Korean J Pain.  2025 Jan;38(1):58-68. 10.3344/kjp.24346.

Validation of the Korean version of defense and veterans pain rating scale for assessment of postoperative pain: a prospective observational cohort study

• Choi S
• Kim T
• Yoo HK
• Park SY
• Yoon SH
• Lee HJ

• KMID: 2563872
• DOI: http://doi.org/10.3344/kjp.24346

Abstract

Background
The defense and veterans pain rating scale (DVPRS) is a pain assessment tool combining a numerical rating scale (NRS) with descriptive words, colors, and facial expressions. This study aimed to validate the Korean version of the DVPRS (K-DVPRS) for postoperative pain assessment.
Methods
This study included patients who underwent elective laparoscopic or robotic abdominal surgery. The original DVPRS was translated into Korean using a forward-backward method. Pain intensities at rest and during coughing were assessed at 24 and 48 hours postoperatively using the NRS and K-DVPRS, respectively. The EuroQol 5-Dimension 5-Level (EQ-5D-5L) questionnaire was also used. The validity, reliability, and responsiveness of the K-DVPRS were evaluated.
Results
Of the 174 patients screened, 150 were enrolled, and 148 completed the study. The K-DVPRS had strong convergent validity with the NRS at 24 and 48 hours postoperatively (ρ: 0.75 to 0.78, all P < 0.001). Construct validity was confirmed by significant differences in pain scores based on surgical extent and duration. The internal consistency was acceptable (Cronbach’s alpha: 0.77 and 0.85 at 24 and 48 hours, respectively), and test-retest reliability at 24 hours was excellent (intraclass correlation coefficient: 0.90 at rest and 0.95 during coughing). Responsiveness, measured by Cliff’s effect size, was high from preoperative to 24 hours postoperatively and moderate from 24 to 48 hours. At 48 hours, the K-DVPRS had stronger correlations with the EQ-5D-5L index and EQVAS than with the NRS.
Conclusions
The K-DVPRS is a valid, reliable, and responsive tool for assessing postoperative pain in Korean patients.

Keyword

Acute Pain; Postoperative Complications; Pain Management; Pain Measurement; Pain, Postoperative; Postoperative Care

Figure

• 

  Fig. 1 Flow chart of the study.

• 

  Fig. 2 Correlations between the K-DVPRS, NRS, EQ-VAS, and EQ-5D-5L index at 24 hr postoperatively. K-DVPRS: Korean version of defense and veterans pain rating scale, NRS: numeric rating scale, EQ-VAS: EuroQoL visual analogue scale, EQ-5D-5L: EuroQol 5-dimensional 5-level. **P < 0.01, ***P < 0.001.

• 

  Fig. 3 Correlations between the K-DVPRS, NRS, EQ-VAS, and EQ-5D-5L index at 48 hr postoperatively. K-DVPRS: Korean version of defense and veterans pain rating scale, NRS: numeric rating scale, EQ-VAS: EuroQoL visual analogue scale, EQ-5D-5L: EuroQol 5-dimensional 5-level. **P < 0.01, ***P < 0.001.

Reference

1. Choi S, Yoon SH, Lee HJ. 2024; Beyond measurement: a deep dive into the commonly used pain scales for postoperative pain assessment. Korean J Pain. 37:188–200. DOI: 10.3344/kjp.24069. PMID: 38769013. PMCID: PMC11220383.

2. Dionne RA, Bartoshuk L, Mogil J, Witter J. 2005; Individual responder analyses for pain: does one pain scale fit all? Trends Pharmacol Sci. 26:125–30. DOI: 10.1016/j.tips.2005.01.009. PMID: 15749157.

3. van Boekel RLM, Vissers KCP, van der Sande R, Bronkhorst E, Lerou JGC, Steegers MAH. 2017; Moving beyond pain scores: multidimensional pain assessment is essential for adequate pain management after surgery. PLoS One. 12:e0177345. DOI: 10.1371/journal.pone.0177345. PMID: 28489926. PMCID: PMC5425226.

4. Nassif TH, Hull A, Holliday SB, Sullivan P, Sandbrink F. 2015; Concurrent validity of the defense and veterans pain rating scale in VA outpatients. Pain Med. 16:2152–61. DOI: 10.1111/pme.12866. PMID: 26257151.

