Common Types of Pain Scales

Different tools for rating your level of discomfort

There are several well-designed pain scales that are used to help assess the extent of one's pain, all of which help improve communication between healthcare providers and patients. Some of these tools are most suited for people of certain ages, while others are more useful for people who are highly involved in their own health care. 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.
  • 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.

No one particular pain scale is considered ideal or better than the others for every situation. Qualitative scales are especially useful in assessing your response to treatment because they can clearly define 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 and whether it is associated with your medical problem or resulting from the treatment itself.

Numerical scales are more quantitative in nature, but most pain scales have quantitative features and qualitative features.

Numerical Rating Pain Scale

A Pain Assessment Tool for the Person in Pain. NIH/Warren Grant Magnusen Clinical Center

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

A Pain Assessment Tool Used by People in Pain. 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

Observer Rated Pain Scale. NIH/Warren Grant Magnusen Clinical Center

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 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 Observer Pain Scale. NIH/Warren Grant Magnusen Clinical Center

CRIES assesses crying, oxygenation, vital signs, facial expression, and sleeplessness. It is often used for infants six 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

COMFORT Observer Pain 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 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

McGill Pain Questionnaire. 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, 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 "like a toothache" 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. 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. 

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 reference a pain scale but are having a hard time clearly communicating your pain to a healthcare provider, ask that you be provided one. Many people find that it helps them have a more productive conversation and better evaluate their discomfort.

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