Visual analogue scale (VAS). Visual analogue pain scale (VAS) Facial pain scale

Verbal Rating Scale

The verbal rating scale allows you to assess the intensity of the severity of pain through a qualitative verbal assessment. The intensity of pain is described in specific terms ranging from 0 (no pain) to 4 (most painful). From the proposed verbal characteristics, patients choose the one that best reflects the pain they experience.

One of the features of verbal rating scales is that the verbal characteristics of the description of pain can be presented to patients in an arbitrary order. This encourages the patient to choose the exact grade of pain that is based on the semantic content.

Verbal Descriptive Pain Scale

Verbal Descriptor Scale (Gaston-Johansson F., Albert M., Fagan E. et al., 1990)

When using a verbal descriptive scale, the patient should be asked if he is experiencing any pain right now. If there is no pain, then his condition is assessed at 0 points. If you experience pain, you need to ask: "Would you say that the pain has intensified, if the pain is unimaginable, or is this the most severe pain you have ever experienced?" If so, the highest score is recorded at 10 points. If there is neither the first nor the second option, then further it is necessary to clarify: “Can you say that your pain is weak, moderate (moderate, tolerable, mild), strong (sharp) or very (especially, excessively) strong (acute) ".

Thus, there are six options for assessing pain:

• 0 - no pain;
• 2 - mild pain;
• 4 - moderate pain;
• 6 - severe pain;
• 8 - very severe pain;
• 10 - unbearable pain.

If the patient experiences pain that cannot be characterized by the proposed characteristics, for example, between moderate (4 points) and severe pain (6 points), then the pain is assessed by an odd number that falls between these values ​​(5 points).

The Verbal Descriptive Pain Scale can also be applied to children over the age of seven who are able to understand and use it. This scale can be useful for assessing both chronic and acute pain.

The scale is equally reliable for both primary school children and older age groups. In addition, this scale is effective in various ethnic and cultural groups, as well as in adults with minor cognitive impairments.

Faces Pain Scale (Bien, D. et al., 1990)

The facial pain scale was created in 1990 by Bieri D. et al. (1990).

The authors developed a scale with the aim of optimizing the child's assessment of pain intensity, using facial expression changes depending on the degree of pain experienced. The scale is represented by pictures of seven faces, with the first person having a neutral expression. The next six faces depict increasing pain. The child should choose the face that, in his opinion, best demonstrates the level of pain he is experiencing.

The facial pain scale has several features compared to other rated facial pain scales. First, it is more of a proportional scale than an ordinal one. In addition, the scale has the advantage that it is easier for children to correlate their own pain with a drawing of the face shown on the scale than with a photograph of a face. The simplicity and ease of use of the scale make it possible for its wide clinical application. The scale is not validated for use with preschool children.

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The Faces Pain Scale-Revised (FPS-R)

(Von Baeyer C. L. et al., 2001)

Carl von Baeyer with students from the University of Saskatch-ewan (Canada), in collaboration with the Pain Research Unit, modified the facial pain scale, which was called the modified facial pain scale. Instead of seven faces, the authors left six in their version of the scale, while maintaining a neutral facial expression. Each of the images presented in the scale received a digital rating in the range from 0 to 10 points.

Instructions for using the scale:

“Look closely at this picture, where there are drawn faces that show how much pain you can have. This face (point to the leftmost) shows a person who is not in pain at all. These faces (show each face from left to right) show people whose pain increases, increases. The face on the right shows a person who is in unbearable pain. Now show me the face that indicates how much you are hurting at the moment. "

Visual analogue scale (VAS)

Visual Analogue Scale (VAS) (Huskisson E. S., 1974)

This method of subjective assessment of pain consists in the fact that the patient is asked to mark a point on an ungraded 10 cm line that corresponds to the severity of pain. The left border of the line corresponds to the definition of "no pain", the right - "the worst pain imaginable." Typically, a 10 cm long paper, cardboard or plastic ruler is used.

