Brazilian Journal of Pain
https://brjp.org.br/article/doi/10.63231/2595-0118.e202685-en
Brazilian Journal of Pain
Original Article

Measurement properties of the pain numerical rating scale in Brazilian children and adolescents with musculoskeletal pain

Propriedades de mensuração da escala numérica de avaliação da dor em crianças e adolescentes brasileiros com dor musculoesquelética

Yasmin Souza; Verônica Santos; Tiê Yamato

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Abstract

BACKGROUND AND OBJECTIVES: Musculoskeletal pain is highly prevalent among children and adolescents and may negatively impact physical function, participation in daily activities, and quality of life. Reliable and valid instruments are essential for accurately assessing pain intensity and monitoring clinical outcomes in both research and clinical practice. Although the Pain Numerical Rating Scale (PNRS) is widely used, evidence regarding its measurement properties in Brazilian children and adolescents with musculoskeletal pain remains limited. Therefore, this study aimed to test the measurement properties related to reliability and construct validity of the PNRS in children and adolescents with musculoskeletal pain.

METHODS: We conducted a methodological study to evaluate the measurement properties of the PNRS. Children and adolescents with musculoskeletal pain were recruited from public schools. Data were collected using self-reported questionnaires. Test-retest reliability was evaluated using the Intraclass Correlation Coefficient (ICC) and the Measurement error was evaluated using Standard Error of Measurement (SEM) and Minimal Detectable Change (MDC). The hypothesis testing of construct validity was measured using a Pearson Correlation (r) between the PNRS and the Brief Pain Inventory.

RESULTS: A sample of 153 children and adolescents with musculoskeletal pain and with a mean age of 16.0 years old (Standard Deviation (SD): 2.7) were included in this study. Test-rest reliability by ICC was of 0.71 (95% Confidence Interval (CI): 0.62 to 0.78). The SEM was 1.74 (15.8%), with an MDC of 3.66 points. The hypothesis testing of construct validity was confirmed with 90% by prior hypotheses. Children and adolescents with disabling musculoskeletal pain reported more intense pain than children and adolescents with musculoskeletal pain (mean difference 1.9 (95% CI: 2.65 to 1.15)).

CONCLUSION: The PNRS demonstrated adequate reliability and construct validity for assessing pain intensity in children and adolescents with musculoskeletal pain, supporting its use in clinical and research settings., considering the Brazilian context; however, caution is needed with the MDC values.

Keywords

Adolescent; Children; Disability; Musculoskeletal pain

Resumo

JUSTIFICATIVA E OBJETIVOS: A dor musculoesquelética é altamente prevalente em crianças e adolescentes e pode impactar negativamente a função física, a participação em atividades diárias e a qualidade de vida. Instrumentos confiáveis e válidos são essenciais para avaliar adequadamente a intensidade da dor e monitorar desfechos clínicos na prática clínica e em pesquisas. Embora a Escala Numérica de Dor (END) seja amplamente utilizada, ainda existem evidências limitadas sobre suas propriedades de medida em crianças e adolescentes brasileiros com dor musculoesquelética. Portanto, este estudo teve como objetivo testar as propriedades de medida relacionadas à confiabilidade e à validade de construto da Escala Numérica de Dor em crianças e adolescentes com dor musculoesquelética.

MÉTODOS: Foi realizado um estudo metodológico para avaliar as propriedades de medida da END. Crianças e adolescentes com dor musculoesquelética foram recrutados em escolas públicas. Os dados foram coletados por meio de questionários de autorrelato. A confiabilidade teste-reteste foi avaliada pelo Coeficiente de Correlação Intraclasse (CCI), e o erro de medida foi avaliado pelo Erro Padrão de Medida (EPM) e pela Mudança Mínima Detectável (MMD). O teste de hipóteses para validade de construto foi mensurado por meio da correlação de Pearson (r) entre a END e o Brief Pain Inventory.

RESULTADOS: Uma amostra de 153 crianças e adolescentes com dor musculoesquelética, com idade média de 16,0 anos (Desvio Padrão [DP]: 2,7), foi incluída neste estudo. A confiabilidade teste-reteste apresentou CCI de 0,71 (Intervalo de Confiança de 95% [IC95%]: 0,62 a 0,78). O EPM foi de 1,74 (15,8%), com uma MMD de 3,66 pontos. O teste de hipóteses para validade de construto confirmou 90% das hipóteses previamente estabelecidas. Crianças e adolescentes com dor musculoesquelética incapacitante relataram dor mais intensa do que aqueles com dor musculoesquelética não incapacitante (diferença média de 1,9 pontos; IC95%: 1,15 a 2,65).

CONCLUSÃO: A END demonstrou confiabilidade e validade de construto adequadas para avaliar a intensidade da dor em crianças e adolescentes com dor musculoesquelética, apoiando seu uso em contextos clínicos e de pesquisa no contexto brasileiro; entretanto, é necessário cautela na interpretação dos valores de MMD.

Palavras-chave

Adolescente; Crianças; Dor musculoesquelética; Incapacidade

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Submitted date:
07/13/2025

Accepted date:
06/10/2026

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