Comparison of Visual Analog Pain Score Reported to Physician vs Nurse

Foot Ankle Int. 2018 Mar;39(3):300-303. doi: 10.1177/1071100717740584. Epub 2017 Nov 21.


Background: The visual analog scale (VAS) is considered a reliable and validated measure of patient-reported acute pain. Patient-reported outcome measures are becoming the standard of care throughout the orthopedic community, but interpretation and clinical applications are still under investigation. The aim of the current study was to compare preoperative patient-reported VAS scores reported at the same visit to nursing staff and the treating surgeon. Our hypothesis was that there would be no difference in the scores reported.

Methods: This study is a retrospective cohort of 201 consecutive foot and ankle patients treated by a single surgeon. The patients were asked to rate their pain intensity by the nursing staff and then by the surgeon using a standard horizontal VAS 0 to 10, from "no pain" to the "worst pain." Differences in reported pain values were analyzed.

Results: The results demonstrate that patients reported higher pain scores to the surgeon in 81% of the encounters, nursing staff 8%, and equal 11%. On average, the VAS score reported to the surgeon was significantly ( P < .05) higher than that reported to the nursing staff.

Conclusion: The current study found a statistically significant higher patient-reported pain score to the treating surgeon compared to the nursing staff. While the exact cause is unclear, the discrepant pain scores call into question the validity of the VAS, considered a fifth vital sign and standard outcome measure in an outpatient clinic setting.

Level of evidence: Level III, comparative study.

Keywords: foot and ankle; pain; patient-reported outcome measures; visual analog scale.

Publication types

  • Comparative Study

MeSH terms

  • Adult
  • Aged
  • Ankle Joint / physiopathology
  • Ankle Joint / surgery
  • Cohort Studies
  • Female
  • Foot / physiopathology
  • Foot / surgery
  • Humans
  • Male
  • Middle Aged
  • Orthopedic Nursing*
  • Orthopedic Procedures / adverse effects
  • Orthopedic Procedures / methods*
  • Orthopedic Surgeons*
  • Pain Measurement*
  • Pain, Postoperative / diagnosis*
  • Patient Reported Outcome Measures*
  • Postoperative Period
  • Preoperative Period
  • Retrospective Studies
  • Risk Assessment