Different Scales for Rating Pain

The Wong-Baker FACES Pain Scale combines pictures and numbers for pain ratings. It can be used in children over the age of 3, and in adults. The six faces on the scale range from a smiling face to a crying face, and are each assigned a numerical rating between zero (smiling) and 10 (crying). If you have pain, you can point to the picture that best represents the degree and intensity of your pain. 

Perhaps one of the most commonly used pain scales in healthcare, the numerical rating scale is designed to be used by those over the age of 9. If you use the numerical scale, you have the option to verbally rate your pain from zero 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.

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. 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

1-3 = Mild discomfort

4-6 = Moderate pain

7-10 = 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.

The CRIES Pain Scale is often used for infants six months old and younger and is widely used in the neonatal intensive care setting. CRIES is an assessment tool based on observations and objective measurements. It is rated by a healthcare professional, such as a nurse or physician. CRIES assesses crying, oxygenation, vital signs, facial expression, and sleeplessness. Two points are assigned to each parameter, with a rating of zero for signs of no pain and a rating of two for signs of maximal pain.   

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:

• Children
• 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 9 and 45 based on nine different parameters, each rated from one to five. Unlike several of the other scales that use multiple factors, low or high scores are not consistently assigned to signs of more or less pain across all of the parameters. 

The nine parameters are:

• Alertness is given a score of one for deep sleep, two for light sleep, three for drowsiness, four for alert and five for high alertness. 
• Calmness is rated at a score of one for completely calm, and is given higher ratings 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 one for no crying, and higher scores for moaning, sobbing, or screaming. 
• Physical movement is given a score of zero for no movement, which can be a sign of less pain or of illness. A score of one or two indicate some movement, and higher scores indicate vigorous movements 
• Muscle tone is rated at a score of three 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 one 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 one 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. 

The McGill Pain Questionnaire consists of 78 words that describe pain. 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 marked their pain words, 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.