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What’s the score in pain assessment?

Carl L von Baeyer
Med J Aust 2012; 196 (6): . || doi: 10.5694/mja12.10314
Published online: 2 April 2012

Carl von Baeyer explores realistic pain assessment when self-report conflicts with observation and context

Self-report measures of pain intensity provide important primary outcomes in randomised trials of pain-relieving interventions. Scores from numerical, visual analogue, and other scales serve well in comparing group outcomes.1 But in the context of individual clinical treatment, certain catchphrases are commonly employed. Self-report of pain is “the gold standard”. Pain intensity scores are “the fifth vital sign”. Analgesic decisions are sometimes based on an “algorithm” that includes self-report of pain. Although such concepts help to draw attention to pain management, each one contributes to oversimplification of the process of assessing pain.


  • University of Saskatchewan, Saskatoon, Saskatchewan, Canada.


Correspondence: carl.vonbaeyer@usask.ca

Competing interests:

No relevant disclosures.

  • 1. Dworkin RH, Turk DC, Farrar JT, et al. Core outcome measures for chronic pain clinical trials: IMMPACT recommendations. Pain 2005; 113: 9-19.
  • 2. IASP Task Force on Taxonomy. Part III: Pain terms, a current list with definitions and notes on usage. In: Merskey H, Bogduk N, editors. Classification of chronic pain. 2nd ed. Seattle: IASP Press, 1994: 209-214.
  • 3. Berde C, McGrath P. Pain measurement and Beecher’s challenge: 50 years later. Anesthesiol 2009; 111: 473-474.
  • 4. Schiavenato M, Craig KD. Pain assessment as a social transaction: beyond the “gold standard”. Clin J Pain 2010; 26: 667-676.
  • 5. Pasero C, McCaffery M. Pain assessment and pharmacologic management. St. Louis, Mo: Mosby, 2011.

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