluation of pain in toothache patients and to assess the influence of oral health on the quality of life of those patients. Methods: Ninety-two patients seeking treatment for toothache were evaluated before and after treatment. At baseline and 1 week after the dental treatment, the patients were requested to fill out the Oral Health Impact Profile Inventory (OHIP-14) as well as the following pain scales: the visual analog scale (VAS), numeric scale (NS), verbal rating scale (VRS), and Faces Pain Scale-Revised (FPS-R). The data were analyzed by Pearson correlation, Student t test, and analysis of variance for repeated measurements, with a significance level of 5%. Results: Patients were, on average, 34.4 years old. The sample was composed of 50 women and 42 men. Fifty-eight patients had dental pain of pulpal origin, and 34 had pain of periodontal origin. The mean OHIP score was 20.83 at baseline and 5.0 at 1 week after the completion of the dental treatment. The mean values of the scales at baseline were 50.7 mm, 56.7 mm, 52.2 mm, and 52.9 mm for the VAS, NS, VRS, and FPS-R, respectively. One week after the treatment, these values were 7.5 mm, 9.4 mm, 10.9 mm, and 8.7 mm. A positive correlation was detected between all four scales at baseline and also 1 week after the treatment (P < .05). At baseline, the NS was significantly different from the other scales. This difference, however, was not detected at the end of the trial. Conclusion: All scales were able to detect differences in the pain reported after dental treatment and may be valid and reliable for use in clinical dental practice. The NS, however, returns higher scores at baseline when assessing the pain.

pain assessment; pain intensity; pain scale; quality of life; toothache

1. Lipton JA, Ship JA, Larach-Robinson D. Estimated prevalence and distribution of reported orofacial pain in the United States. J Am Dent Assoc 1993;124:115–121.

2. Seymour RA, Charlton JE, Phillips ME. An evaluation of dental pain using visual analogue scales and the McGill pain questionnaire. J Oral Maxillofac Surg 1983;41:643–648.

3. Raspe H, Kohlmann T. Disorders characterised by pain: A methodological review of population surveys. J Epidemiol Community Health 1994;48:531–537.

4. 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.

5. Oliveira BH, Nadanovsky P. Psychometric properties of the Brazilian version of the oral health impact profile–short form. Community Dent Oral Epidemiol 2005;33:307–314.

6. Mariño R, Schofield M, Wright C, Calache H, Minichiello

V. Self-reported and clinically determined oral health status predictors for quality of life in dentate older migrant adults. Community Dent Oral Epidemiol 2008;36:85–94.

7. Slade GD. Derivation and validation of a short-form oral health impact profile. Community Dent Oral Epidemiol 1997;25:284–290.

8. Allen PF, McMillan AS, Locker D. An assessment of sensitivity to change of the oral health impact profile in a clinical trial. Community Dent Oral Epidemiol 2001;29:175–182.

9. Zheng J, McMillan AS, Wong MC, Luo Y, Lam CL. Investigation of factors associated with treatment-seeking in southern Chinese with orofacial pain. J Orofac Pain 2010;24:181–188.

10. Giske L, Sandvik L, Røe C. Comparison of daily and weekly retrospectively reported pain intensity in patients with localized and generalized musculoskeletal pain. Eur J Pain 2010;14:959–965.

11. Huber A, Suman AL, Rendo CA, Biasi G, Marcolongo R, Carli G. Dimensions of “unidimensional” ratings of pain and emotions in patients with chronic musculoskeletal pain. Pain 2007;130:216–224.

12. Conti PC, de Azevedo LR, de Souza NV, Ferreira FV. Pain measurement in TMD patients: Evaluation of precision and sensitivity of different scales. J Oral Rehabil 2001;28: 534–539.

13. Downie WW, Leatham PA, Rhind VM, Wright V, Branco JA, Anderson JA. Studies with pain rating scales. Ann Rheum Dis 1978;37:378–381.

14. Williamson A, Hoggart B. Pain: A review of three commonly used pain rating scales. J Clin Nurs 2005;14:798–804.

15. Lara-Muñoz 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;35:43–48.

16. Ponce de Leon S, Lara-Muñoz 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;35:157–162.

17. Breivik EK, Björnsson GA, Skovlund E. A comparison of pain rating scales by sampling from clinical trial data. Clin J Pain 2000;16:22–28.

18. Hjermstad MJ, Fayers PM, Haugen DF, et al. Studies comparing numerical rating scales, verbal rating scales, and visual analogue scales for assessment of pain intensity in adults: A systematic literature review. J Pain Symptom Manage 2011;41:1073–1093.

19. Holdgate A, Asha S, Craig J, Thompson J. Comparison of a verbal numeric rating scale with the visual analogue scale for the measurement of acute pain. Emerg Med (Fremantle) 2003;15:441–446.

20. Clark P, Lavielle P, Martínez H. Learning from pain scales: Patient perspective. J Rheumatol 2003;30:1584–1588.

21. Miró J, Huguet A, Nieto R, Paredes S, Baos J. Evaluation of reliability, validity, and preference for a pain intensity scale for use with the elderly. J Pain 2005;6:727–735.

22. Ware LJ, Epps CD, Herr K, Packard A. Evaluation of the revised faces pain scale, verbal descriptor scale, numeric rating scale, and Iowa pain thermometer in older minority adults. Pain Manag Nurs 2006;7:117–125.

23. 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;1:379–384.

24. Jensen MP, Turner JA, Romano JM. What is the maximum number of levels needed in pain intensity measurement? Pain 1994;58:387–392.

25. Jamison RN, Gracely RH, Raymond SA, et al. Comparative study of electronic vs paper VAS ratings: A randomized, crossover trial using healthy volunteers. Pain 2002;99:341–347.

26. Svensson E. Concordance between ratings using different scales for the same variable. Stat Med 2000;19:3483–3496.

27. Luo Y, McMillan AS, Wong MC, Zheng J, Lam CL. Orofacial pain conditions and impact on quality of life in community-dwelling elderly people in Hong Kong. J Orofac Pain 2007;21:63–71.

28. Zheng J, Wong MC, Lam CL. Key factors associated with oral health-related quality of life (OHRQOL) in Hong Kong Chinese adults with orofacial pain. J Dent 2011;39:564–571.

29. Barros Vde M, Seraidarian PI, Côrtes MI, de Paula LV. The impact of orofacial pain on the quality of life of patients with temporomandibular disorder. J Orofac Pain 2009;23:28–37.

30. Reissmann DR, John MT, Schierz O, Wassell RW. Functional and psychosocial impact related to specific temporomandibular disorder diagnoses. J Dent 2007;35:643–650.

31. John MT, Reissmann DR, Schierz O, Wassell RW. Oral health-related quality of life in patients with temporomandibular disorders. J Orofac Pain 2007;21:46–54.