On the reverse side of the ruler, centimeter divisions are marked, according to which the doctor (and in foreign clinics this is the duty of the nursing staff) marks the value obtained and enters it into the observation sheet. The undoubted advantages of this scale include its simplicity and convenience.

Also, in order to assess the intensity of pain, you can use a modified visual analogue scale, in which the intensity of pain is also determined by different shades of colors.

The disadvantage of VAS is its one-dimensionality, that is, according to this scale, the patient notes only the intensity of pain. The emotional component of the pain syndrome introduces significant errors in the VAS indicator.

In dynamic assessment, the change in pain intensity is considered objective and significant if the present VAS value differs from the previous one by more than 13 mm.

Numerical Pain Scale (NSP)

Numeric Pain Scale (NPS) (McCaffery M., Beebe A., 1993)

According to the principle outlined above, another scale is built - the numerical scale of pain. The ten-centimeter segment is divided by marks corresponding to centimeters. According to it, it is easier for the patient, in contrast to the VAS, to assess pain in digital terms, he much faster determines its intensity on the scale. However, it turned out that with repeated tests, the patient, remembering the numerical value of the previous measurement, subconsciously reproduces an unrealistic intensity

pain, but tends to remain in the area of ​​the previously named values. Even with a feeling of relief, the patient tries to recognize a higher intensity, so as not to provoke the doctor to reduce the dose of opioids, etc. - the so-called symptom of fear of repeated pain. Hence the desire of clinicians to move away from digital meanings and replace them with verbal characteristics of pain intensity.

Pain Scale Bloechle et al.

Pain scale of Bloechle et al. (Bloechle C., Izbicki J. R. et al., 1995)

The scale was developed to assess the intensity of pain in patients with chronic pancreatitis. It includes four criteria:

1. Frequency of pain attacks.
2. Pain intensity (pain score on a VAS scale from 0 to 100).
3. The need for analgesics to relieve pain (the maximum degree of severity is the need for morphine).
4. Lack of performance.

NB !: The scale does not include such characteristics as the duration of the onset of pain.

When more than one analgesic is used, the analgesic requirement for pain relief is 100 (maximum estimate).

In the presence of continuous pain, it is also rated at 100 points.

The scale is assessed by summing the assessments for all four criteria. The pain index is calculated using the formula:

Overall rating on a scale / 4.

The minimum score on the scale is 0, and the maximum is 100 points.

The higher the score, the more intense the pain and its effect on the patient.

Observational ICU Pain Assessment Scale

Critical Care Pain Observation Tool (CPOT) (Gelinas S., Fortier M. et al., 2004)

The SROT scale can be used to assess pain in adult ICU patients. It includes four features, which are presented below:

1. Facial expression.
2. Motor reactions.
3. Muscle tension of the upper limbs.
4. Speech reactions (in non-intubated) or ventilator resistance (in intubated) patients.

To assess the severity of the pain syndrome, as well as the effectiveness of its elimination, the so-called rank scales... The visual analogue scale (VAS) is a segment of a straight line 10 cm long, the beginning and the end, which reflect the absence of pain and the extreme limit of its sensation (Fig. 2.15).

The patient was asked to mark a segment of a straight line, the value of which approximately corresponded to the intensity of the pain he experienced. By measuring the marked area, the conditional pain intensity in points (corresponding to the length in cm) was determined. The verbal rank scale is the same VAS, but with pain scores along a straight line: weak, moderate, strong, etc. A numerical rating scale is the same segment of a straight line with numbers from 0 to 10. The most objective are pain assessments obtained using horizontally located scales. They correlate well with the assessment of pain sensations and more accurately reflect their dynamics.

We obtained qualitative characteristics of the pain syndrome using the McGill pain questionnaire (183). This test includes 102 pain parameters, divided into three main groups. The first group (88 descriptive expressions) is associated with the nature of pain, the second (5 descriptive expressions) - with the intensity of pain and the third (9 indicators) - with the duration of pain. The parameters of the first group are divided into 4 classes and 20 subclasses. The first class is the parameters of sensory characteristics (pain "pulsating, shooting, burning", etc.).

