Chronic Pain Diagnosis Pain Scales: Types of Scales and Using Them to Explain Pain 11 Common Pain Scales Doctors Use to Assess Pain By Erica Jacques Updated on August 30, 2023 Medically reviewed by Grant Hughes, MD Print Pain scales are used by healthcare providers to improve communication and understanding about the pain you may be experiencing. Pain is felt differently from one person to the next ranging from mild to severe and varying in type. Having a means of measuring your pain helps with: Diagnosing what may be the cause of your painTracking how your condition progressesDetermining if treatment is working for you Several types of pain scales are in use for acute, chronic, and neuropathic pain. Whether your pain comes on suddenly (acute), persists for several months (chronic), or is caused by nerve damage (neuropathic), the 11 common scales explored in this article can be tools that help you move through it. Types of Pain Scales Healthcare providers have at least 11 types of pain scales to choose from. They generally fall into one of three categories: Numerical rating scales (NRS): Uses numbers to rate painVisual analog scales (VAS): Asks you to select a picture that best matches your pain levelCategorical scales: Primarily uses words, possibly along with numbers, colors, or location(s) on the body The scales may provide quantitative measurements, qualitative measurements, or both. Quantitative scales answer the question, "How bad is your pain?" They're helpful for gauging your response to treatment over time. Qualitative pain scales answer the question, "What does it feel like?" They can give your healthcare provider ideas about the cause of your pain, whether it's associated with any medical problems you have, or whether it's caused by the treatment itself. No one particular pain scale is considered ideal or better than the others for every situation. Some of these tools are best suited for people of certain ages. Others are more useful for people who are highly involved in their own health care. Numerical Rating Pain Scale NIH / Warren Grant Magnusen Clinical Center The Numerical Rating Scale (NRS) is designed for anyone over age 9. It is one of the most commonly used pain scales in health care. To use it, you just say the number that best matches the level of pain you are feeling; you can also place a mark on the scale itself. Zero means you have no pain, while 10 represents the most intense pain possible. Wong-Baker Faces Pain Scale NIH / Warren Grant Magnusen Clinical Center The Wong-Baker FACES Pain Scale combines pictures and numbers for pain ratings. It can be used in adults and children over age 3. Six faces depict different expressions, ranging from happy to extremely upset. Each is assigned a numerical rating between 0 (smiling) and 10 (crying). To use it, you can point to the picture that best represents the degree and intensity of your pain. Primary and Secondary Chronic Pain FLACC Pain Scale NIH / Warren Grant Magnusen Clinical Center The FLACC Pain Scale is based on observations made by a healthcare provider. Originally created to evaluate young children, it can be used for anyone who cannot communicate. FLACC stands for: Facial expressionLeg tension or relaxationActivity (still or squirming with pain)CryingConsolability (whether you can be comforted) Zero to two points are assigned for each of the five categories. Then the overall score is tallied. Scores are interpreted as follows: 0: Relaxed and comfortable1 to 3: Mild discomfort4 to 6: Moderate pain7 to 10: Severe discomfort/pain By recording the FLACC score on a regular basis, healthcare providers can gain some sense of whether someone's pain is increasing, decreasing, or staying the same. CRIES Pain Scale NIH / Warren Grant Magnusen Clinical Center The CRIES Pain Scale assesses: Crying Oxygenation Vital signs Facial expression Sleeplessness It's often used for babies 6 months and younger. It's widely used in neonatal intensive care units (NICU). This assessment tool is based on a healthcare provider's observations and objective measurements. In each category: A rating of 0 means you're showing no signs of pain.A rating of 2 means you're showing signs of extreme pain. COMFORT Pain Scale NIH / Warren Grant Magnusen Clinical Center The COMFORT Scale is another pain scale designed for people who can't describe or rate their pain, such as: Children Adults with cognitive impairments Adults who are temporarily impaired by medication or illness People who are sedated in an intensive care unit (ICU) or operating room The COMFORT Scale provides a pain rating between nine and 45 based on nine different parameters. Each is rated from 1 to 5: Alertness: 1 for deep sleep, 2 for light sleep, 3 for drowsiness, 4 for alertness, and 5 for high alertness Calmness: 1 for complete calmness, higher ratings for increased anxiety and agitation Respiratory distress: How much your breathing indicates pain, with higher ratings for agitated breathing Crying: 1 for no crying, higher scores for moaning, sobbing, or screaming Physical movement: 0 for no movement (a sign of less pain), 1 or 2 for some movement, and higher scores for vigorous movements (e.g., thrashing in pain) Muscle tone: A score of 3 for normal, lower scores for diminished muscle tone, and higher scores for rigid muscles Facial tension: 1 for a completely normal, relaxed face, and higher ratings for signs of strain Blood pressure and heart rate: Rated according to your baseline; 1 means they're below baseline (abnormally low), 2 is baseline, and higher scores are for elevated or abnormally high levels McGill Pain Questionnaire NIH / Warren Grant Magnusen Clinical Center The McGill Pain Questionnaire, also known as the McGill Pain Index, consists of 78 words that describe pain. You rate your own pain by marking the words that best match your feelings. Some examples of the words used are: TuggingTerrifyingColdSharpWretched