A comparative analysis of four pain rating scales in the assessment of acute oral and maxillofacial pain

Various pain assessment scales, including the Visual Analog Scale (VAS), Numerical Rating Scale (NRS), Verbal Rating Scale (VRS), and Wong-Baker Faces Scale (WBS), are commonly used, yet their comparative effectiveness in maxillofacial pain remains unclear. This study aims to compare four commonly used pain scales—VAS, NRS, VRS, and WBS—and evaluate their correlation and agreement in adult patients presenting with acute maxillofacial pain. This prospective cross-sectional study included 197 adult patients who presented to the emergency department with acute maxillofacial pain and were subsequently referred to the maxillofacial surgery clinic. Pain intensity was assessed using all four scales in randomized sequence. Spearman correlation analysis was performed to evaluate relationships between scales, while Bland-Altman analysis was used to assess agreement. Patient preferences were analyzed based on age, sex, and educational level. All four pain scales demonstrated strong correlations, with the highest correlation between NRS and VRS and the lowest between VAS and WBS. Bland-Altman analysis revealed the strongest agreement between VAS and NRS, while the weakest agreement was observed between VAS and WBS. NRS emerged as the most reliable and preferred scale, especially among younger and highly educated patients. WBS was preferred by older adults and those with lower education levels. While NRS appears to be the most reliable and broadly applicable assessment scale, VAS and VRS can serve as alternatives for patients with strong numerical or verbal comprehension skills. WBS remains valuable for elderly or less-educated populations due to its intuitive visual representation.