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  • Review Article
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Pain measurement in patients with low back pain

Nature Clinical Practice Rheumatology volume 3, pages 610–618 (2007)Cite this article

Abstract

Pain is a multidimensional experience that is a prominent feature of many musculoskeletal disorders. Despite its subjective nature, pain is a highly relevant complaint; hence, nothing should deter physicians from attempting to formally assess it. This Review summarizes the main aspects of pain measurement from a practical standpoint, with a specific focus on low back pain. On balance, for the assessment of pain intensity, categorical scales with verbal descriptors or numerical rating scales seem to be preferable to traditional visual analogue scales, although no single best measure can be recommended. Pain per se should be assessed, rather than surrogate measures such as analgesic use. Back and leg pain should be evaluated separately in patients in whom these conditions coexist. For assessing change, prospective measurements are preferable to retrospective reports. Pain is not synonymous with function or quality of life, and other tools covering these important outcome dimensions should complement the assessment of pain, especially in patients with chronic symptoms. Clinicians should be aware of the psychometric properties of the tool to be used, including its level of imprecision (random measurement error) and its minimum clinically important difference (score difference indicating meaningful change in clinical status).

Key Points

  • The evaluation of pain should be part of a physician's daily clinical activity

  • In low back pain and other painful musculoskeletal disorders, pain per se should be assessed, rather than surrogate measures such as analgesic use

  • For assessment of pain intensity, categorical scales with verbal descriptors and numerical rating scales appear to be preferable to traditional visual analogue scales; however, there is no single best tool and there is a tool for everyone

  • In patients with sciatica, pain in the lumbar area and pain in the lower limb are two different dimensions that should be evaluated separately

  • Pain is not synonymous with function or quality of life, and other tools covering these important outcome dimensions are recommended for clinical practitioners

  • For research purposes, tools should be selected according to the purpose of the study, the population to be evaluated and the most suitable method for gathering data; in assessing change over time, prospective measurements are preferable to retrospective reports

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Acknowledgements

A Mannion gratefully acknowledges funding support from the Swiss National Science Foundation National Research Programme 53 'Musculoskeletal Health – Chronic Pain' and the Schulthess Klinik Research Funds. Désirée Lie, University of California, Irvine, CA, is the author of and is solely responsible for the content of the learning objectives, questions and answers of the Medscape-accredited continuing medical education activity associated with this article.

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Authors and Affiliations

  1. AF Mannion is Senior Research Fellow (Spine Center) and Head of Research and Development at the Schulthess Klinik, Zürich, Switzerland.,

    Anne F Mannion

  2. F Balagué is Associate Clinical Director of the Department of Rheumatology, Physical Medicine and Rehabilitation, Fribourg Hospital, Switzerland.,

    Federico Balagué

  3. Orthopaedic Department, F Pellisé is a Consultant Spine Surgeon at the Spine Unit, Hospital Universitari de Traumatologia I Rehabilitació Vall d'Hebron, Barcelona, Spain.,

    Ferran Pellisé

  4. C Cedraschi is a Research and Clinical Psychologist in the Divisions of General Medical Rehabilitation and Clinical Pharmacology and Toxicology, Geneva University Hospitals, Switzerland.,

    Christine Cedraschi

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Correspondence to Anne F Mannion.

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Mannion, A., Balagué, F., Pellisé, F. et al. Pain measurement in patients with low back pain. Nat Rev Rheumatol 3, 610–618 (2007). https://doi.org/10.1038/ncprheum0646

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