Chronic Pain Diagnosis 10 Common Types of Pain Scales By Erica Jacques Erica Jacques LinkedIn Erica Jacques, OT, is a board-certified occupational therapist at a level one trauma center. Learn about our editorial process Updated on January 04, 2022 Medically reviewed Verywell Health articles are reviewed by board-certified physicians and healthcare professionals. These medical reviewers confirm the content is thorough and accurate, reflecting the latest evidence-based research. Content is reviewed before publication and upon substantial updates. Learn more. by Grant Hughes, MD Medically reviewed by Grant Hughes, MD LinkedIn Grant Hughes, MD, is board-certified in rheumatology and is the head of rheumatology at Seattle's Harborview Medical Center. Learn about our Medical Expert Board Print 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. Using Pain Scales to Effectively Communicate Pain Intensity 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 comfortable1 to 3: Mild discomfort4 to 6: Moderate pain7 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: ChildrenAdults who are cognitively impairedAdults whose cognition is temporarily impaired by medication or illnessPeople 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: TuggingTerrifyingColdSharpWretched 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 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 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 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 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. Assessing Someone Else's Pain Level 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 monthsChronic pain: Ongoing, consistent pain that lasts longer than six months, such as headaches, arthritis, and back painNeuropathic pain: Caused by damaged peripheral nerve fibers in the organs, arms, legs, fingers, and toes Learn More: Main Types of Chronic Pain 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? Thanks for your feedback! Sign up for our Health Tip of the Day newsletter, and receive daily tips that will help you live your healthiest life. Sign Up You're in! Thank you, {{form.email}}, for signing up. There was an error. Please try again. What are your concerns? Other Inaccurate Hard to Understand Submit 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. 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 Garra G, Singer AJ, Taira BR, et al. Validation of the wong-baker FACES pain rating scale in pediatric emergency department patients. 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Medicina Oral Patología Oral y Cirugia Bucal. doi:10.4317/medoral.21584 Additional Reading 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 Sarpangala M, Devasya A, George AL, Kumara A, Panicker P, Mathew M. Comparative evaluation of the efficacy of lignocaine containing topical anesthetic agents during extraction of deciduous anterior teeth. Minerva Stomatol. 2018;67(1):26-31. doi:10.23736/S0026-4970.17.04052-3