Rice. 2.15. Visual scales for subjective pain assessment

The second class - parameters of affective characteristics (pain "tiring, terrifying, exhausting", etc.), the third class - evaluating parameters (pain "causing irritation, suffering, unbearable", etc.), the fourth - mixed sensory-affective parameters (pain "annoying, excruciating, tormenting", etc.). Each indicator in the subclass is located according to its rank value and has a weighted mathematical expression (first = 1, second = 2, etc.). In the subsequent analysis, the number and rank of the selected parameters for each class were taken into account.

A quantitative assessment of pain was carried out using a dolorimeter (Kreimer A. Ya., 1966). The principle of operation of the dolorimeter is based on measuring the pressure value at which pain occurs at the point under study. The pressure measurement is recorded using a rubber-tipped rod connected to a spring mechanism. On the flat surface of the stem, there is a scale graduated in 30 divisions with a step of 0.3 kg / cm. The amount of displacement of the stem is recorded using a retaining ring.

Algesimetry data are expressed in absolute units - kg / cm. The rate of pain of 9.2 ± 0.4 kg / cm or more, determined in 30 practically healthy people, was taken as the norm. To standardize the indicators, the morbidity coefficient (KB), which shows the ratio of normal algesimetric indicators to the corresponding indicators in the points under study. Normally, it is equal to one relative unit. The test was also used during treatment to determine the effectiveness of the chosen treatment method.

The described approach made it possible to carry out an objective differential diagnosis and, on the basis of the results of complex diagnostics, an individual scheme of treatment and rehabilitation in the postoperative period was selected.

Edgar Degas, Washerwomen Suffering from Toothache. Image from forbes.ru

Pain relief is one of the most painful points of our medicine. Despite some simplification of the procedure for obtaining the necessary drugs for cancer patients, the problem is far from being solved, while in the national healthcare system, pain management is not separated into a separate branch of knowledge and medical service.

Meanwhile, in this area of ​​medicine, there are international standards based on the recommendations of the World Health Organization. They relate to pain management not only for patients in the last stage of cancer, but also for other cases of acute and chronic pain, and involve the presence of pain management specialists in medical centers, who will certainly participate in consultations of other doctors who jointly develop a plan for the patient's treatment and care.

The first step in work is pain assessment. Of course, there are obvious cases: for example, trauma with rupture of tissues or organs, fracture of bones - it is clear that the patient suffers from severe or even unbearable pain. However, often the doctor has to ask the patient himself to rate his pain on a scale from 1 to 10. What is such a scale?

Pain scale

1 - pain is very weak, barely noticeable. Most of the time, the patient does not think about her.

2 - mild pain. It can be annoying and get worse from time to time.

3 - the pain is noticeable, it is distracting, but you can get used to it and adapt to it.

4 - moderate pain. If a person is deeply immersed in some activity, he can ignore it, but only for some time, but then she will certainly divert attention to herself.

5 - moderately severe pain. It cannot be ignored for more than a few minutes, but by making an effort on himself, a person can do some work or participate in some event.

6 - Moderately severe pain that interferes with normal daily activities, as focusing on something becomes extremely difficult.

Followed by severe pain(disables, does not allow you to perform normal duties, communicate with people).

7 - severe pain, subjugating all sensations and significantly limiting a person's ability to perform normal actions and communicate with others. Interferes with sleep.

8 - intense pain. Physical activity is severely limited. Verbal communication takes a tremendous amount of effort.

9 - excruciating pain. The person is unable to talk. Uncontrolled moaning or crying is possible.

10 - unbearable pain. The person is tied to bed and possibly delirious. Painful sensations of such strength have to be experienced during the life of a very small number of people.

In order to orient the patient, the doctor can hang in his office a scale with emoticons (emoticons) corresponding to its divisions, from a happy smile at 0 to a face sobbing in agony at 10. Another landmark, but only for women and only for those giving birth , - this is a hint: natural childbirth without pain relief corresponds to the mark 8.

The pain scale may seem very simple, but according to Stephen Cohen, professor of pain at the Johns Hopkins School of Medicine (Baltimore, USA), it is based on fairly deep research.

