Pain Scales: Types of Scales and Using Them to Explain Pain

Numerical Rating Pain Scale

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

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. 

FLACC Pain Scale

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 expression
• Leg tension or relaxation
• Activity (still or squirming with pain)
• Crying
• Consolability (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 comfortable
• 1 to 3: Mild discomfort
• 4 to 6: Moderate pain
• 7 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

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

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

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:

• Tugging
• Terrifying
• Cold
• Sharp
• Wretched

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

The Color Analog Scale (CAS) uses colors to represent different levels of pain on a pain scale:

• Red: Severe pain
• Yellow: Moderate pain
• Green: 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

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 annoyance
• Occasional minor twinges
• Cannot be ignored for more than 30 minutes

After reading the descriptions, you tell the provider which number best fits your pain level.

Brief Pain Inventory

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 people
• How well you can walk
• How 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

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

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 distressed
• Colors: Green for no pain, then moving through the spectrum to red for the worst possible pain
• Numbers: 0 for no pain, 10 for the worst possible pain
• Descriptors: 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.