Signs Pain Scale Research Articles

Effect of perioperative oral pregabalin on the incidence of post-thoracotomy pain syndrome

Background Chronic post-thoracotomy pain, which is defined as pain that recurs or persists for more than 2 months, is a common problem affecting the quality of life of patients. We have evaluated the efficacy of perioperative pregabalin for reducing postoperative pain and the incidence of chronic post-thoracotomy pain. Patients and methods Sixty patients aged 30-49 years undergoing thoracotomy were allocated randomly to receive either pregabalin (75 mg oral twice daily for 5 days before and 5 days after the operation) or placebo at corresponding times in a double-blinded manner. Both groups received the same anesthetic technique. Our primary target was to measure the incidence of chronic postsurgical pain using the Leeds Assessment of Neuropathic Symptoms and Signs Pain Scale at 3- and 6-month intervals. Morphine consumption was measured as well as the length of hospital stay and the occurrence of postoperative systemic complications. Results Pregabalin decreased the incidence of chronic postoperative pain at 3 and 6 months from 60 and 40% to 10 and 6.7%, respectively. Also, pregabalin decreased the postoperative acute pain intensity as indicated by lower morphine consumption ( P P Conclusion Perioperative pregabalin reduces the incidence of chronic post-thoracotomy pain, with less postoperative morphine consumption together with early hospital discharge.

Cross‐Cultural Psychometric Assessment of the Leeds Assessment of Neuropathic Symptoms and Signs (LANSS) Pain Scale in the Portuguese Population

Chronic pain is a well-known phenomenon. The differential diagnosis between neuropathic and nociceptive pain syndromes is a challenge. Consequently, assessment instruments that can distinguish between these conditions in a standardized way are of the utmost importance. The Leeds Assessment of Neuropathic Symptoms and Signs (LANSS) is a screening tool developed to identify chronic neuropathic pain. The aim of this study was the Portuguese language translation, linguistic adaptation of the LANSS pain scale, its semantic validation, internal consistency, temporal stability, as well its validity and discriminative power. LANSS Portuguese version scale was applied to 165 consecutive patients attending the pain clinic: 103 fulfilled the clinical criteria for the diagnosis of pain of neuropathic origin and the remaining 62 fulfilled the criteria for nociceptive pain. The scale proved to be an internally consistent (Cronbach's alpha=0.78) and reliable instrument with good test-retest stability (r=0.7; P<0.001). However, its validity and specificity with a cutoff point of ≥12, for differentiating patients with neuropathic pain from those with non-neuropathic pain, had 89% sensitivity, 74% specificity, positive predictive value of 85%, and negative predictive value of 81%. The Portuguese LANSS version pain scale properties lead us to the conclusion that such a cross-cultural version is a reliable and valid instrument for the differentiation of this type of pain. Its usage is recommended.

Use of S-LANSS, a Tool for Screening Neuropathic Pain, for Predicting Postherpetic Neuralgia in Patients After Acute Herpes Zoster Events: A Single-Center, 12-Month, Prospective Cohort Study

Postherpetic neuralgia (PHN) is one of the most severe sequelae of herpes zoster events. Several risk factors have been reported for PHN, including old age, severe skin rash, and intense pain. This study therefore aims to evaluate the usefulness of the Self-completed Leeds Assessment of Neuropathic Symptoms and Signs pain scale (S-LANSS) in conjunction with previously reported risk factors for predicting PHN. A group of herpes zoster patients (N = 305) were included in the cohort study. Subjects were asked for their demographic information, clinical symptoms and signs, intensity of pain by visual analog scale (VAS), and S-LANSS. They were followed up in clinical visits or via telephone for 12 months. Nineteen patients (6.2%) suffered from PHN in this study. Using logistic regression, 3 risk factors for PHN were identified: age ≥70 years, high VAS scores, and high S-LANSS scores. Prediction of PHN using VAS (≥8) and S-LANSS (≥15) criteria achieved a sensitivity of 78.9% and specificity of 78.0%. Prediction of PHN in elderly patients (≥70 years), using the criteria of VAS (≥6) and S-LANSS (≥15) as well, achieved 100% sensitivity and 57.1% specificity. S-LANSS could be a useful prediction tool for PHN, particularly if combined with previously well-known risk factors and VAS. PerspectiveAmong acute herpes zoster patients, subjects with characteristics of neuropathic pain showed high frequency of PHN. The tools for screening neuropathic pain like S-LANSS could be helpful for predicting PHN and enabling early intervention of pain management.

