A Comparison of Visual Analog and Graphic Rating Scales for Assessing Pain Following Delayed Onset Muscle Soreness

This study evaluated a visual analog scale (VAS) and a graphic rating scale (GRS) for the measurement of pain following delayed onset muscle soreness (DOMS) and following treatment for the symptoms of DOMS. Data from two studies were used to evaluate the scales. Pain intensity was assessed prior to and following induction of DOMS and immediately before and after each treatment session. In Study 1, subjects were randomly assigned to receive a 20min ice pack followed by a 7-min sham ultrasound treatment or a 20-min ice pack followed by a 7min nonthermal ultrasound treatment. In Study 2, subjects received a 20-min microcurrent neuromuscular stimulation (MENS) treatment or a 20-min sham MENS treatment. In both studies, significant differences were found between the VAS and GRS scales for pretest conditions on Days 1 and 2 for all subjects. There were no significant differences between any other days or tests. The differences on Day 1 and Day 2 were attributed to the novelty of filling out the scales. Therefore, a visual analog or graphic rating scale can be used to evaluate pain intensity following DOMS when repeated measurement is involved, although consideration should be given to potential differences the first one or two times the scales are completed. Article: The measurement of pain intensity is common in clinical and experimental settings. The study of descriptive rating scales originated in psychological and medical experimentation (11, 16), and variations of these scales are commonly used in the clinical setting. For example, athletic trainers frequently ask athletes to * C.G. Mattacola was a doctoral student at the University of Virginia, Charlottesville, at the time of this study and is now with the Department of Physical Education, Temple University, Philadelphia, PA 19122. D.H. Perrin and B.M. Gansneder are with the Curry School of Education, University of Virginia. J.D. Allen was a student at the University of Virginia at the time of this study and is now a student at Shenandoah University, Winchester, VA. C.A. Mickey was a student at the University of Virginia at the time of this study and is now with Waynesburg College, Pittsburgh. Figure 1— Visual Analog Scale and Graphic Rating Scale. rate their pain arbitrarily from 1 to 10 to assess the effectiveness of a treatment intervention. The visual analog scale (VAS) and graphic rating scales (GRS) are two common measurement instruments used in this setting (Figure 1). The VAS consists of a line of specified length (usually 10 cm) that has polar descriptors at its two extremes. The left end of the VAS is signified by the category of no pain and the right end by unbearable pain. The VAS offers a continuous spectrum with which to quantify subjectively the intensity of a pain stimulus (12, 15, 19). The GRS is similar to the VAS except that it contains descriptors placed at equal intervals along the base of the scale, The GRS contains, from left to right, categories of descriptors such as no pain, dull ache, slight pain, more slight pain, painful, very painful, and unbearable pain. It has been suggested that these descriptors may lack sufficient sensitivity to measure the pain experience (12). It has been suggested that the placement of descriptors along the base of the scale creates an expression of the pain experience or intensity (10) and forces a patient to transform feelings into words (19), It has also been stated that the use of descriptor scales results in an artificial augmentation of the effect of treatment (19). Despite these criticisms, graphic rating scales are frequently used to measure the intensity of pain, especially when assessing pain following experimental inducement of delayed onset muscle soreness (5-7). Our study was designed to determine if a difference existed between a visual analog scale and a graphic rating scale for measurement of pain intensity. Data from two studies that used an experimental model of delayed onset muscle soreness (DOMS) were used for this comparison. To our knowledge, this is the first comparison of a VAS and a GRS using a model of DOMS. METHODS All subjects volunteered and gave informed consent to participate in the investigation. The subjects had no history of upper extremity injury, surgery, or disease and had not participated in a weight-training program in the previous 6 months.