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Moving Beyond the Limitations of the Visual Analog Scale for Measuring Pain: Novel Use of the General Labeled Magnitude Scale in a Clinical Setting

González-Fernández, Marlís MD, PhD; Ghosh, Nilasha BA; Ellison, Tambrea MD; McLeod, Julia C. MBBS (Hons I); Pelletier, Cathy A. PhD; Williams, Kayode MD, MBA

American Journal of Physical Medicine & Rehabilitation: January 2014 - Volume 93 - Issue 1 - p 75–81
doi: 10.1097/PHM.0b013e31829e76f7
Case Report

Objective: Quantifying pain intensity is challenging, particularly for patients with chronic pain. The visual analog scale (VAS) is limited by ceiling effects that often leave patients with no ability to quantify worsening pain. The goal of this study was to determine whether the general Labeled Magnitude Scale (gLMS) can be feasibly used to measure pain clinically while overcoming limitations of the VAS.

Design: Eighty patients (mean age, 53.7 yrs) scheduled for evaluation of a painful complaint were asked to rate their current pain using the gLMS and the VAS. The time necessary to administer the gLMS was recorded to determine feasibility. The difference in rating between the two scales (VAS and gLMS) was the main outcome measure.

Results: After scaling and rounding off the gLMS scores for direct comparison, it was found that the gLMS scores were significantly lower than the corresponding VAS scores by a mean of 1.78 (P < 0.001). The mean time to administer the gLMS was 2.66 mins.

Conclusions: These results suggest that the gLMS has great potential and can be feasibly used to measure pain intensity clinically. The gLMS scores were consistently lower than the VAS scores, thus reducing the ceiling effect and allowing range at the high end of the scale for rating worsening pain.

From the Department of Physical Medicine and Rehabilitation (MG-F, TE) and Department of Anesthesiology and Critical Care Medicine (KW), Johns Hopkins University School of Medicine, Baltimore, Maryland; School of Medicine, University of California, Irvine (NG); Department of Internal Medicine and Aged Care, Royal Brisbane and Women’s Hospital, Brisbane, Australia (JCM); and Charlestown Retirement Community, Catonsville, Maryland (CAP).

All correspondence and requests for reprints should be addressed to Marlís González-Fernández, MD, PhD, Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, 600 North Wolfe St, Phipps 174, Baltimore, MD 21287.

Financial disclosure statements have been obtained, and no conflicts of interest have been reported by the authors or by any individuals in control of the content of this article.

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