The Verbal Rating Scale: How Do Patients Actually Interpret This Pain Scale?

Close up of a doctor doing a medical exam while both him and the patient are wearing protective masks
Researchers sought to explore how inpatients understand and utilize the Verbal Rating Scale in a hospital setting.

An interview-based study found that inpatients explained their pain in idiosyncratic ways which likely leads to loss of clinical information. These findings were published in Frontiers in Pain Research.

Inpatients (N=45) at a central hospital in London participated in semi-structured interviews. The interviews aimed at assessing how the patients understood the Verbal Rating Scale (VRS) and which aspects of their pain they considered when rating pain. In addition, they were asked about emotional impacts from pain, how they coped with their pain, and were asked how they would communicate information about their pain to hospital staff.

Most participants were women (n=35), they were aged mean 50 (range, 19-81) years, they had been experiencing pain for a median of 6 years (range, 1 day-40 years), and patients were recruited from orthopedics (47%), gastroenterology (31%), oncology (16%), and surgery (7%).

Use of the VRS varied across 3 main areas: how pain was anchored, relationship with analgesics, and relationship with staff.

Within each area, patients described 3-5 themes or subthemes, indicating that although VRS areas were semantically similar among patients, there were idiosyncratic differences. Some patients considered pain impacting physical functioning and others thought about pain tolerance levels.

In general, a patient’s relationship with analgesics played a key role in communication and whether they had a positive or negative experience with staff. In fact, a large proportion of interviews was spent talking about analgesics even though the interview protocol only included 1 question about pain medications.

A total of 29 patients chose to modify the VRS. Overall, each patient created a unique pain scale, in which some added their own categories, some completely changed the categories, and some made large structural changes to the scale.

This study was limited by the fact that interviews were conducted bedside in open wards with no privacy or confidentiality, so some sensitive issues may not have been captured.

The researchers concluded that reporting pain to clinicians was a complex decision process which considered unidimensional pain scales and comparison with previous personal experience. Many patients incorporated their capacity to endure pain, but, that capacity was fluid and varied among individuals. Emotional needs were important factors, and many spoke about the emotional consequences of pain.

“These results have implications for staff training in using the pain scale and interpreting scores, and in involving patients in this process,” the researchers stated. “Pain scale ratings should not be assumed to represent simple pain intensity and need further investigation in setting such as this where they are widely used for monitoring care.”


Bosdet L, Herron K, Williams ACdeC. Exploration of Hospital Inpatients’ Use of the Verbal Rating Scale of Pain. Front Pain Res. Published online August 18, 2021. doi:10.3389/fpain.2021.723520