Table 1.
Characteristics of included studies. BNS, box numerical rating scale; CAS, coloured analogue scale; CCPS, colour circle pain scale; ENT, ear, nose and throat; FPS, face pain scale; ICU, intensive care unit; MPQ, McGill pain questionnaire; M-VRS, modified verbal rating scale with 11 description of pain intensity; NR, not reported; NRS, numerical rating scale; OPS, objective pain score; PCA, patient controlled analgesia; PPI, present pain intensity; PROM/s, patient-reported outcome measures; RWS, red wedge scale; sd, standard deviation; THA, total hip arthroplasty; TKA, total knee arthroplasty; VAS-R, visual analogue scale at rest; VAS-M; visual analogue scale at movement; VDS, verbal descriptor scale; VPS, 11-point verbal scale; VRS∗∗, 4-point verbal rating scale; VRS-5, 5-point verbal rating scale; VRS-P; verbal rating scale for pain relief.
| First author, year (country) | PROM/s | Study design | Surgical procedure | Outcome(s) | High anchor∗ | Main exclusion criteria | Patient characteristics |
|
|---|---|---|---|---|---|---|---|---|
| n (Female%) | Age (yr) Mean (sd) [range] |
|||||||
| Van Dijk, 201513 (The Netherlands) | NRS | Cross-sectional design | Orthopaedic, ENT, gynaecological, cardiothoracic, Others | Ability to detect desire for analgesics | Worst pain imaginable | ICU patients, not proficient in Dutch or English, ambulatory surgery | 1084 (48) | 53 [18–90] |
| Banos, 198934 (Spain) | VAS VRS-5 |
Descriptive correlational design | Abdominal, orthopaedic, gynaecological | Convergent validity | 10 Unbearable pain |
NR | 212 (50) | <30=43 31–50=69 >50=107 |
| Akinpelu, 200230 (Nigeria) | VAS M-VRS BNS |
Cross-sectional design | Caesarean section | Convergent validity | Worst pain Worst imaginable Worst pain |
Complications, illness unconscious | 35 (100) | 31 (5) |
| Briggs, 199935 (UK) | VAS VRS∗∗ |
Secondary analysis of RCT | Orthopaedic | Convergent validity Feasibility |
Number 100 Severe pain at rest and movement |
NR | 417 (45) | 47 (20)∗ 64 (17) |
| Fadaizadeh, 200939 (Iran) | VAS FPS |
Cross-sectional design | General, gynaecological | Convergent validity | 10 Agonised |
History of substance abuse, unconscious | 82 (72) 34 GS 48 GYN |
32 (14) GYN 27 (7) GS 38 (18) |
| Deloach, 199838 (USA) | VAS VPS |
Descriptive correlational design | Various type of surgeries | Convergent validity | Worst imaginable Horrible pain |
NR | NR | NR |
| Pesonen, 200851 (Finland) | VAS VRS-5 RWS FPS-7 |
Descriptive correlational design | Cardiac surgery: elective CABG, valvular repair | Feasibility | Worst possible pain Unbearable pain Worst possible pain Worst possible pain |
Dementia, cognitive impairment | 160 FPS 80 (36) RWS 80 (44) |
73 (5) |
| Aubrun, 200332 (France) | VAS NRS VRS Behavioural scale |
Prospective observational design | Orthopaedic, abdominal, gynaecological, others | Feasibility | Worst imaginable pain Worst imaginable pain Severe NR |
NR | 600 (47) | 51 (17) |
| Myles, 199949 (Australia) | VAS | Clinical study | General, orthopaedic, ENT, faciomaxillary, cardiothoracic | Interpretability | 100 worst pain ever | Severe pain, inability to complete the VAS | 52 (40) | 42 (15) |
| Myles, 200550 (Australia) | VAS | Clinical study | General, orthopaedic, ENT, faciomaxillary, cardiothoracic | Interpretability | 100 worst pain ever | Postoperative delirium Frailty, visual impairment |
22 (NR) | 33 (17) |
| Jensen, 200344 (USA) | VAS VRS-4 VRS-P |
Secondary analysis of RCT | Total knee replacement, hysterectomy, laparotomy | Interpretability | Worst pain Severe pain Complete relief |
NR | 123 (66) | 65 (10) |
| Gerbershagen, 201141 (Germany) | NRS | Comparative study design | Cholecystectomy, thyroidectomy, gastrointestinal, inguinal hernia repair, others | Interpretability | Worst imaginable pain | Repeated surgical, procedures, mechanical ventilation | 444 (44) | 18–20=38 21–30=75 31–40=88 41–50=96 51–60=87 61–70=49 71–80=2 |
| Cepeda, 200336 (USA) | NRS VRS |
Clinical study | Head and neck, thoracic, spinal abdominal, orthopaedic | Interpretability | Worst imaginable Severe pain |
NR | 700 (62) | 50 (15) |
| Jensen, 200245 (USA) | VAS VRS Pain relief |
Secondary analysis of RCT | Total knee replacement, abdominal hysterectomy, laparotomy | Responsiveness | Worst pain Severe pain Complete relief |
