How Pain Rating Scales Work

Pain is subjective, which means no one but you knows how you really feel. This subjectivity makes it difficult to determine whether medications or other pain treatments are effective. Nurses and healthcare providers may ask you to measure your pain on a scale up to 10, or by pointing to a series of faces.

Doctor and patient talking in clinic about pain rating scales
Jose Luis Pelaez Inc / Blend Images / Getty Images

Types of Pain Scales

Because pain assessment resists standardized measurements, healthcare providers can use one or more of several different rating methods, including:

  • Numerical rating: Usually based on a scale from zero to 10, this scale assigns a measurable number to your pain level. Zero represents no pain at all while 10 represents the worst imaginable pain.
  • Wong-Baker: Represented by faces with expressions, this scale follows the same guideline as the numerical scale. Zero is represented by a smiley face, while 10 is represented as a distraught, crying face. This scale is useful when rating pain in children or adults with mild cognitive impairments.
  • Verbal rating scales: Using words to describe pain rather than a measurable scale makes verbal rating scales a qualitative measurement technique. In other words, the person in pain describes the intensity of pain, and how he feels. One example is the McGill Pain Questionnaire.
  • Observer scales: Often used with people who are unable to communicate their pain level effectively, observation-based scales offer objective measurements for pain. These include facial expression, muscle tone, blood pressure, and heart rate. Some examples of observer pain scales are the FLACC scale, the CRIES scale, and the COMFORT scale.

Each approach offers a mix of strengths and weaknesses.

The Purpose of Pain Scales

Most scales make pain measurable and can tell providers whether your pain is mild, moderate, or severe. They can also set baselines and trends for your pain, making it easier to find appropriate treatments. If your pain rating decreases after you take a certain medication, for example, then clearly that medication worked for you. If there was no change, or if the number increased, then your healthcare provider knows it is time to try something else.

This approach is also true in the case of a verbal rating scale. Even though there is no numerical rating, healthcare providers can look for a change in the intensity of pain words. You may initially describe your pain using more words from a high-intensity group. A treatment could be considered effective if in you choose more moderate pain descriptors afterward.

How to Use a Pain Scale

When a nurse asks you to rate your pain, be honest. Don’t exaggerate your pain. If you rate your pain as 10 out of 10 but are chatting happily on the phone with your spouse, you are probably not rating it effectively. The more accurately you describe your pain experience, the better your caregivers can help you control your pain.

Pain scales can also be an effective communication tool at home. Teach the scales to your family. Use a face scale to demonstrate the effects of your pain when talking to your children. Tell your spouse when you are a level eight, and show your children when you are at two ​​tears. Using numbers and faces can help you communicate an otherwise subjective experience to the people you love.​

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  • Pain Intensity Scales. NIH Pain Consortium.

  • Pain Rating Scales: Overview. Pain Channel.

By Erica Jacques
Erica Jacques, OT, is a board-certified occupational therapist at a level one trauma center.