Identification of neuropathic pain in patients with neck/upper limb pain: Application of a grading system and screening tools

The Neuropathic Pain Special Interest Group (NeuPSIG) of the International Association for the Study of Pain has proposed a grading system for the presence of neuropathic pain (NeP) using the following categories: no NeP, possible, probable, or definite NeP. To further evaluate this system, we investigated patients with neck/upper limb pain with a suspected nerve lesion, to explore: (i) the clinical application of this grading system; (ii) the suitability of 2 NeP questionnaires (Leeds Assessment of Neuropathic Symptoms and Signs pain scale [LANSS] and the painDETECT questionnaire [PD-Q]) in identifying NeP in this patient cohort; and (iii) the level of agreement in identifying NeP between the NeuPSIG classification system and 2 NeP questionnaires. Patients (n=152; age 52±12years; 53% male) completed the PD-Q and LANSS questionnaire and underwent a comprehensive clinical examination. The NeuPSIG grading system proved feasible for application in this patient cohort, although it required considerable time and expertise. Both questionnaires failed to identify a large number of patients with clinically classified definite NeP (LANSS sensitivity 22%, specificity 88%; PD-Q sensitivity 64%, specificity 62%). These lowered sensitivity scores contrast with those from the original PD-Q and LANSS validation studies and may reflect differences in the clinical characteristics of the study populations. The diagnostic accuracy of LANSS and PD-Q for the identification of NeP in patients with neck/upper limb pain appears limited.

Diagnostic accuracy of two questionnaires for the detection of neuropathic pain in the Spanish population

Several questionnaires have been developed for the detection of neuropathic pain. This study aimed to compare the diagnostic accuracy of the Leeds Assessment of Neuropathic Symptoms and Signs (LANSS) pain scale and the Douleur Neuropathique en 4 questions (DN4) questionnaire for the detection of peripheral neuropathic pain in the Spanish population, and to analyse in detail the diagnostic quality of each item in these questionnaires. A total of 192 patients were enrolled. We compared the validity of the DN4 and LANSS questionnaires by studying sensitivity and specificity and using receiver operating characteristic (ROC) curve analysis. We also analysed the validity of each item in the questionnaires. The sensitivity of the DN4 questionnaire with an accepted cut-off value of ≥ 4 was 95.04% and that of the LANSS questionnaire with an accepted cut-off value of ≥ 12 was 80.17%. The specificity of the DN4 instrument was 97.18% and that of the LANSS instrument was 100%. The estimated area under the ROC curve (95% confidence interval) was 0.989 (0.977-1) for the DN4 instrument and 0.973 (0.956-0.991) for the LANSS questionnaire. The area under the ROC curve was significantly larger for the DN4 than the LANSS questionnaire (p < 0.05). Analyses of specific items showed that tingling and numbness in the DN4 tool, and light touch pain and altered pinprick threshold in the LANSS scale, were the most important features of neuropathic pain. These results show that although both questionnaires are good screening tools, the DN4 questionnaire is particularly recommended for identifying patients with neuropathic pain in clinical practice and research studies.

Neuropathic Pain in Spinal Cord Injury

Background: Several studies have described pain prevalence, risk factors, pain and medical variables in spinal cord injury (SCI) populations. In this study on traumatic SCI in Turkey, we surveyed the neuropathic pain experiences during in-patient rehabilitation and defined the relationships between neuropathic pain and demographic and SCI characteristics of patients. Objectives: To survey the neuropathic pain experiences during in-patient rehabilitation in traumatic SCI and to define the relationships between neuropathic pain and demographic and SCI-related characteristics of patients. Study Design: Descriptive study. Setting: Physicial Medicine and Rehabilitation inpatient clinic, Ankara, TUrkey Methods: Sixty-nine SCI patients as inpatients were included in this descriptive study. All patients demographic and SCI-related characteristics were enrolled. The diagnosis of neuropathic pain was made with the Leeds Assessment of Neuropathic Symptoms and Signs (LANSS) Pain Scale. Location of pain and pain description, relation to time and severity according to McGill Pain Questionnaire (MPQ) were enrolled. Results: The neuropathic pain localization was below the lesion level in 67 (97.1%) and at the lesion level in 2 (2.9%) patients. The pain was at the hip and leg regions in 36 (52.2%) patients. The neuropathic pain was defined as burning in 27 (39.1%), aching in 26 (37.7%), sharp in 4 (5.8%), stinging in 3 (4.3%), and cramping in 3 (4.3%). We did not find a significant difference between demographic and SCI-related characteristics and the localization of neuropathic pain for the patients (P &gt; 0.05). There was no significant difference according to pain description by MPQ and pain localization (P &gt; 0.05). We found a significant relationship between the patient’s lesion level and the region of pain (P &lt; 0.05). Conclusion: We found the neuropathic pain due to SCI to be mostly below the lesion level with a burning or aching character and we did not find a significant relationship between the demographic and SCI-related characteristics of the patient and the pain characteristics. Key words: Spinal cord injury, pain, neuropathic pain