Pain is a separate disorder that requires intervention

In Western medicine, the emphasis on chronic pain has shifted for some time: it is no longer viewed simply as a symptom of a particular disease, but as an independent disorder that requires intervention. While the pain scale is a useful tool for most patients, for some it becomes decisive in the choice of treatment.

“The scale is especially important for those with communication problems,” says Cohen, referring primarily to young children and patients with cognitive impairments.

The doctor, in addition to assessing pain on a scale, it is important to know other parameters. So, Dr. Seddon Savage, President of the American Pain Society and Professor of Anesthesiology at the Dartmouth School of Medicine (USA), asks the patient to talk about how the pain level has changed over the last week, how the pain behaves during the day, whether it gets worse in the evening, gives whether the opportunity to sleep and so on.

If the scale is used constantly in the work with the patient, then over time you can get a picture of how chronic pain affects his quality of life, how therapies and pain medications work.

“I also ask the patient to show me on a scale what level of pain will be acceptable to him,” says Savage. “With chronic diseases, we cannot always reduce the pain to nothing, but it is possible to reach a level that will allow the patient to still lead an acceptable lifestyle.”

Pain specialists must ask the patient what its nature is: shooting, dull, throbbing, whether there are sensations of burning, tingling or numbness, as well as what external factors influence the pain, what makes it stronger and what weakens it.

It is vitally important not only how severe the patient's pain is and what its nature is, but also how it affects his daily life. This is what is meant by the shift in emphasis. The doctor should focus not only on treating the disease itself (which is certainly extremely important), but also find a way to help the patient to deviate as little as possible from a normal life due to pain.

This, according to Savage, requires the joint efforts of a number of specialists: the attending physician, pain specialist, physical therapist, psychologist and psychiatrist, and, most importantly, the patient himself, who must play an active role in the treatment process.

Questionnaires are one way to assess intensity and severity of pain, make a diagnosis, monitor the effectiveness of treatment. For complaints of pain in the lower back, neck, or other part of the spine, practitioners and researchers most often resort to to several options for scales and questionnaires:

• VASH - visual analogue scale;
• SHVO - scale of verbal assessment;
• McGill Pain Questionnaire;
• The Roland-Morris Pain Questionnaire.

Most of these questionnaires are universal, they serve to work with patients who complain of pain in any location. But there are also specific questionnaires developed for patients with back pain: Roland-Morris, Oswestry, Hopkins.

General back pain questionnaires

• YOUR scale- a universal method of subjective assessment of pain syndrome, it is used for pains of different etiology and localization, it does not necessarily mean the treatment of the spine. The patient is asked to mark a point on the 10 cm line that corresponds to the severity of pain. In this case, the left border means "no pain", and the right - "unbearable pain, the worst that I have ever experienced." For these purposes, any ruler is suitable, but it should face the patient with the non-graduated side. Then the doctor will turn the ruler over to see the scale, and enter the obtained values ​​on the observation sheet.

The disadvantage of the YOUR scale is in its one-dimensionality and imprecision - under the influence of emotions, the patient is able to greatly exaggerate the intensity of pain.

But the doctor gets the opportunity to effectively monitor change in pain before treatment, in its process and after the completion of procedures.

• ShVO scale also belongs to the universal methods for determining the intensity of pain, its task is to help control the severity of pain before, during and after treatment. The scale is a list of verbal descriptions of the gradations of pain: "no pain", "weak", "moderate", "strong", "very strong", "unbearable". It can be supplemented with digital values. The patient is asked to choose the option appropriate for his condition, but descriptive scales have recently been used less and less.
• Tsung scale- one of the methods for determining depressive conditions, which often develop in patients with chronic low back pain. Instead of the Zung scale, you can use the Beck and Hamilton scale or other questionnaires aimed at determining the state of mind of a person. The test takes into account 20 factors that determine the 4 degrees of depression.
• McGill Questionnaire designed to qualitatively assess the nature of pain - usually a short version of this questionnaire is used. The results obtained make it possible to judge not only the nature of the pain, but also the emotional state of the patient. The patient will spend about 5-15 minutes filling out the questionnaire, and all he needs is to choose descriptions that correspond to his condition. The use of the McGill questionnaire gives reliable results, it can be used as one of the diagnostic tools, because the proposed words correspond to certain syndromes. The doctor calculates the pain index depending on the number of selected positions.

