Exploring Established Cut-Off Points for Pain Levels in the Numeric Rating Scale: Insights From a Literature Overview.

Purpose: Measuring pain in various settings, such as hospitals or long-term care facilities, is commonly done through the use of numerical pain assessment scales, e.g. the Numeric Rating Scale. While cut-off points are already used in daily practice for pain management and quality monitoring, a better understanding of these thresholds is needed.The aim of this study is to identify cut-off points for different pain intensities on the Numeric Rating Scale in the existing Literature.

Design: Literature study.

Methods: The literature search aimed to identify articles that establish independent cut-off points for pain levels on the Numeric Rating Scale. PubMed and Embase were searched using an identical search string. Additionally, the grey literature was reviewed on Google Scholar. Papers were screened for relevancy using Rayyan. The data was extracted using a data abstraction manual and synthesised to describe the findings.

Results: A total of 21 papers were included in the overview of pain cut-off points. The identified cut-off points for pain vary widely across studies, with definitions of pain encompassing between one and five levels. Values for mild pain ranged between scores 0 and 5, with the most cited range being 1-4. Moderate pain ranged from 3 to 8, with 4-8 as the most cited range. Severe pain ranged from 5 to 10, with the most popular category of 7-10. There was little consistency between studies even within similar populations, highlighting the lack of consensus. A debate persists regarding the use of a single cut-off point versus a range, with some studies advocating for overlapping ranges while others support nonoverlapping thresholds.

Conclusion: Establishing a cut-off value for pain is challenging, with no consensus in the literature on what constitutes optimal values. This variability may be attributed to differences in study populations, pain type and study methodologies. This emphasizes the need for alternative assessment tools or the inclusion of additional measures alongside the NRS. It is crucial to reassess the current pain assessment guidelines that continue to rely on these cut-off points in clinical practice, as well as to reconsider policies that use cut-offs for quality monitoring.