Translation and Linguistic Validation of the Self‐Completed Leeds Assessment of Neuropathic Symptoms and Signs (S‐LANSS) Scale for Use in a Libyan Population

The Leeds Assessment of Neuropathic Symptoms and Signs (LANSS) pain scale is used to identify pain of neuropathic origin and has been validated as a self-completed tool (S-LANSS). We translated the S-LANSS into Arabic and evaluated its reliability and linguistic validity for use by Libyan people. Thirteen of 45 Libyan nationals living in the UK were identified as having chronic pain and completed an English and Arabic S-LANSS 1 week apart. In addition, 23 of 104 respondents to a telephone interview in Derna City, Libya, were identified as having chronic pain and completed the Arabic S-LANSS. Seven of these 23 completed the S-LANSS again 1 week later. Cronbach's alpha was 0.72 (P < 0.001) for the Arabic S-LANSS and 0.71 (P < 0.001) for the English S-LANSS. There was good measurement of agreement of individual items in Arabic and English S-LANSS tools with kappa coefficients ranging from 0.69 to 1.00. Twelve of the 23 (52.2%) individuals with chronic pain scored 12 or more on the Arabic S-LANSS and were classified as possibly having neuropathic pain. There was good measurement of agreement of individual items in Arabic S-LANSS tools with kappa coefficients ranging from 0.462 to 1.00. There were strong intraclass correlations in both versions for test-retest reliability of total score. The Arabic S-LANSS is reliable and linguistically valid to use in Libya. Our translation of the S-LANSS into Arabic was shown to be linguistically valid and reliable for use in a Libyan population.

The Prevalence And Management Of Pain In Gynaecological Malignancy Within The Outpatient Setting

Objectives: Despite pain being a common symptom in gynaecological malignancies there is limited literature on accurate rates of prevalence or current management. Our aim was to investigate these issues to establish integrated pain pathways with our oncology colleagues. This information would also be considered in future research for the development of cancer specific pain pathways.Method: We recorded pain scores from those attending gynaecology outpatient clinics in our tertiary cancer referral hospital. The characteristics of the pain and its management were assessed using the Brief Pain Inventory, the self-assessed Leeds Assessment of Neuropathic Symptoms and Signs pain scale and the Pain Management Index. We also investigated associated risk factors (age, tumor site, cancer treatment types) in presence and severity of pain.Results: Of all patients investigated, 38% were in pain from any cause with 80% of these patients scoring their pain as moderate to severe. Background pain lasted for more than three months in 75% of patients with pain whilst 42% complained of breakthrough pains of similar duration. Just under half of patients in pain suffered from neuropathic involvement. A negative PMI signifying under-treatment was seen in 63% of patients with pain. Surprisingly the most common cause of pain was from non-cancer causes. Over half of patients in pain accepted post-study assistance when offered. We could not identify any associated risk factors.Conclusions: Patients with gynaecological malignancies in the outpatient setting commonly experience pain which is chronic and undertreated. Many also have complicating neuropathies which would benefit from specialist input. We recommend that all patients attending gynaecological cancer outpatient clinics should be routinely assessed for pain to improve cancer management. This information is to be incorporated in future cancer specific pain pathways. Grant: The Royal Marsden Hospital NHS Foundation Trust

Prevalence of Peripheral Neuropathy and Painful Peripheral Neuropathy in Turkish Diabetic Patients

