Several national and international pain management guidelines and professional organizations state that "pain assessment, pain measurement and pain documentation should be mandatory in all in-hospital patients".

In the Emergency Department, the most commonly used pain measurement tools are the Visual Analogue Scale (VAS) and the Numeric Rating Scale (NRS). Both scales are unidimensional and can only measure pain intensity. 

Visual Analogue Scale (VAS)

This is a continuous scale consisting of a bold line (horizontal or vertical), usually 10 cm in length (=100 mm) and anchored on both sides by the extremes of pain, described as: 'no pain' and 'worst imaginable pain' or 'pain as bad as it can be'. In between,

no numbers or verbal descriptors should be depicted. The patient puts a perpendicular line on the scale to record his or her pain intensity. Afterwards, the health care provider measures the pain intensity (usually in millimeters) corresponding with the mark, as set on the scale by the patient. 


Numeric Rating Scale (NRS)

The most commonly used NRS is the 11-item verbally administered NRS. Patients are asked to rate their pain with an integer on the scale of 0 to 10, in which 0 means 'no pain' and 10 means 'worst pain imaginable' or 'worst possible pain'. The NRS can also be administered visually, just like the VAS. 

Numeric Rating Scale or NRS


Both pain scoring tools have been validated for use in the Emergency Department. When doing so, several clinical questions might arise.

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