Psychometric Properties of the Numerical Rating Scale to Assess Self-Reported Pain Intensity in Children and Adolescents: A Systematic Review

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The Numerical Rating Scale-11 (NRS-11) is one of the most widely used scales to assess self-reported pain intensity in children, despite the limited information on its psychometric properties for assessing pain in pediatric populations. Recently, there has been an increase in published findings regarding the strengths and weaknesses of the NRS-11 as a measure of pain in youths. The purpose of this study was to review this research and summarize what is known regarding the reliability and validity of the NRS-11 as a self-report measure of pediatric pain intensity.


A literature search was conducted using PubMed, PsycINFO, CINAHL, and the Psychology and Behavioral Sciences Collection from their inception to February 2016.


A total of 382 articles were retrieved, 301 were screened for evaluation, and 16 were included in the review. The findings of reviewed studies support the reliability and validity of the NRS-11 when used with children and adolescents.


Additional research is needed to clarify some unresolved questions and issues, including (1) the minimum age that children should have to offer valid scores of pain intensity and (2) the development of consensus regarding administration instructions, in particular with respect to the descriptors used for the upper anchor. On the basis of available information, the NRS-11 can be considered to be a well-established measure for use with pediatric populations.

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