Once you've made your selections, the provider figures out a numerical score with a maximum rating of 78 based on how many words you marked. This pain scale is helpful for adults and children who can read. Color Analog Pain Scale BSIP / Getty Images The Color Analog Scale (CAS) uses colors to represent different levels of pain on a pain scale: Red: Severe painYellow: Moderate painGreen: Comfortable The colors are usually positioned in a line with corresponding numbers or words that describe your pain. The Color Analog Scale is often used for children and is considered reliable. Mankoski Pain Scale Valis The Mankoski Pain Scale uses numbers and specific descriptions of pain to ensure your healthcare provider understands your pain. Descriptions are detailed. They include phrases such as: Very minor annoyanceOccasional minor twingesCannot be ignored for more than 30 minutes After reading the descriptions, you tell the provider which number best fits your pain level. Somatic and Visceral Pain: What's the Difference? Brief Pain Inventory RamiNaif / Researchgate The Brief Pain Inventory (BPI) is a worksheet made up of 15 questions. You're asked to numerically rate the effect of your pain in categories such as: How you relate with other peopleHow well you can walkHow you've slept over the last 24 hours This pain scale captures more nuance in terms of how your pain is affecting your day-to-day life. Descriptor Differential Scale of Pain Intensity Ratologydisabled This pain scale has 12 lines, each of which has a descriptor—such as faint, strong, intense, and very intense—placed in the middle of it. Each line has a minus sign at the start and a plus sign at the end. First, you find the line with the descriptor that best matches your pain.For less intense pain, you mark somewhere on the minus side.For more intense pain, you mark someone on the plus side. Defense and Veterans Pain Rating Scale U.S. Department of Defense The United States Department of Defense in 2021 announced it was using a new pain scale called the Defense and Veterans Pain Rating Scale (DVPRS). According to a news release, it's the response to dissatisfaction with other pain scales from both healthcare providers and patients. Rather than a simple scale, it includes: Faces: Expressions range from smiling to highly distressedColors: Green for no pain, then moving through the spectrum to red for the worst possible painNumbers: 0 for no pain, 10 for the worst possible painDescriptors: These include "hardly notice pain," "hard to ignore, avoid usual activities," and "can't bear the pain, unable to do anything" Combining aspects of many other pain scales may give your healthcare provider more information to work from. Summary Pain scales can help healthcare providers determine how much pain you're in and its impact on you. They can also help define your pain in mutually understood terms. The medical community uses several kinds of pain scales. Some use pictures or colors, others use numbers or words, and some use combinations of these. A provider can choose which scale to use based on your ability to read or communicate and what they want to learn. Abnormal Pain Types Some doctors regularly use a pain scale. Some hospital rooms even have them posted on their walls. If you're not asked to use a pain scale and are having a hard time clearly communicating with a healthcare provider, ask for one. They're a useful tool for improving diagnosis and treatment. Assessing Someone Else's Pain Level 11 Sources Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. Boonstra AM, Stewart RE, Köke AJ, et al. Cut-off points for mild, moderate, and severe pain on the numeric rating scale for pain in patients with chronic musculoskeletal pain: variability and influence of sex and catastrophizing. Front Psychol. 2016;7:1466. doi:10.3389/fpsyg.2016.01466 Wong-Baker Faces Foundation. Pain Rating Scale. Crellin DJ, Harrison D, Santamaria N, Huque H, Babl FE. The psychometric properties of the FLACC scale used to assess procedural pain. J Pain. 2018;19(8):862-872. doi:10.1016/j.jpain.2018.02.013 New York Society of Physical Medicine and Rehabilitation. Pain Scales Assessment. Boerlage AA, Ista E, Duivenvoorden HJ, De wildt SN, Tibboel D, Van dijk M. The COMFORT behaviour scale detects clinically meaningful effects of analgesic and sedative treatment. Eur J Pain. 2015;19(4):473-9. doi:10.1002/ejp.569 Bourdel N, Alves J, Pickering G, Ramilo I, Roman H, Canis M. Systematic review of endometriosis pain assessment: how to choose a scale?. Human Reproduction Update. 2015;21(1):136-152.doi:10.1093/humupd/dmu046 Le may S, Ballard A, Khadra C, et al. Comparison of the psychometric properties of 3 pain scales used in the pediatric emergency department: visual analogue scale, faces pain scale-revised, and colour analogue scale. Pain. 2018;159(8):1508-1517. doi:10.1097/j.pain.0000000000001236. George Francis McMahon, I. I. I. (n.d.). Comparison of a numeric and a descriptive pain scale in the Occupational Medicine Setting. SJSU ScholarWorks. Lin, C, Poquet, N. The Brief Pain Inventory. Journal of Physiotherapy. 2016;62(52). doi:10.1016/j.jphys.2015.07.001 Atkinson JH, Slater MA, Capparelli EV, et al. A randomized controlled trial of gabapentin for chronic low back pain with and without a radiating component. Pain. 2016;157(7):1499-507. doi:10.1097/j.pain.0000000000000554 U.S. Department of Defense. Your pain on a scale of 1-10? Check out a new DOD way to evaluate pain. Additional Reading Sarpangala M, Devasya A, George AL, Kumara A, Panicker P, Mathew M. Comparative evaluation of the efficacy of lignocaine containing topical anesthetic agents during extraction of deciduous anterior teeth. Minerva Stomatol. 2018;67(1):26-31. doi:10.23736/S0026-4970.17.04052-3 By Erica Jacques Erica Jacques, OT, is a board-certified occupational therapist at a level one trauma center. 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