Original Article| Volume 23, ISSUE 3, P370-373, June 2022

Association Between Type of Face Mask and Visual Analog Scale Scores During Pain Assessment

Published:November 24, 2021DOI:



      To examine the association between the type of mask worn by health care professionals and assessment of pain intensity in patients after orthopedic surgery using the visual analog scale (VAS).


      A nonrandomized controlled trial conducted among 176 patients hospitalized in an orthopedic department of a hospital located in northern-central Israel from January to March 2021.


      In the intervention group (n = 83), pain assessment using the VAS was performed by a health care professional wearing a transparent face mask, while in the control group (n = 93), pain assessment was performed by a health care professional wearing a standard nontransparent face mask. The initial assessment was performed by a nurse, and 15 minutes later, an additional assessment was performed by a physician.


      Health care professionals wearing a standard non-transparent mask obtained higher VAS scores than health care professionals wearing a transparent mask. In addition, nurses obtained lower VAS scores than physicians. The discrepancy in VAS scores between nurses and physicians was found in 50% of cases. This discrepancy was more prevalent among female patients, patients after knee replacement or spinal surgery, and when health care professionals were wearing a standard nontransparent mask.


      This study supports the use of transparent face masks by health care professionals in an orthopedic department, particularly by nurses. In addition, this study supports the assumption of problems involving the reliability of VAS.
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        • Carbon C.C.
        Wearing face masks strongly confuses counterparts in reading emotions.
        Frontiers in Psychology. 2020; 11: 2526
        • Chodosh J.
        • Weinstein B.E.
        • Blustein J.
        Face masks can be devastating for people with hearing loss Innovation is urgently needed to ensure clear communication in medical settings.
        British Medical Journal. 2020; 370: 2683
        • Coll A.M.
        • Ameen J.R.
        • Mead D.
        Postoperative pain assessment tools in day surgery: literature review.
        Journal of Advanced Nursing. 2004; 46: 124-133
        • Hjermstad M.J.
        • Fayers P.M.
        • Haugen D.F.
        • Caraceni A.
        • Hanks G.W.
        • Loge J.H.
        • European Palliative Care Research Collaborative
        Studies comparing numerical rating scales, verbal rating scales, and visual analogue scales for assessment of pain intensity in adults: A systematic literature review.
        Journal of Pain and Symptom Management. 2011; 41: 1073-1093
        • Klimek L.
        • Bergmann K.C.
        • Biedermann T.
        • Bousquet J.
        • Hellings P.
        • Jung K.
        • Pfaar O.
        Visual analogue scales (VAS): Measuring instruments for the documentation of symptoms and therapy monitoring in cases of allergic rhinitis in everyday health care.
        Allergo Journal International. 2017; 26: 16-24
        • Lambert B.S.
        Pain assessed using the visual analog scale differs between initial clinic visit and the day of surgery in orthopedic patients and is associated with several demographic variables.
        EC Orthopaedics. 2020; 11: 83-93
        • Marler H.
        • Ditton A.
        I'm smiling back at you”: Exploring the impact of mask wearing on communication in healthcare.
        International Journal of Language & Communication Disorders. 2021; 56: 205-214
        • Martin K.D.
        • McBride T.
        • Wake J.
        • Van Buren J.P.
        • Dewar C.
        Comparison of visual analog pain score reported to physician vs nurse in nonoperatively treated foot and ankle patients.
        Foot & Ankle International. 2018; 39: 1444-1448
        • Macintyre P.E.
        • Schug S.A.
        Acute pain management: A practical guide.
        CRC Press, Boca Raton2015
        • Myles P.S.
        • Myles D.B.
        • Galagher W.
        • Boyd D.
        • Chew C.
        • MacDonald N.
        • Dennis A.
        Measuring acute postoperative pain using the visual analog scale: The minimal clinically important difference and patient acceptable symptom state.
        British Journal of Anaesthesia. 2017; 118: 424-429
        • Seale H.
        • Leem J.S.
        • Gallard J.
        The cookie monster muffler”: Perceptions and behaviours of hospital healthcare workers around the use of masks and respirators in the hospital setting.
        Intentional Journal Infectaction Control. 2014; 11
        • Pamela M.
        Acute pain management: A practical guide.
        CRC Press, Boca Raton2015
        • Wu H.
        • Zhang F.
        • Cheng W.
        • Lin Y.
        • Wang Q.
        Factors related to acute anxiety and depression in inpatients with accidental orthopedic injuries.
        Shanghai Archives of Psychiatry. 2017; 29: 77