10 Common Types of Pain Scales

Pain scales are tools that healthcare providers use to help measure and better define a person's pain.

There are several well-designed pain scales that have various benefits. For example, while some involve rating the intensity of pain, others give patients a means of characterizing their pain (e.g., stabbing or squeezing).

Pain scale results can help guide the diagnostic process, track the progression of a condition, and determine how effective a treatment is. All pain scales help improve communication between healthcare providers and patients.

This article explains the different pain scales healthcare providers use to help patients communicate their levels of pain.

Types of Pain Scales

There are at least 10 pain scales being used today. They generally fall into one of three categories:

  • Numerical rating scales (NRS) use numbers to rate pain.
  • Visual analog scales (VAS) typically ask a patient to mark a place on a scale that matches 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.

Quantitative scales are especially useful in measuring your response to treatment because they can clearly determine whether your pain has improved or worsened.

Qualitative pain scales are helpful in giving your healthcare provider an idea about the cause of your pain. This type of pain scale also helps the healthcare provider decide whether the pain is associated with your medical problem. It can also determine if it's caused by the treatment itself.

No one particular pain scale is considered ideal or better than the others for every situation. Some of these tools are most suited for people of certain ages. Others are more useful for people who are highly involved in their own health care.

Numerical Rating Pain Scale

NIH / Warren Grant Magnusen Clinical Center

The numerical rating scale is designed to be used by those over age 9. It is one of the most commonly used pain scales in health care.

If you use the numerical scale, you have the option to verbally rate your pain from 0 to 10. You can also 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

NIH / Warren Grant Magnusen Clinical Center

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.

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

NIH / Warren Grant Magnusen Clinical Center

The FLACC (face, legs, activity, crying, and consolability) pain scale was developed to help medical observers measure 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. Zero to two points are assigned for each of the five categories. 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 on a regular basis, healthcare providers can gain some sense of whether someone's pain is increasing, decreasing, or staying the same.

CRIES Scale

NIH / Warren Grant Magnusen Clinical Center

CRIES assesses crying, oxygenation, vital signs, facial expression, and sleeplessness. It is often used for infants 6 months old and younger. It's widely used in the neonatal intensive care (NICU) 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. A rating of 0 means there are no signs of pain. A rating of 2 means there are signs of extreme pain.

COMFORT Scale

NIH / Warren Grant Magnusen Clinical Center

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 intensive care unit (ICU) or operating room setting

The COMFORT Scale provides a pain rating between nine and 45 based on nine different parameters. Each is rated from 1 to 5:

  • 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. Higher ratings are given for increased anxiety and agitation.
  • Respiratory distress is rated based on how much a person's breathing reflects pain. Agitated breathing receives higher ratings.
  • Crying is given a score of 1 for no crying. There are 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. Lower scores indicate diminished muscle tone and higher scores indicate increased tone or rigidity.
  • Facial tension is rated at a score of 1 for a completely normal, relaxed face. There are higher ratings for signs of facial muscle strain.
  • Blood pressure and heart rate are rated according to the normal baseline. A score of 1 indicates that these measures are below the baseline, or abnormal. A score of 2 indicates they are at baseline, or normal. Higher scores are given for elevated or abnormally high levels. 

McGill Pain Scale

NIH / Warren Grant Magnusen Clinical Center

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
  • 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.

Color Analog Scale

Pain scale

BSIP / Getty Images

The color analog pain scale uses colors:

  • Red represents severe pain.
  • Yellow represents moderate pain.
  • Green represents comfort.

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

Mankoski pain scale

Valis

The Mankoski pain scale uses numbers and corresponding, specific descriptions of pain so you can be sure that you and your healthcare provider understand one another.

Descriptions are detailed. They include phrases such as "very minor annoyance, occasional minor twinges" or "cannot be ignored for more than 30 minutes."

Brief Pain Inventory

Brief pain inventory

RamiNaif / Researchgate

The brief pain inventory is a worksheet made up of 15 questions. You are asked to numerically rate the effect of your pain on categories such as how you relate with other people, how well you can walk walk, and how you've sleep over the last 24 hours.

Descriptor Differential Scale of Pain Intensity

DDSI Scale

Ratologydisabled

This scale has 12 lines, each of which has a descriptor—such as faint, strong, intense, and very intense—placed in the middle of it.

There is a plus sign at the end of each line. There is a minus sign at the start of each line.

You are asked to mark each line in the middle if your pain matches what the descriptor implies.

If your pain is less intense, you place your mark on the minus side of the line instead.

Likewise, if your pain is more intense, your mark should be placed on the plus side of the line.

Summary

Pain scales can help doctors determine how much pain you are experiencing and the impact it is having on you. They can also help define your pain in mutually understood terms.

