PAIN
HEIDE BASING-A, RN
10 Common Types of Pain Scales
Types of Pain Scales
Pain scale results can help guide the diagnostic process, track the progression of a condition,
and more. There are at least 10 pain scales in common use, which are described below.
They tend to fall into certain categories:
• Numerical rating scales (NRS) use numbers to rate pain.
• Numerical scales are more quantitative in nature, but most pain scales have quantitative features and qualitative features.
• Visual analog scales (VAS) typically ask a patient to mark a place on a scale that aligns with
their level of pain.
• Categorical scales use words as the primary communication tool and may also incorporate
numbers, colors, or relative location to communicate pain.
Numerical Rating
Pain Scale
Perhaps one of the most commonly used pain scales in health care,
the numerical rating scale is designed to be used by those over age 9.
If you use the numerical scale, you have the option to verbally rate
your pain from 0 to 10 or to place a mark on a line indicating your
level of pain. Zero indicates the absence of 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.2 It can be used in children over the age of 3 and in
adults.
Six faces depict different expressions, ranging from happy to
extremely upset. Each is assigned a numerical rating between 0
(smiling) and 10 (crying). If you have pain, you can point to the
picture that best represents the degree and intensity of your pain.
FLACC Scale
FLACC stands for face, legs, activity, crying, and consolability. The FLACC pain scale was developed to
help medical observers assess the level of pain in children who are too young to cooperate verbally.3 It can
also be used in adults who are unable to communicate.
The FLACC scale is based on observations, with zero to two points assigned for each of the five areas.
The overall score is recorded 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 periodically, healthcare providers can gain some sense of whether
someone's pain is increasing, decreasing, or stable.
CRIES Scale
CRIES assesses crying, oxygenation, vital signs, facial expression, and
sleeplessness.4
It is often used for infants 6 months old and younger and is widely used
in the neonatal intensive care setting.
This assessment tool is based on observations and objective
measurements. It is rated by a healthcare professional, such as a nurse or
physician. Two points are assigned to each parameter, with a rating of 0
for signs of no pain and a rating of 2 for signs of maximal pain.
COMFORT
Scale
The COMFORT Scale is a pain scale that may be used by a healthcare provider
when a person cannot describe or rate their pain. Some of the common
populations this scale might be used with include:
• Children5
•
• Adults who are cognitively impaired
• Adults whose cognition is temporarily impaired by medication or illness
• People who are sedated in an ICU or operating room setting
The COMFORT Scale provides a pain rating between nine and 45 based on nine different parameters, each rated from one to five:
• Alertness is given a score of 1 for deep sleep, 2 for light sleep, 3 for drowsiness, 4 for alertness, and 5 for high alertness.
• Calmness is rated with a score of 1 for complete calmness, and higher ratings given for increased anxiety and agitation.
• Respiratory distress is rated based on how much a person's breathing reflects pain, with agitated breathing given higher ratings.
• Crying is given a score of 1 for no crying, and higher scores for moaning, sobbing, or screaming.
• Physical movement is given a score of 0 for no movement, which can be a sign of less pain or of illness. A score of 1 or 2 indicates
some movement, and higher scores indicate vigorous movements.
• Muscle tone is rated at a score of 3 if it is normal, with lower scores indicating diminished muscle tone and higher scores indicating
increased tone or rigidity.
• Facial tension is rated at a score of 1 for a completely normal, relaxed face, and given higher ratings for signs of facial muscle strain.
• Blood pressure and heart rate are rated with respect to the normal baseline. A score of 1 indicates that these measures are below the
baseline (abnormal), and a score of 2 indicates they are at baseline, while higher scores are given for elevated (abnormal) levels.
McGill Pain
Scale
The McGill Pain Questionnaire consists of 78 words that describe pain. 6 A
person rates their own pain by marking the words that most closely match up to
their feelings. Some examples of the words used are tugging, terrifying, cold,
sharp, and wretched.
Once a person has made their selections, a numerical score with a maximum
rating of 78 is assigned based on how many words were marked. This scale is
helpful for adults and children who can read.
It can be particularly useful for you if there is a plan for rehabilitation, which
would require substantial participation on your part.
Color Analog
Scale
The color analog pain scale uses colors, with red representing severe
pain, yellow representing moderate pain, and green representing
comfort.
The colors are usually positioned in a linear format 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 corresponding
descriptions of pain so you can be sure that you and your healthcare
provider understand one another.
Descriptions are detailed, including phrases such as "very minor
annoyance, occasional minor twinges" or "cannot be ignored for
more than 30 minutes."
Brief Pain
Inventory
The brief pain inventory scale uses a worksheet with 15 questions
that ask you to numerically rate the effect of your pain on categories
such as how you relate with other people, walking, and sleep over
the last 24 hours
Descriptor
Differential Scale
of Pain Intensity
This scale uses 12 descriptors, such as faint, strong, intense and, very
intense.10 Each word is placed in the middle of its own line with a
plus sign at one end of the line and a minus sign at the other end.
You can mark each line at the level of the word itself, or near the
plus or minus sign to convey how well the word describes your pain.