Short version of the McGill questionnaire consists of 20 classes. Each class describes one group of events, but offers different degrees of pain.

McGill Pain Inventory

Describe your pain, highlighting certain characteristics in any of the 20 questions, not necessarily in each, but only one for each question.

• In what words can you describe your pain?
• pulsating, grasping, twitching, quilting, pounding, hammering
• like an electric discharge, an electric shock, a shot
• stabbing, digging, boring, boring, piercing
• sharp, cutting, stripping
• pressing, squeezing, pinching, squeezing, crushing
• pulling, twisting, pulling out
• hot, stinging, scalding, scorching
• itchy, pinching, corrosive, stinging
• dull, aching, cerebral, breaking, splitting
• bursting, stretching, tearing, tearing
• spilled, spreading, penetrating, penetrating
• scratching, sore, scuffing, sawing, gnawing
• mute, reducing, chilling
• What feelings does pain cause, what effect does it have on the psyche?
• tiring, exhausting
• . a feeling of nausea, suffocation
• feeling of anxiety, fear, horror
• depressing, annoying, angry, enraged, desperate
• weakens, blinds
• pain - hindrance, annoyance, suffering, torment, torture
• How do you rate your pain?
• weak, moderate, strong, strong, unbearable.

Special questionnaires

Roland-Morris Questionnaire"Pain in the lower back and disability" serves to assess the patient's quality of life, it is compiled taking into account the specifics of diseases of the spine, its closest analogue is the Oswestry questionnaire.

The patient is asked to emphasize those statements that are relevant to him on the day seeking medical attention. Then the specialist counts the number of points.

With the help of the Roland-Morris questionnaire, he can assess the severity of disorders and monitor the effectiveness of treatment.

Roland-Morris Questionnaire

When your back hurts, it may be difficult for you to do some of the activities or activities that you usually do. Underline only those statements that characterize your condition today.

• I stay at home most of the time because of my back
• I walk slower than usual because of my back
• Because of my back, I cannot do my usual housework.
• From behind my back I have to use a stick to walk up the stairs
• Because of my back, I often have to lie down and rest
• From behind my back I have to hold onto something to get out of my chair (chair)
• From behind my back I have to ask other people to do something for me
• I dress slower than usual because of my back
• I only stand for a short time because of my back
• From behind my back, I don't try to bend over or kneel down
• It is very difficult for me to get up from a chair (chair) because of my back
• My back or legs hurt almost all the time.
• I find it hard to turn in bed because of my back
• I have problems putting on socks from behind my back
• I sleep less because of my back
• I avoid hard chores from behind my back
• Back pain makes me more irritable and harsh with other people than usual.
• Because of back pain, I walk the stairs more slowly than usual.

Oswestry Questionnaire- one of the most popular questionnaires in the world, with the help of which the quality of life of a patient with low back pain is determined.

Consists of 10 sections, each of which is devoted to a specific area of ​​life. When the patient has filled out the questionnaire, the doctor puts in front of the answers the points corresponding to the ordinal number of the answer (the score starts not from one, but from zero).

Answer index is the sum of the points multiplied by two. The Oswestry questionnaire gives a comprehensive picture of a person's condition; it differs from previous questionnaires in detail and comprehensive coverage.

Oswestry Questionnaire

Section 1. PAIN INTENSITY

1. I can tolerate pain without taking pain relievers
2. The pain is severe, but I can manage it without taking pain relievers
3. Pain relievers completely relieve me of pain
4. Pain relievers moderately relieve pain
5. Pain relievers have very little pain relief
6. Pain relievers don't work on pain

Section 2. SELF-SERVICE (washing, dressing, cooking, eating, etc.)

