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Assessment of Visual Analog versus Categorical Scale for Measurement of Osteoarthritis Pain

From the Division of Analgesic, Anti-inflammatory, and Ophthalmic Drug Products, Center for Drug Evaluation and Research, Food and Drug Administration (FDA), Rockville, Maryland.

There is disagreement in the literature regarding which scales to use in pain measurement. The difference has usually been between nonverbal scales, such as visual analog scales and verbal ones, which usually provide only a limited number of response categories. A 12-week, randomized, double-blind naproxen sodium (500 mg bid) and placebo-controlled trial using the hip osteoarthritis (OA) flare-up pain mode, in which pain was measured on both visual analog and categorical scales simultaneously, was analyzed. The authors found a good correlation (> 0.995) between the time-series average of the unconstrained visual analog scale and a 5-point categorical scale pain measurement in the osteoarthritis pain model in both active and placebo treatment arms. However, for individuals, there is a wide range of VAS responses for each categorical score, with overlaps between categories. The visual analog and categorical scales appear as effective in determining average osteoarthritis pain. However, a combined metric scale for pain measurement that provides the subject with multiple cues may improve communication and concordance between scales for individual pain determination.

Key Words: Visual analog • categorical • scale • pain

Address for reprints: Dr. Meyer Katzper, Division of Analgesic, Anti-inflammatory and Ophthalmic Drug Products, HFD-550, Center for Drug Evaluation and Research, Food and Drug Administration, 5600 Fisher's Lane, Rockville, MD 20857.

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				M. P. Couper, R. Tourangeau, F. G. Conrad, and E. Singer Evaluating the Effectiveness of Visual Analog Scales: A Web Experiment Social Science Computer Review, May 1, 2006; 24(2): 227 - 245. [Abstract] [PDF]