The Numeric Pain Rating Scale (NPRS) is used to quantify pain on a numerical scale. It is an 11-item scale that ranges from 0 through 10 (sometimes 0-20 or 0-100) to represent pain severity levels from “no pain” to “most intense pain imaginable.
Clinical Considerations
The NPRS may have advantages over a verbal rating scale for its simplicity, and that it does not require understanding of English.
ICF Domain
Body Function ▶ Sensory Function
Administration
The NPRS can be described verbally or as a pen/paper version, the latter commonly as a box-scale.
Number of Items
- 0: No pain
- 10: Worst pain imaginable
Equipment
N/A
Scoring
- Ask the participant to make 3 pain ratings, corresponding to current, best, and worst pain experienced over the past 24 hours.
- Scores range from 0-10 points, with higher scores indicating greater pain intensity. The average of the 3 rating is used.
Languages
English
Training Required
None
Availability
The Numeric Pain Rating Scale (NPRS) worksheet can be found here.
Measurement Property Summary
# of studies reporting psychometric properties: 4
Interpretability
Higher scores indicate greater pain intensity.
- MCID: 1.80 points or 36%
(Hanley et al. 2006; n=82; mean age 41.44 years; level of injury: 54% cervical SCI, 38% thoracic SCI, 7% lumbar/sacral SCI)
- Pooled/weighted MCID: 1.6
(Sobreira et al. 2021; n=57; 36 males, 24 females; mean (SD) age: 54.5 (15.9) years; level of injury: 31 cervical, 19 thoracic, 10 lumbar; ASIA A-D; mean (SD) time since injury: 5.5 (1.47) months)
Typical Values
Cut-off Scores:
- For rating overall pain:
- Mild = 1-3, Moderate = 4-7, Severe = 8-10
- For rating worst pain problem:
- Mild = 1-3, Moderate = 4-6, Severe = 7-10
(Hanley et al. 2006; For questions about general pain: N=307, mean age=43.1 (13.0) years. For questions about worst pain: N=174, mean age=41.6 (13.6) years; inclusion criteria of SCI >6 months)
Reliability – High
- High internal consistency: ICC = 0.95
(Bryce et al. 2007; N=50 health care providers attending the 2006 combined American Spinal Injury Association (ASIA)/International Spinal Cord Society (ISCoS) scientific meeting)
- High test-retest reliability: 100%
(Sobreira et al. 2021; n=57; 36 males, 24 females; mean (SD) age: 54.5 (15.9) years; level of injury: 31 cervical, 19 thoracic, 10 lumbar; ASIA A-D; mean (SD) time since injury: 5.5 (1.47) months)
Validity – Moderate
- Moderate correlation between NPRS and Verbal Rating Scale: r = 0.38
(Dijkers et al. 2010; n=168; mean age 38 years; 10% paraplegia incomplete, 26% paraplegia complete, 45% tetraplegia incomplete, 19% tetraplegia complete)
Responsiveness
No values were reported for the responsiveness of the NPRS for the SCI population.
Floor/Ceiling Effect
No values were reported for the presence of floor/ceiling effects in the NPRS for the SCI population.
Reviewers
Jane Hsieh, Dr. Carlos Leonardo Cano-Herrera, Matthew Querée
Date Last Updated
31 December 2024
Dijkers M. Comparing quantification of pain severity by verbal rating and numeric rating scales. J Spinal Cord Med. 2010;33(3):232-42. doi: 10.1080/10790268.2010.11689700.
https://pubmed.ncbi.nlm.nih.gov/20737796/
Hanley MA, Masedo A, Jensen MP, Cardenas D, Turner JA. Pain interference in persons with spinal cord injury: classification of mild, moderate, and severe pain. J Pain. 2006 Feb;7(2):129-33. doi: 10.1016/j.jpain.2005.09.011.
https://pubmed.ncbi.nlm.nih.gov/16459278/
Hanley MA, Jensen MP, Ehde DM, Robinson LR, Cardenas DD, Turner JA, Smith DG. Clinically significant change in pain intensity ratings in persons with spinal cord injury or amputation. Clin J Pain. 2006 Jan;22(1):25-31. doi: 10.1097/01.ajp.0000148628.69627.82. PMID: 16340590.
https://pubmed.ncbi.nlm.nih.gov/16340590/
Sobreira M, Almeida MP, Gomes A, Lucas M, Oliveira A, Marques A. Minimal Clinically Important Differences for Measures of Pain, Lung Function, Fatigue, and Functionality in Spinal Cord Injury. Phys Ther. 2021 Feb 4;101(2):pzaa210. doi: 10.1093/ptj/pzaa210.
https://pubmed.ncbi.nlm.nih.gov/33336700/