1. Self-service is not compromised and does not cause additional pain
2. Self-service is not impaired, but causes additional pain
3. In self-care, due to increasing pain, I act slowly.
4. In self-service I need some help, but I do most of the actions on my own
5. I need help with most self-service activities
6. I can't get dressed, I wash my face with great difficulty and stay in bed.

Section 3. LIFTING OBJECTS

1. I can lift heavy objects without additional pain
2. I can lift heavy objects, but it makes the pain worse
3. The pain prevents me from lifting heavy objects, but I can lift them if they are conveniently located, for example, on a table
4. The pain prevents me from lifting heavy objects, but I can lift moderately heavy objects if they are conveniently located
5. I can only lift very light objects
6. I cannot lift or hold any objects

Section 4. WALK

1. Pain does not prevent me from walking any distance
2. Pain prevents me from walking more than 1 kilometer
3. Pain prevents me from walking more than 1/2 kilometer
4. Pain prevents me from walking more than 1/4 of a kilometer
5. I can only groom with a stick or crutches
6. Mostly I lie in bed and have a hard time getting to the toilet

Section 5. SEATING

1. I can sit in any chair for as long as I like
2. I can only sit for a long time in my favorite chair
3. Pain prevents me from sitting for more than 1 hour
4. Pain prevents me from sitting for more than 1/2 hour
5. Pain prevents me from sitting for more than 10 minutes
6. Because of the pain, I can't sit at all

Section 6. STANDING

1. I can stand as long as I want without increasing pain
2. I can stand for as long as I like, but it intensifies the pain
3. Pain prevents me from standing for more than 1 hour
4. Pain prevents me from standing for more than 30 minutes
5. Pain prevents me from standing for more than 10 minutes
6. Because of the pain I can't stand at all

Section 7. DREAM

1. I have a good sleep and pain does not disturb it.
2. I can only sleep soundly with pills
3. Even taking pills, I sleep less than 6 hours a night.
4. Even taking pills, I sleep less than 4 hours a night.
5. Even taking pills, I sleep less than 2 hours a night.
6. I don't sleep at all because of the pain

Section 8. SEXUAL LIFE

1. My sex life is normal and does not cause additional pain.
2. My sex life is normal, but it causes increased pain.
3. My sex life is almost normal, but the pain increases dramatically.
4. Pain significantly limits my sex life.
5. Pain almost completely interferes with sex
6. Sexual life is impossible due to pain

Section 9. PUBLIC LIFE

1. My social life is normal and does not cause an increase in pain.
2. My social life is normal, but it causes increased pain
3. The pain does not significantly disrupt my social life, but limits those activities that require a lot of energy (such as dancing)
4. Pain limits my social life, and because of the pain I often cannot leave the house.
5. Pain limited my social life to only the area of ​​my home

Because of the pain, I do not participate at all in public life.

Section 10. TRAVEL

1. I can ride anywhere without increasing pain
2. I can ride anywhere, but it causes increased pain
3. Pain prevents me from traveling for more than 1 hour
4. Because of the pain, I can only make the most necessary trips of no more than 30 minutes.
5. Pain interferes with all my travel except doctor visits

Hopkins symptom questionnaire- a clinical questionnaire that helps to form a comprehensive picture of the condition of patients with chronic low back pain.

Consists of 20 items, grouped into 4 scales: mood, interpersonal relationships, psychosomatic symptoms and adaptation to illness.

Since patients with chronic diseases of the spine have neurotic spectrum disorders, the Hopkins questionnaire can record not only pain, but also anxiety, depression and other accompanying symptoms.

This questionnaire can replace the Tsung scale, but the Hopkins questionnaire is considered a bit outdated - experts prefer the later developed Oswestry questionnaire.

