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Visual Analog Scale (VAS)
Please visit this website for more information about the instrument: Visual Analogue Scale  
Supplementary: Cerebral Palsy (CP)
Short Description of Instrument
The Visual Analog Scale (VAS) is a validated, subjective measure for acute and chronic pain. The scale provides a graphic representation of pain intensity by marking a point on a 10-cm line anchored by 2 extremes of pain: "no pain" and "pain as bad it could be" (Jensen et al., 1986).
Comments/Special Instructions
In a summary of self-report pain scales, Jensen and Karoly (2001) describe the 3 most used single-item methods to measure pain intensity. (1) Verbal rating scales (VRS) consist of a series of descriptive words (e.g., "no pain" to "severe pain"). (2) Visual analog scales generally consist of a 10-cm line with anchor terms at each end (e.g., "no pain" or "lack of any pain" at one end versus "severe pain" or "pain as bad as it could be" at the other end). Subjects may mark any point along the line and scoring may range from the nearest centimeter (0-10) to the nearest millimeter (0-100). (3) Numeric rating scales ask subjects to rate their pain using numbers, usually 0 to 10 (11 points) or 0 to 20 (21 points). However, other versions have been trialed in children, with the 100mm most used. (Stinson et al., 2006)
CP-specific Pain Category: Pain intensity
CP-specific ICF Domain: Body Functions (World Health Organization, 2001)
Scoring and Psychometric Properties
Scoring: Scores are recorded by making a handwritten mark on a 10-cm line that represents a continuum between "no pain" and "worst pain". The scale is scored by measuring the distance from the "no pain" end to the patient's mark (Jensen et al., 1986).
Psychometric Properties: The VAS scale has been extensively studied in children as a measure of acute pain intensity with good acceptability, responsivity, and validity (Stinson et al., 2006). The reported repeatability coefficient (a measure of test-retest reliability) of the VAS in children 8-17 years of age with acute pain is 10-16 mm on a 100-mm paper VAS (Powell et al., 2001; Bailey et al., 2012).  The VAS intraclass correlation coefficient and coefficient of repeatability estimates in a study of acute pain among children was acceptable (0.79 and ±2.29) (LeMay et al., 2018). Reliability of the VAS in children with chronic pain is not well established.  
The psychometric properties of the VAS for measuring chronic pain intensity in children with CP in not known. However, the VAS was used in numerous studies to assess acute pain management in children with CP (Ostojic et al., 2019) and was used in 2 interventional studies of young children with CP and complex motor disorders (Misra et al., 2015; Libzon et al., 2018).
Strengths: The VAS is quick and easy to administer. The Pediatric Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials (PedIMMPACT) recommend the VAS as a measure of pain intensity in children and youth with chronic and recurrent pain (McGrath et al., 2008). The VAS has also been shown to be reliable for acute pain measurement in children (Bailey et al., 2012). The VAS is applicable to children and youth with CP with all levels of mobility (Gross Motor Function Classification System I-V) (Schiariti and Oberlander, 2019).
Weaknesses: VAS can be difficult to administer to patients with perceptual-motor problems. It is not specifically validated in CP but has been extensively used. There is a lack of standardization regarding the name for the anchors, length of the line, and orientation of the line (vertical or horizontal) for children with many versions existing (Stinson et al., 2006).  
Key References:
McGrath PJ, Walco GA, Turk DC, Dworkin RH, Brown MT, Davidson K, Eccleston C, Finley GA, Goldschneider K, Haverkos L, Hertz SH, Ljungman G, Palermo T, Rappaport BA, Rhodes T, Schechter N, Scott J, Sethna N, Svensson OK, Stinson J, von Baeyer CL, Walker L, Weisman S, White RE, Zajicek A, Zeltzer L; PedIMMPACT. Core outcome domains and measures for pediatric acute and chronic/recurrent pain clinical trials: PedIMMPACT recommendations. J Pain. 2008 Sep;9(9):771-83.
Stinson JN, Kavanagh T, Yamada J, Gill N, Stevens B. Systematic review of the psychometric properties, interpretability and feasibility of self-report pain intensity measures for use in clinical trials in children and adolescents. Pain. 2006 Nov;125(1-2):143-57.
Additional References:
Bailey B, Gravel J, Daoust R. Reliability of the visual analog scale in children with acute pain in the emergency department. Pain. 2012 Apr;153(4):839-842.
Jensen MP, Karoly P, Braver S. The measurement of clinical pain intensity: a comparison of six methods. Pain. 1986 Oct;27(1):117-126.
Jensen MP, Karoly P. Self-report scales and procedures for measuring pain in adults. In: Turk D, Melzack R, editors. Handbook of pain assessment. New York: Guilford Press; 2001:15-34.
Le May S, Ballard A, Khadra C, Gouin S, Plint AC, Villeneuve E, Mâsse B, Tsze DS, Neto G, Drendel AL, Auclair MC, McGrath PJ, Ali S. Comparison of the psychometric properties of 3 pain scales used in the pediatric emergency department: Visual Analogue Scale, Faces Pain Scale-Revised, and Colour Analogue Scale. Pain. 2018 Aug;159(8):1508-1517.
Letzkus L, Fehlings D, Ayala L, Byrne R, Gehred A, Maitre NL, Noritz G, Rosenberg NS, Tanner K, Vargus-Adams J, Winter S, Lewandowski DJ, Novak I. A Systematic Review of Assessments and Interventions for Chronic Pain in Young Children with or at High Risk for Cerebral Palsy. J Child Neurol. 2021 Aug;36(9):697-710.
Libzon S, Schleider LB, Saban N, Levit L, Tamari Y, Linder I, Lerman-Sagie T, Blumkin L. Medical Cannabis for Pediatric Moderate to Severe Complex Motor Disorders. J Child Neurol. 2018 Aug;33(9):565-571.
Ostojic K, Paget SP, Morrow AM. Management of pain in children and adolescents with cerebral palsy: a systematic review. Dev Med Child Neurol. 2019 Mar;61(3):315-321.
Powell CV, Kelly AM, Williams A. Determining the minimum clinically significant difference in visual analog pain score for children. Ann Emerg Med. 2001 Jan;37(1):28-31.
Schiariti V, Oberlander TF. Evaluating pain in cerebral palsy: comparing assessment tools using the International Classification of Functioning, Disability and Health. Disabil Rehabil. 2019 Nov;41(22):2622-2629.
World health Organization (2001). International Classification of Functioning, Disability and Health (ICF) Retrieved 19August2021
Document last updated August 2022