5. Polomano RC, Galloway KT, Kent ML, Brandon-Edwards H, Kwon KN, Morales C, et al. 2016; Psychometric testing of the Defense and Veterans Pain Rating Scale (DVPRS): a new pain scale for military population. Pain Med. 17:1505–19. DOI: 10.1093/pm/pnw105. PMID: 27272528.

6. Piva SR, Switzer GE, Mikolic JM, Boudreaux-Kelly MY, Faruque S, Aloziem OU, et al. 2023; Validity of the modified Defense and Veterans Pain Rating Scale supplemented with items germane to total joint replacement: secondary analysis from a randomized trial. Mil Med. 188:e3017–25. DOI: 10.1093/milmed/usad155. PMID: 37208305.

7. von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP. STROBE Initiative. 2008; The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. J Clin Epidemiol. 61:344–49. DOI: 10.1016/j.jclinepi.2007.11.008. PMID: 18313558.

8. Yoon S, Joo H, Oh YM, Lee J, Bahk JH, Lee HJ. 2020; Validation and clinical utility of the Korean version of the Quality of Recovery-15 with enhanced recovery after surgery: a prospective observational cohort study. Br J Anaesth. 125:614–21. DOI: 10.1016/j.bja.2020.06.040. PMID: 32703550.

9. Herdman M, Gudex C, Lloyd A, Janssen M, Kind P, Parkin D, et al. 2011; Development and preliminary testing of the new five-level version of EQ-5D (EQ-5D-5L). Qual Life Res. 20:1727–36. DOI: 10.1007/s11136-011-9903-x. PMID: 21479777. PMCID: PMC3220807.

10. Abola RE, Bennett-Guerrero E, Kent ML, Feldman LS, Fiore JF Jr, Shaw AD, et al. Perioperative Quality Initiative (POQI) 2 Workgroup. 2018; American Society for Enhanced Recovery and Perioperative Quality Initiative Joint Consensus Statement on patient-reported outcomes in an enhanced recovery pathway. Anesth Analg. 126:1874–82. Erratum in: Anesth Analg 2018; 127: e95. DOI: 10.1213/ANE.0000000000002758. PMID: 29293180.

11. Protopapa KL, Simpson JC, Smith NC, Moonesinghe SR. 2014; Development and validation of the Surgical Outcome Risk Tool (SORT). Br J Surg. 101:1774–83. DOI: 10.1002/bjs.9638. PMID: 25388883. PMCID: PMC4240514.

12. Schober P, Boer C, Schwarte LA. 2018; Correlation coefficients: appropriate use and interpretation. Anesth Analg. 126:1763–18. DOI: 10.1213/ANE.0000000000002864. PMID: 29481436.

13. Gerbershagen HJ, Pogatzki-Zahn E, Aduckathil S, Peelen LM, Kappen TH, van Wijck AJ, et al. 2014; Procedure-specific risk factor analysis for the development of severe postoperative pain. Anesthesiology. 120:1237–45. DOI: 10.1097/ALN.0000000000000108. PMID: 24356102.

14. Aubrun F, Valade N, Coriat P, Riou B. 2008; Predictive factors of severe postoperative pain in the postanesthesia care unit. Anesth Analg. 106:1535–41. DOI: 10.1213/ane.0b013e318168b2ce. PMID: 18420872.

15. Olofsen E, Dahan A, Borsboom G, Drummond G. 2015; Improvements in the application and reporting of advanced Bland-Altman methods of comparison. J Clin Monit Comput. 29:127–39. DOI: 10.1007/s10877-014-9577-3. PMID: 24806333.

16. Kim SH, Ahn J, Ock M, Shin S, Park J, Luo N, et al. 2016; The EQ-5D-5L valuation study in Korea. Qual Life Res. 25:1845–52. DOI: 10.1007/s11136-015-1205-2. PMID: 26961008.

17. Steiger JH. 1980; Tests for comparing elements of a correlation matrix. Psychol Bull. 87:245–51. DOI: 10.1037/0033-2909.87.2.245.

18. Holder CR, Schenker ML, Baker JL, Giordano NA. 2024; Defense and Veterans Pain Rating Scale scores associated with longer PROMIS measures. Reg Anesth Pain Med. 49:461–3. DOI: 10.1136/rapm-2022-104010. PMID: 36517201.

