OBJECTIVES: Measuring different qualities of pain in an international study required the linguistic validation of the 9-item Neuropathic Pain Scale (NPS) in 24 languages. The original scale was developed in US English. A rigorous methodology was required to ensure conceptual equivalence and cultural relevance across different languages. METHODS: The translation process was conducted by a specialist in each target country using the following standardized methodology: 1) two forward translations by professional translators who were native speakers of the target language and fluent in English; 2) comparison and reconciliation of the translations by the specialist in the target country and the translators; 3) backward translation by a native English speaker; 4) comparison of source and backward version; and 5) comprehension test on three patients suffering from general pain and two from neuropathic pain. RESULTS: Issues regarding the instructions and the translation of certain expressions used to describe the different aspects of pain emerged during the creation of the individual language versions. Patient feedback allowed the instructions to be placed in a more relevant location on the measure. For some of the pain descriptions and synonyms on the original US English version of the NPS, country-specific substitutes had to be identified. CONCLUSIONS: The 24-language versions of the NPS were established according to a rigorous translation methodology. The process aims to ensure conceptual equivalence across different language versions to facilitate international comparison and pooling of data. Issues encountered during the linguistic validation process support the advantage of integrating international feedback on concepts and wording before a questionnaire is finalized.