Hopkins symptom questionnaire

• Do you feel unhappy or depressed most of the time?
• Do you feel hopeless about the future?
• Are you worried about the little things?
• Do you have panic (severe fright, fear) for no reason?
• Are you considered a nervous person?
• Are you easily annoyed?
• Are you afraid of sudden outbursts of irritation that you are unable to control?
• Do you feel lonely?
• Are you considered a touchy person?
• Are your senses easily vulnerable?
• Do you feel that people do not understand you or do not sympathize with you?
• Do you often have headaches?
• Do you have sleep problems: sleep disturbances, restless sleep, sleep that does not bring rest?
• Are you satisfied with the quality of the medical care provided?
• Do you feel that your lower back problems severely limit your activities?
• Do you feel unhappy about your health problems?
• Do you abuse alcohol or drugs not prescribed by your doctor?
• Have you ever had a nervous breakdown?
• Have you ever received help from a psychiatrist?
• Have you looked for advice on your problems?

Painful sensations are always unpleasant. With their frequent occurrence, most patients immediately consult a doctor. However, pain can be not only of a different nature, but also of an unequal degree of intensity. Currently, there is no device that would most accurately determine the severity of unpleasant sensations in a patient. This is why the Visual Analogue Pain Scale (VAS) was developed. With its help, doctors can establish the fact whether the patient can tolerate pain, or if it is unbearable. To date, several methods have been developed for determining the intensity of unpleasant sensations. But the visual analogue pain scale is still the most informative.

Abbreviation

A method for determining the intensity of discomfort was developed in 1974 by an American scientist. Immediately, the method was widely used in medical practice. It was decided to designate it with the abbreviation VAS, which stands for Visual Analogue Scale. In Russia, it is customary to use the abbreviation VAS - visual analogue scale.

Method essence

VAS is a subjective way of assessing the pain of the patient who is currently experiencing it. For example, in some conditions a person feels one degree of discomfort, in others - another. The most common situation is when the patient experiences increased pain in the affected area at night, and during the day his quality of life practically does not change.

The VAS visual analogue scale is a way of identifying the degree of discomfort at the very time when a person is at the doctor's appointment. In this situation, the patient only needs to point out to the specialist that an increase in the intensity of pain occurs, for example, at night or in the evening.

The doctor invites the person to mark a point on the non-graduated line, which, in his opinion, will reflect the severity of the uncomfortable sensations. At the same time, the specialist informs the patient that the left border corresponds to the absence of pain, and the right one indicates its presence, and it is so intolerable that it is practically incompatible with life.

In practice, a plastic, cardboard or paper ruler is most often used. Its length is 10 cm.

Application in medical practice

The visual analogue pain scale is rarely used in therapy. For a generalist in most cases, it is enough to know that there are uncomfortable sensations in principle. In addition, it is important for the therapist to have information about what hours they disturb, what their nature is.

The scale for assessing pain intensity is widely used in oncology and anesthesiology. This is due to the fact that in some cases, doctors must, in a short time, receive the most complete information regarding the presence of discomfort without any prompts. In recent years, in practice, VAS has also begun to be used by rheumatologists.

Modified scale

It's no secret that colors affect a person in different ways. The doctors, knowing this property, decided to slightly modify the visual analogue scale. The essence of the method remains the same. The changes directly affected the line. The usual scale is shown in black. The modified one has a line, the color of which changes from green to red. Doctors are convinced that such a neoplasm will reduce the likelihood of obtaining inaccurate data, since patients, at a subconscious level, better associate their feelings with flowers.

How the research is done

Despite the fact that the VAS is the most popular in anesthesiology and oncology, it can be used in any field of medicine. The research algorithm is as follows:

• The doctor examines the patient. Already at this stage, he can assume how strong painful sensations a person experiences.
• The doctor offers the patient a 10 cm ruler, on which he should mark a point. You need to point to the area that, in the opinion of the subject, corresponds to the degree of intensity of the pain that bothers him. In this case, it is imperative to take into account that the left side of the ruler means the complete absence of discomfort, the right, respectively, its presence.
• Centimeter marks are marked on the other side of the product. The doctor evaluates the test results, taking into account other nuances. For example, he may ask if the patient is physically active, how long and how well they sleep. This information provides an opportunity to confirm the reliability of the study.