The aim of this study was to determine the prevalence of diabetic peripheral neuropathy (DPN) and neuropathic pain in diabetic patients attending university outpatient clinics in Turkey. In this multicenter cross-sectional study, neurologic examinations and nerve conduction studies along with clinical diabetic neuropathy score, and Leeds Assessment of Neuropathic Symptoms and Signs pain scale were performed on 1,113 patients (46.2% male) from 14 centers. Prevalence of DPN determined only by clinical examination was 40.4% and increased to 62.2%, by combining nerve conduction studies with clinical examination. According to Leeds Assessment of Neuropathic Symptoms and Signs scores, neuropathic pain prevalence was 16.0% in those who reported pain. Poor glycemic control, retinopathy, microalbuminuria, hyperlipidemia, diabetic foot, and foot amputation were more commonly observed in patients with DPN. Clinical DPN affected 40.4% of diabetic patients, and neuropathic pain prevalence in diabetic patient population was 14.0%. Clinical examinations and nerve conduction studies are important components for early detection and accurate diagnosis of DPN and painful DPN.

Prevalence of Neuropathic Pain among Patients with Chronic Low-Back Pain in the Arabian Gulf Region Assessed Using the Leeds Assessment of Neuropathic Symptoms and Signs Pain Scale

This prospective, multicentre, epidemiological study was designed to assess the prevalence of neuropathic pain among adults with chronic low-back pain (LBP) in the Arabian Gulf region. A total of 1134 patients recruited from the outpatient medical setting were assessed using the Leeds Assessment of Neuropathic Symptoms and Signs (LANSS) Pain Scale. A LANSS Pain Scale score ≥ 12 was used to differentiate between patients with a neuropathic contribution to their pain and those with nociceptive pain only. Using this criterion, 628 patients (55%) were classified as having neuropathic pain. Factors associated with neuropathic pain included advanced age, female gender and diabetes with or without hypertension. It was concluded that neuropathic pain is a major contributor to chronic LBP in the Gulf region, and that the LANSS Pain Scale is a practical and rapidly administered screening test for distinguishing the relative contributions of neuropathic and nociceptive pain in patients with chronic LBP that resulted in the use of a more appropriate treatment.

Pregabalin, celecoxib, and their combination for treatment of chronic low-back pain.

BackgroundThe efficacy and safety of the association of celecoxib [a selective cyclooxygenase-2 (COX-2) inhibitor] and pregabalin (commonly used to control neuropathic pain), compared with monotherapy of each, were evaluated for the treatment of chronic low-back pain, a condition known to be due to neuropathic as well as nociceptive pain mechanisms.Materials and methodsIn this prospective randomized trial, 36 patients received three consecutive 4-week treatment regimes, randomly assigned: celecoxib plus placebo, pregabalin plus placebo, and celecoxib plus pregabalin. All patients were assessed by using a visual analogue scale (VAS, 0–100 mm) and the Leeds Assessment of Neuropathic Symptoms and Signs (LANSS) pain scale by an investigator blinded to the administered pharmacological treatment.ResultsCelecoxib and pregabalin were effective in reducing low-back pain when patients were pooled according to LANSS score. The association of celecoxib and pregabalin was more effective than either monotherapy in a mixed population of patients with chronic low-back pain and when data were pooled according to LANSS score. Adverse effects of drug association and monotherapies were similar, with reduced drug consumption in the combined therapy.ConclusionsCombination of celecoxib and pregabalin is more effective than monotherapy for chronic low-back pain, with similar adverse effects.

Factors That Affect the Number of Tender Points in Fibromyalgia and Chronic Widespread Pain Patients Who Did not Meet the ACR 1990 Criteria for Fibromyalgia: Are Tender Points a Reflection of Neuropathic Pain?