NR | 246 (66) | Knee 65 (10) Laparotomy 41 (7.5) |
| Jenkinson, 199543 (UK) | VAS CPI McGill |
RCT | Orthopaedic | Responsiveness | Severe pain | NR | 75 (64) | Male: 41 (13) Female: 43 (12) |
| Aubrun, 200331 (France) | VAS | Clinical study | Orthopaedic, urological, abdominal gynaecological, vascular, thoracic | Interpretability | 100 | Minor pain, delirium, dementia, non-French speaking | 3045 (54) | 50 (18) |
| Sriwatanakul, 198252 (USA) | VAS | Secondary analysis of RCT | NR | Interpretability | Pain as bad as it could be | NR | NR | NR |
| Van Giang, 201555 (Vietnam) | FPS NRS |
Validation study | Orthopaedic | Concurrent validity Responsiveness | The worst possible pain | Hearing impairment Altered mental status |
144 (45) | 37 (13) |
| Van Dijk, 201254 (The Netherlands) | NRS VRS |
Cross-sectional design | General, ENT, orthopaedic, neurosurgical, urological, gynaecological, plastic, vascular, cardiothoracic | Interpretability | 10 Worst pain imaginable |
ICU patients Non-Dutch speaking Cognitive or hearing impairment, inability to use self-report |
2674 (51) | 73 (6) |
| Li, 200747 (China) | VAS NRS-11 VDS FPS |
Prospective clinical study | NR | Convergent validity Scale reliability Responsiveness Feasibility |
10 The most intense imaginable pain 10 The most intense imaginable pain The most intense imaginable pain Worst pain |
NR | 173 (45) | 45.3 (15) |
| Li, 200946 (China) | FPS NRS IPT |
Descriptive correlational design | Gastrointestinal, orthopaedic, abdominal | Convergent validity Scale reliability Responsiveness Feasibility |
10 10 The most intense imaginable pain |
Did not speak Chinese More than one surgery ASA score of 4 Chronic pain |
180 (68) | 72 (6) |
| Zhou, 201156 (China) | VDS NRS FPS CAS |
Descriptive comparative design | NR | Criterion validity Convergent validity Test–retest reliability Feasibility |
Worst pain | Severe cognitive impairment | 200 (46) | 56 (16) |
| Gagliese, 20056 (Canada) | VAS-H VAS-V NRS VDS MPQ |
Validation study | NR | Feasibility Convergent validity Criterion validity |
10 Worst possible pain 10 Worst pain imaginable Excruciating |
On epidural or regional analgesia, ASA score of >3 Chronic pain, cognitive impairment, opioid or substance abuse |
504 (58) | 53 (15) |
| Tandon, 201653 (India) | OPS NRS |
Descriptive correlational design | Abdominal surgery | Convergent validity | Worst possible pain Inadequate pain relief/pain at rest |
Haemodynamic instability Unable to use a PCA pump |
93 | NR |
| Aziato, 201533 (Ghana) | NRS FPS CCPS |
Two phases: qualitative and psychometric testing | Caesarean section, leg amputation, laminectomy, laparotomy, others | Convergent validity Inter-rater reliability Responsiveness Feasibility |
Worst possible pain Hurts worst |
NR | 150 (77) | <30=44.7 30–39=35 40+=21 |
| Hamzat, 200942 (Ghana) | VAS | Validation study | Various gynaecological procedures | Cross-cultural validity | Worst possible pain | History of psychological or psychiatric disorders | 60 (100) | NR |
| Gagliese, 200340 (Canada) | MPQ PPI VAS-R VAS-M |
Descriptive correlation design | Radical prostatectomy | Convergent validity Responsiveness |
Worst possible pain 5 Excruciating 10 Worst possible 10 Worst possible pain |
Non-English speaker ASA >3 Chronic pain Chronic use of opioids |
200 | Younger patients: 56 (6) Older patients: 67 (3) |
| Myles, 201748 (Australia) | VAS | Observational design | General, orthopaedic, gynaecological, urological, major vascular, cardiac faciomaxillary, others | Test–retest reliability Interpretability |
Very severe pain | Poor English comprehension Drug or alcohol dependence Psychiatric disorder Uncontrolled pain |
219 (68) | 53 (17) |
| Danoff, 201837 (USA) | VAS | Prospective observational design | THA TKA |
Measurement error | Worst possible pain | Preoperative pain Catastrophizing Scale score greater than 30 points | 304 THA (21) TKA (30) |
THA: 60 [20–81] TKA; 63 [46–88] |
| Sloman, 20062 (Israel) | NRS | One group pretest–post-test design | Abdominal, orthopaedic, others | Interpretability | 10 Excruciating | NR | 150 (47) | 47 [14–89] |
| Bodian, 20013 (USA) | VAS McGill |
Clinical study | Intra-abdominal Surgery | Interpretability Desire for analgesics |
Worst pain imaginable | NR | 150 (48) | 49 [37–61] |
∗
The low anchor was “no pain”.