19. Safran SL, Follonier D, Weber E, Vayne-Bossert P, Ahrendts U, Rehberg-Klug B. 2024; Cross-cultural adaptation and psychometric validation of the French version of the Defense and Veterans Pain Rating Scale for acute and chronic pain: a prospective clinical study. Pain Med. 25:630–6. DOI: 10.1093/pm/pnae049. PMID: 38870517.

20. Markman JD, Gewandter JS, Frazer ME. 2020; Comparison of a pain tolerability question with the numeric rating scale for assessment of self-reported chronic pain. JAMA Netw Open. 3:e203155. DOI: 10.1001/jamanetworkopen.2020.3155. PMID: 32310281. PMCID: PMC7171555.

21. Krebs EE, Carey TS, Weinberger M. 2007; Accuracy of the pain numeric rating scale as a screening test in primary care. J Gen Intern Med. 22:1453–8. DOI: 10.1007/s11606-007-0321-2. PMID: 17668269. PMCID: PMC2305860.

22. van Dijk JF, Kappen TH, Schuurmans MJ, van Wijck AJ. 2015; The relation between patients' NRS pain scores and their desire for additional opioids after surgery. Pain Pract. 15:604–9. DOI: 10.1111/papr.12217. PMID: 24735082.

23. van Dijk JF, van Wijck AJ, Kappen TH, Peelen LM, Kalkman CJ, Schuurmans MJ. 2012; Postoperative pain assessment based on numeric ratings is not the same for patients and professionals: a cross-sectional study. Int J Nurs Stud. 49:65–71. DOI: 10.1016/j.ijnurstu.2011.07.009. PMID: 21840522.

24. Sheikh S, Fishe J, Norse A, Henson M, James D, Sher W, et al. 2021; Comparing pain intensity using the Numeric Rating Scale and Defense and Veterans Pain Rating Scale in patients revisiting the emergency department. Cureus. 13:e17501. DOI: 10.7759/cureus.17501.

25. Crisman E, Appenzeller-Herzog C, Tabakovic S, Nickel CH, Minotti B. 2024; Multidimensional versus unidimensional pain scales for the assessment of analgesic requirement in the emergency department: a systematic review. Intern Emerg Med. 19:1463–71. DOI: 10.1007/s11739-024-03608-5. PMID: 38664325. PMCID: PMC11364591.

26. Carr EC, Nicky Thomas V, Wilson-Barnet J. 2005; Patient experiences of anxiety, depression and acute pain after surgery: a longitudinal perspective. Int J Nurs Stud. 42:521–30. DOI: 10.1016/j.ijnurstu.2004.09.014. PMID: 15921983.

27. Zalon ML. 2014; Mild, moderate, and severe pain in patients recovering from major abdominal surgery. Pain Manag Nurs. 15:e1–12. DOI: 10.1016/j.pmn.2012.03.006. PMID: 24882032. PMCID: PMC4691356.

28. Clark CW, Yang JC, Tsui SL, Ng KF, Clark SB. 2002; Unidimensional pain rating scales: a multidimensional affect and pain survey (MAPS) analysis of what they really measure. Pain. 98:241–7. DOI: 10.1016/S0304-3959(01)00474-2. PMID: 12127025.

29. Bjurström MF, Irwin MR. 2019; Perioperative pharmacological sleep-promotion and pain control: a systematic review. Pain Pract. 19:552–69. DOI: 10.1111/papr.12776. PMID: 30762974.

30. Gorsky K, Black ND, Niazi A, Saripella A, Englesakis M, Leroux T, et al. 2021; Psychological interventions to reduce postoperative pain and opioid consumption: a narrative review of literature. Reg Anesth Pain Med. 46:893–903. DOI: 10.1136/rapm-2020-102434. PMID: 34035150.

31. Langford DJ, Gewandter JS, Amtmann D, Reeve BB, Corneli A, McKenna K, et al. 2022; Initial content validation and roadmap for a new patient-reported outcome measure of pain intensity. J Pain. 23:1945–57. DOI: 10.1016/j.jpain.2022.07.001. PMID: 35868594.

32. Buckenmaier CC 3rd, Galloway KT, Polomano RC, McDuffie M, Kwon N, Gallagher RM. 2013; Preliminary validation of the Defense and Veterans Pain Rating Scale (DVPRS) in a military population. Pain Med. 14:110–23. DOI: 10.1111/j.1526-4637.2012.01516.x. PMID: 23137169.