There are several kinds of pain scales. Some uses pictures or colors, while others use numbers or words. A healthcare provider may choose to use one scale over another depending on what they want to learn, the capacity of their patient (e.g., whether or not they can read), and so on.

Regardless, pain scales help ensure better communication between a healthcare provider and a patient so a proper diagnosis and treatment plan can be established.

A Word From Verywell

Some doctors regularly use a pain scale with patients. Some hospital rooms even have them posted on their walls, prompting staff to have a discussion about pain each time they pay a patient a visit.

If you are not asked to use a pain scale but are having a hard time clearly communicating your pain to a healthcare provider, ask for one. Many people find that it helps them more easily measure their pain and explain it to their doctor.

Frequently Asked Questions

  • What is the FLACC scale?

    The FLACC scale is a pain scale that works by observation. FLACC stands for face, legs, activity, crying, and consolability. Each category is scored from zero to two points based on a person's expression and demeanor. It was originally created to be used for children too young to verbally communicate, but can also be used for adults unable to communicate.

  • Which pain scale has faces?

    The Wong-Baker Faces pain scale is a visual and numbered scale that depicts six faces with varying expressions of happiness and sadness. The numbers range from zero to 10, with a different face accompanying the degree of pain that is felt.

  • What are the different types of pain?

    There are many different types of pain, but they can be separated into a handful of categories.

    • Acute pain: Sudden, specific pain that results from an event such as a burn, cut, dental work, or surgery and lasts for less than six months
    • Chronic pain: Ongoing, consistent pain that lasts longer than six months, such as headaches, arthritis, and back pain
    • Neuropathic pain: Caused by damaged peripheral nerve fibers in the organs, arms, legs, fingers, and toes
  • What is the Universal Pain Assessment Tool?

    The Universal Pain Assessment Tool (UPAT) is a pain scale that uses elements found in other scales. It uses the facial expressions of the Wong-Baker Faces pain scale, observations outlined in the FLACC scale, and the numerical rating scale to gauge pain intensity.

Was this page helpful?
13 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Boonstra AM, Stewart RE, Köke AJ, et al. Cut-off points for mild, moderate, and severe pain on the numeric rating scale for pain in patients with chronic musculoskeletal pain: variability and influence of sex and catastrophizing. Front Psychol. 2016;7:1466. doi:10.3389/fpsyg.2016.01466

  2. Garra G, Singer AJ, Taira BR, et al. Validation of the wong-baker FACES pain rating scale in pediatric emergency department patients. Acad Emerg Med. 2010;17(1):50-4. doi:10.1111/j.1553-2712.2009.00620.x

  3. Crellin DJ, Harrison D, Santamaria N, Huque H, Babl FE. The psychometric properties of the FLACC scale used to assess procedural pain. J Pain. 2018;19(8):862-872. doi:10.1016/j.jpain.2018.02.013

  4. Hand IL, Noble L, Geiss D, Wozniak L, Hall C. COVERS neonatal pain scale: development and validation. Int J Pediatr. 2010;2010:496719. doi:10.1155/2010/496719

  5. Boerlage AA, Ista E, Duivenvoorden HJ, De wildt SN, Tibboel D, Van dijk M. The COMFORT behaviour scale detects clinically meaningful effects of analgesic and sedative treatment. Eur J Pain. 2015;19(4):473-9. doi:10.1002/ejp.569

  6. Ngamkham S, Vincent C, Finnegan L, Holden JE, Wang ZJ, Wilkie DJ. The McGill Pain Questionnaire as a multidimensional measure in people with cancer: an integrative review. Pain Manag Nurs. 2012;13(1):27-51. doi:10.1016/j.pmn.2010.12.003

  7. Le may S, Ballard A, Khadra C, et al. Comparison of the psychometric properties of 3 pain scales used in the pediatric emergency department: visual analogue scale, faces pain scale-revised, and colour analogue scale. Pain. 2018;159(8):1508-1517. doi:10.1097/j.pain.0000000000001236.

  8. George Francis McMahon, I. I. I. (n.d.). Comparison of a numeric and a descriptive pain scale in the Occupational Medicine Setting. SJSU ScholarWorks.

  9. MD Anderson Cancer Center. The brief pain inventory.

  10. Atkinson JH, Slater MA, Capparelli EV, et al. A randomized controlled trial of gabapentin for chronic low back pain with and without a radiating component. Pain. 2016;157(7):1499-507. doi:10.1097/j.pain.0000000000000554

  11. Cleveland Clinic. Acute vs. chronic pain.

  12. Cleveland Clinic. Neuropathic pain.

  13. Dugashvili G, Van den Berghe L, Menabde G, Janelidze M, Marks L. Use of the universal pain assessment tool for evaluating pain associated with TMD in youngsters with an intellectual disability. 2017;22(1):e88-e94. Medicina Oral Patología Oral y Cirugia Bucal. doi:10.4317/medoral.21584

Additional Reading