Adult Pain Assessment Scales

Presented by: John Kenneth Salise

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 Learning Objective
1. Understand the different types of adult pain scales.

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Pain Assessment Scales
As a healthcare provider, it is essential to know and understand which pain assessment
tools and scales are used in your institution.
• Pain scales are typically applied to all pain types. However, chronic and cancer-related pain may
require more complex evaluation tools.
• Although pain is multi-factorial, the majority of pain scales assess pain intensity.
• There are different validated pain scales available for a variety of patient populations such as:
 adults
 pediatrics
 elderly
 non-verbal
• Not all pain scales are equal and one should be chosen based on the patient.
• For example, it would be inappropriate to use a pain scale intended for
adults, such as the Defense and Veterans Pain Rating Scale 2.0, when
assessing a three-year-old child.
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 Pain Assessment Using Pain Scales
• Once a pain scale is chosen, interpretation of the score is not so straightforward.
• There is no defined score or threshold for what score correlates to actual pain and to what
intensity the pain is felt by the patient.
• Using the same scale for two different patients doesn’t allow for comparison of pain
intensity. For example, a patient with a score of 9 on the Numerical Rating Scale may not
necessarily be experiencing more pain than one with a score of 6 on the same scale.
• Because of the subjective nature of standardized pain scales, patient functionality may be the
best indicator of pain intensity.
• Pain scales DO NOT take into account patient genetics, past experiences,
comorbidities, or other pain influencing factors.
• In patients with preexisting pain it is important to determine their baseline pain
level.

Select a scale and be consistent! 54

 Pain Assessment Using Pain Scales
• When using a pain scale in a verbal adult it is best to ground the scale by
providing context for the patient.
• For example, ask the patient at which level on the pain scale would they take an over-the-
counter pain medication? For those with chronic pain, what level of pain do they experience
every day?
• Surrogate reporting (pain history obtained from a parent, caregiver or loved one)
of a non-verbal patient’s pain and behavior or activity changes can also aid in
pain assessment.
• Try to determine who really provides the patient’s daily care and is knowledgeable about
their history, disease, and past pain management or experiences.

Don’t forget that abnormal vital signs or a change in vital

signs can also serve as an indirect marker for pain.
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 Examples of Pain Scales
Pain Scales* Verbal, Alert and Oriented Non-verbal, GCS <15 or Cognitive Impairment

Adult 1. Verbal Numeric Scale (VNS)/ 1. Adult Non-Verbal Pain Scale (NVPS)
Numeric Rating Scale (NRS) 2. Assessment of Discomfort in Dementia (ADD)
2. Visual Analogue Scale (VAS) 3. Behavioral Pain Scale (BPS)
3. Defense and Veterans Pain 4. Critical-Care Observation Tool (CPOT)
Rating Scale (DVPRS 2.0)

*This is a short list of pain scales. Determine which pain assessment tools are used by your agency or facility.
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To learn more about the different scales, visit PAMI
a. Adult Pain Assessment Scales
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Adult Pain Scales: Verbal, alert and oriented

Measurement Scale Description

Verbal Numeric Scale (VNS)/ Self-report scale. Eleven point scale that requires understanding of numbers, addition and
Numeric Rating Scale (NRS) subtraction.

Five pain levels are indicated in large print on a sheet give to the patient: no, pain, mild pain,
Verbal rating scale (VRS) moderate pain, severe pain, unbearable pain.

A 100-mm rule with a movable cursor: “no pain” is written at he left end of the horizontal line
Visual Analogue Scale along which the cursor is moved, and “maximal pain” at the right end.

Self-report scale. Eleven point scale that requires the patient to identify pain by numerical
Defense and Veterans Pain
rating, color intensity, facial expression, and pain disruption. Followed by four supplemental
Rating Scale 2.0 (DVPRS) questions evaluating the biopsychosocial impact of pain.

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Verbal Numeric Scale (VNS)
Numeric Rating Scale (NRS)

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Verbal Numeric Scale(VNS)
Numeric Rating Scale(NRS)

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Defense and Veterans Pain Rating Scale 2.0
(DVPRS)

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Defense and Veterans Pain Rating Scale 2.0
(DVPRS)

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 Adult Pain Scales: Non-verbal, GCS <15 or
Cognitive Impairment

Measurement Scale Description

Adult Non-Verbal Pain Scale Behavioral scale. Based on FLACC scale and contain behavioral dimensions and physiology
(NVPS) dimensions that are graded by severity.

Assesses pain in patients with dementia. Total scores range from 0 to 10 (based on a scale of 0 to
Pain Assessment in Advanced
2 for five items: breathing. Vocalization, facial expression, body language, and consolability),
Dementia (PAINAD) Scale higher score indicates more severe pain

Behavioral scale. Three observational items (facial expression, upper limbs, and compliance with
Behavioral Pain Scale (BPS)
ventilation). Higher score, greater discomfort.

Behavioral scale. Used for intubated and nonintubated critical care patients. Four domains (facial
Critical-Care Observation Tool
expressions, movements, muscle tension, and ventilator compliance. Higher score, great pain
(CPOT) level

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Adult Non-Verbal Pain Scale (NVPS)

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Pain Assessment in Advanced Dementia (PAINAD)
Scale

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 Behavioral Pain Scale (BPS)

Payen JF, Bru O, Bosson JL, Lagrasta A, Novel E, et al. Assessing pain in critically ill sedated patients by using a 64
behavioral pain scale. Crit Care Med. 2001; 29:2258-2263.
Critical-Care Observation Tool (CPOT)

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