With the help of a visual analogue scale, the doctor is able to track the dynamics and assess the success of the prescribed treatment. The best scenario is one in which at each subsequent appointment, the patient indicates a point closer to the left edge.

Interpretation of results

As mentioned above, the visual analogue pain rating scale is an ungraded 10 cm line. It can be standard or modified. The corresponding markings are shown on the reverse side, that is, the patient does not see them during the test.

The interpretation of the results (values ​​and their interpretation) is as follows:

• 0. This is the absence of pain, the person does not feel it at all.
• 1. Discomfort is extremely weak. A person practically does not think about them. The presence of mild pain does not affect the quality of life in any way.
• 2. Unpleasant sensations are poorly expressed. But at the same time, the pain is periodically paroxysmal and can sometimes intensify. A person experiencing discomfort is most often irritated.
• 3. Pain bothers regularly, the patient is constantly distracted by it. But at the same time, a person easily gets used to it and is able, if it is available, to carry out any type of activity.
• 4. Pain of a moderate nature. If the patient is very involved in any activity, he may not notice it for a while. However, the rest of the time she bothers him, it is quite difficult to get distracted from her.
• 5. The pain is moderately severe. You can ignore it for a maximum of several minutes. Discomfort is constantly disturbing. However, if a person makes an effort, he will be able to do some work or take part in a mass event.
• 6. The pain is still moderately severe. But it already greatly interferes with normal daily activities. It becomes extremely difficult to concentrate on something.
• 7. The pain is severe. She literally dominates all other sensations. In addition, it significantly interferes with communication with other people and the performance of daily activities. The person does not sleep well at night because of the pain.
• 8. The sensations are intense. Physical activity is extremely limited. It takes considerable effort to maintain communication.
• 9. The pain is excruciating. The person is not even able to talk. Sometimes he lets out uncontrollable groans.
• 10. The pain is unbearable. The patient is bedridden, often delirious. Pain of this nature is almost incompatible with life.

Based on the results of the study, the doctor can judge not only the intensity of sensations, but also the course of the pathology as a whole.

Error

The specialist must draw conclusions about the patient's health, taking into account not only the obtained indicator of the visual analogue scale. You must rely on the margin of error. For example, some patients do not feel relief after the therapy, but for some reason they do not want to offend the doctor. In this regard, they deliberately reduce the pain score.

Some individuals, on the other hand, are prone to exaggeration. For example, women may indicate excruciating pain. At the same time, if you ask them about what sensations they experienced during childbirth, most of them will indicate pain that is almost incompatible with life. In such situations, it is necessary to halve the resulting indicator.

Thus, the doctor should be guided not only by the VAS, but also closely monitor the patient's condition. The most indicative criteria are speech and facial expressions.

Advantages

The doctor, focusing on the visual analogue scale, the pain syndrome can be stopped using the most effective means. For example, in case of weak sensations, the use of non-narcotic drugs, such as Ibuprofen, Paracetamol, Diclofenac, is indicated. If the pain is unbearable, the administration of the strongest medications is required. In addition, in many cases it is advisable to carry out a blockade or alcoholization.

Another advantage of the VASH scale is its simplicity and ease of use. It is indispensable in cases where the doctor needs to find out the severity of pain, and the patient, for some reason, cannot speak or does it with great difficulty.

disadvantages

The main disadvantage of the visual analogue scale is its one-dimensionality. In other words, a person can only indicate the intensity of the pain.

In addition, the emotional component of the syndrome often leads to an unreliable result. As mentioned above, many patients deliberately underestimate the severity of pain or, on the contrary, significantly increase it. In such situations, the further development of events depends on the literacy and attentiveness of the doctor.

Finally

The Visual Analogue Scale (VAS) is a simple way to measure the intensity of pain in a patient. It is an ungraded 10 cm line. It can be either black or colored. The patient points to the line a point that, in his opinion, corresponds to the intensity of the pain. The severity of sensations increases from left to right. Based on the test results, the doctor can select the most suitable drugs and evaluate the dynamics of treatment. In addition, he gets the opportunity to analyze the course of the disease as a whole.