This study aims to compare fibromyalgia (FM) and chronic widespread pain (CWP) patients who do not fulfill the criteria for tender points (TP). We included 150 patients diagnosed with FM according to ACR 1990 criteria and 42 patients with CWP who did not fulfill TP criteria for FM into the study. The clinical features of the patients were recorded, and the TP count was determined. By means of a visual analog scale (VAS), all patients were questioned about the severity of pain and FM-related symptoms. In addition, the patients were administered the Duke Anxiety Depression (Duke-AD) scale and somatization symptom questionnaire. Leeds Assessment of Neuropathic Symptoms and Signs (LANSS) pain scale was used to determine the neuropathic pain score. According to VAS, the severity of pain, sleep disturbance, the number of somatization symptoms, LANSS, and Duke-AD scores were significantly higher in FM patients than in patients with CWP (all P values <0.05). The number of TP correlated with severity of pain (r = 0.32, P < 0.001), the number of somatization symptoms (r = 0.26, P = 0.01), sleep disturbance (r = 0.18, P = 0.01), and LANSS score (r = 0.4, P < 0.001). Multiple logistic regression analysis revealed that independent factors that affected the presence of > or =11 TP were the severity of pain on VAS (OR: 1.03, 95% CI: 1.01-1.06, P = 0.045) and LANSS score (OR: 1.36, 95% CI: 1.12-1.62, P = 0.001). CWP patients have symptoms similar to FM patients, though less severe. The most important factor that affects the criteria for fulfilling the number TP in CWP patients is the neuropathic pain score, which suggests that FM is primarily a neuropathic pain syndrome.

Identifying Neuropathic Pain Among Patients With Chronic Low-Back Pain: Use of the Leeds Assessment of Neuropathic Symptoms and Signs Pain Scale

Although the literature contains information about prevalence and incidence of low-back pain (LBP), little information is available about the contribution of the neuropathic element to LBP. Our study was designed to investigate the prevalence of neuropathic pain among a sample of chronic LBP patients in Saudi Arabia by use of the Leeds Assessment of Neuropathic Symptoms and Signs (LANSS) pain scale. A total of 1,169 patients from 117 centers agreed to participate in the study over a period of 6.5 months. The LANSS pain scale was applied to each patient in an interview format. The characteristics of pain and sensory dysfunction were tested and recorded. According to the LANSS pain scale, 639 patients (54.7%) had scores of 12 points or more, which suggested a neuropathic type of pain, and 530 patients (45.3%) had scores of less than 12, which suggested a nociceptive type of pain. Factors that are associated with neuropathic pain are advanced age, female gender, increased height, white race, hypertension and diabetes, a history of smoking, previous back surgery, and previous medications. Neuropathic pain is a major contributor to chronic LBP, and the LANSS pain scale is a useful tool to distinguish patients with neuropathic pain from those with nociceptive pain.

The S-LANSS score for identifying pain of predominantly neuropathic origin: Validation for use in clinical and postal research

This article describes the development and validation of the S-LANSS score, a self-report version of the Leeds Assessment of Neuropathic Symptoms and Signs pain scale. The S-LANSS aims to identify pain of predominantly neuropathic origin, as distinct from nociceptive pain, without the need for clinical examination. Two hundred patients with chronic pain were asked to complete the S-LANSS unaided. A researcher then administered the S-LANSS scale and the Neuropathic Pain Scale (NPS) in interview format. An independent clinician determined the pain type (neuropathic versus nociceptive) and rated his or her certainty about diagnosis. The S-LANSS scale was also incorporated into a chronic pain questionnaire that was sent to 160 community patients and 150 newly referred patients waiting for pain clinic assessment. The S-LANSS scale correctly identified 75% of pain types when self-completed and 80% when used in interview format. Sensitivity for self-completed S-LANSS scores ranged from 74% to 78%, depending on the cutoff score. There were significant associations between NPS items and total score with S-LANSS score. In the postal survey, completed questionnaires were returned by 57% of patients (n = 174). Internal consistency and convergent validity of the survey S-LANSS scores were confirmed. The findings support the S-LANSS scale as a valid and reliable self-report instrument for identifying neuropathic pain and it is also acceptable for use in postal survey research. Perspective Establishing valid measures of symptoms and signs in neuropathic pain will allow standardized comparisons with other investigational measures. This might lead to new insights into the relationship between pathophysiologic mechanisms and clinical manifestations of pain.

