Providers’ Perspectives on Measurement Indices for Pain Intensity

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The goal of the study was to assess whether certain aspects of pain intensity other than ‘average’ pain could be perceived as useful to healthcare providers.

Nearly all healthcare providers use the 10 point visual analog and numeric rating scales to measure pain intensity in patients with chronic pain, despite concerns regarding their use, according to study findings published in Frontiers in Pain Research. The study investigators found that the use of a pain index, combined with assessment of timing, functionality, and disability, may help clinicians better understand patients’ perceptions of ‘high pain,’ the impact pain has on patients’ lives and how pain responds to therapy.

According to the researchers, the goal of the study was to assess whether certain aspects of pain intensity other than ‘average’ pain could be perceived as useful to healthcare providers. To investigate this objective, the researchers conducted semi-structured telephone interviews of 20 US healthcare providers who manage patients with chronic pain.

In the qualitative interview, researchers asked open ended questions to assess clinicians’ perspectives on pain measurement. The interviews included quantitative ratings of the importance of 7 pain indices, including average pain, worst pain, least pain, time in no/low pain, time in high pain, fluctuating pain, and unpredictable pain.

Interviewed providers included medical doctors (n=15), nurse practitioners (n=2), a physician assistant (n=1), a PhD psychologist (n=1), and a PhD pharmacologist/toxicologist (n=1). The mean age of the sample was 43.8 years, and the mean years in practice was 14 years (range, 1-30 years).

Nearly all providers asked their patients to rate their level of pain on a 10 point visual analog or numeric rating scale; however, several providers cited issues with this strategy. For instance, some providers noted that some patients rated their pain level consistently at a high level over time, even if other indicators (eg, increased function) have suggested their pain had improved.

Healthcare providers most commonly asked their patients with chronic pain about ‘average’ pain, but these providers also reported concerns about the index’s informational value and patient reporting. There were some healthcare providers who supplemented ‘average’ with ‘worst’ and ‘least’ pain, and almost all providers perceived pain intensity as better understood “within the context of patient functioning.”

The rating of ‘worst’ pain received the highest mean importance rating (7.60), followed by ’time in high’ pain (6.95), ‘least’ pain (6.90), ‘fluctuating’ pain (6.58), ‘time in no’ pain/’low’ pain (5.75), ‘average’ pain (5.65), and ‘unpredictable’ pain (5.20). Post-hoc pairwise comparisons demonstrated that ‘worst’ pain was rated more important than ‘time in no’/’low’ pain (P =.040) and ‘unpredictable’ pain (P =.01). ‘Least’ pain and ‘fluctuating’ pain were also rated significantly more important than ‘unpredictable’ pain (P =.040 and P =.048, respectively).

Most providers used pain indices, regardless of preference, to identify how pain has changed over time as well as how pain changed in response to therapy.

Limitations of this study were the small number of healthcare providers as well as the inclusion of mostly medical doctors, which may limit the generalizability of the findings.

“Provider preferences are just 1 important aspect in a comprehensive effort to identify the relevance of alternative pain intensity measures,” the study authors stated.


Goldman RE, Broderick JE, Junghaenel DU, et al. Beyond average: Providers’ assessments of indices for measuring pain intensity in patients with chronic pain. Front Pain Res. Published online August 12, 2021. doi:10.3389/fpain.2021.692567