Results of the leeds assessment of neuropathic symptoms and signs pain scale in Turkey: A validation study

Abstract Classification of pain and identification of the specific pain mechanisms through utilization of clinical data are helpful to the physician in choosing the appropriate treatment model. For discrimination between different pain types, various tests could be used. The Leeds Assessment of Neuropathic Symptoms and Signs (LANSS) Pain Scale is a scale based on the analysis of data obtained during bedside examination. The LANSS Pain Scale, as first used by Bennett, is a very useful tool that provides immediate information in the clinical setting and helps distinguish nociceptive pain from neuropathic pain. In this study we targeted validation of the LANSS Pain Scale in the Turkish population. A total of 104 patients who consulted the Algology Department of Istanbul Faculty of Medicine Outpatient Clinic were enrolled in our validation study. The sensitivity and specificity of the scale were found to be 89.9% and 94.2%, respectively. These results suggest a high validity level for the Turkish version of the LANSS Pain Scale. We believe that this scale is a useful tool for the differential diagnosis of neuropathic pain and can be used in future pharmacologic studies. Perspective Any measures that aid in differentiating neuropathic pain from nociceptive pain would facilitate effective management of pain. In daily practice the simplicity of the classification method is important. The present study suggests that Turkish version of LANSS can be used for the discrimination between neuropathic and nociceptive types of pain.

Use of the leeds assessment of neuropathic symptoms and signs questionnaire in patients with fibromyalgia

Objective: Neuropathic pain syndrome is characterized by chronic, stimulus-independent pain sensation accompanied by hyperalgesia/allodynia and paresthesia. Fibromyalgia (FM) syndrome displays such features. The Leeds Assessment of Neuropathic Symptoms and Signs (LANSS) Pain Scale is an instrument developed and validated to recognize neuropathic pain and set it apart from nociceptive pain. Methods: This study assessed the responses of patients with FM versus patients with rheumatoid arthritis (RA) to the LANSS Pain Scale questionnaire. Twenty patients with FM and 20 patients with RA answered the Fibromyalgia Impact Questionnaire and LANSS Pain Scale questions related to the following neuropathic sensory disturbance domains: dysesthetic, autonomic, evoked, paroxysmal, and thermal. Results: Pain severity was similar in both groups according to visual analog scale values (5.3 ± 3.0 for FM v 5.4 ± 3.1 for RA). There were sharp differences between FM and RA groups in the percentage of affirmative responses to 4 of 5 sensory disturbance questions: dysesthetic (95 v 30), evoked (95 v 35), paroxysmal (90 v 15), and thermal (90 v 20); P < .0001 for each comparison. Conclusions: The high prevalence of associated sensory disturbances supports the notion that FM is a neuropathic pain syndrome. Clinical Relevance: The LANSS Pain Scale items may become a useful, easily applied bedside test to differentiate FM pain from the nociceptive pain present in RA and in similar arthritic illnesses. Semin Arthritis Rheum 32:407-411. © 2003 Elsevier Inc. All rights reserved.

The LANSS Pain Scale: the Leeds assessment of neuropathic symptoms and signs. (St. Gemma's Hospice, Leeds, United Kingdom) Pain. 2001;92:147–157.

This study described the development and validation of a novel tool for identifying patients in whom neuropathic mechanisms dominate their pain experience. The Leeds assessment of neuropathic symptoms and signs (LANSS) Pain Scale is based on analysis of sensory description and bedside examination of sensory dysfunction, and provides immediate information in clinical settings. It was developed in 2 populations of chronic pain patients. In the first, the use of sensory descriptors and questions were compared in patients with nociceptive and neuropathic pain, combined with an assessment of sensory function. This data was used to derive a 7‐item pain scale, consisting of grouped sensory description and sensory examination with a simple scoring system. The LANSS Pain Scale was validated in a second group of patients by assessing discriminant ability, internal consistency, and agreement by independent raters. Clinical and research applications of the LANSS Pain Scale are discussed.

The LANSS Pain Scale: the Leeds assessment of neuropathic symptoms and signs

This study describes the development and validation of a novel tool for identifying patients in whom neuropathic mechanisms dominate their pain experience. The Leeds assessment of neuropathic symptoms and signs (LANSS) Pain Scale is based on analysis of sensory description and bedside examination of sensory dysfunction, and provides immediate information in clinical settings. It was developed in two populations of chronic pain patients. In the first ( n=60), the use of sensory descriptors and questions were compared in patients with nociceptive and neuropathic pain, combined with an assessment of sensory function. This data was used to derive a seven item pain scale, consisting of grouped sensory description and sensory examination with a simple scoring system. The LANSS Pain Scale was validated in a second group of patients ( n=40) by assessing discriminant ability, internal consistency and agreement by independent raters. Clinical and research applications of the LANSS Pain Scale are discussed.