11 Common Types of Pain Scales

Pain scales are tools healthcare providers use to improve communication with you about your pain. They're helpful because pain is subjective (experienced differently by different people) and can vary greatly in severity and nature (e.g., aching, stabbing, squeezing, etc.)

Having a means of measuring your pain helps with:

  • The diagnostic process
  • Tracking the progression of a condition
  • Determining how effective a treatment is

Several types are in use, each with its own benefits. This article looks at eleven common pain scales and how they work.

Pain Scale Categories

Healthcare providers have at least 11 types of pain scales to choose from. They generally fall into one of three categories:

  • Numerical rating scales (NRS): Use numbers to rate pain
  • Visual analog scales (VAS): Ask you to select a picture that best matches your pain level
  • Categorical scales: Primarily use words, possibly along with numbers, colors, or location(s) on the body

The scales may provide quantitative measurements, qualitative measurements, or both.

Quantitative scales answer the question "how bad is your pain?" They're helpful for gauging your response to treatment over time.

Qualitative pain scales answer the question "what does it feel like?" They can give your healthcare provider ideas about the cause of your pain, whether it's associated with any medical problems you have, or whether 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 best 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 for anyone over age 9. It is one of the most commonly used pain scales in health care.

To use the numerical scale, you can just say the number or place a mark on the scale itself. Zero means you have no 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 adults and children over age 3.

Six faces depict different expressions, ranging from happy to extremely upset. Each is assigned a numerical rating between 0 (smiling) and 10 (crying).

To use it, you can point to the picture that best represents the degree and intensity of your pain. 

FLACC Pain Scale

NIH / Warren Grant Magnusen Clinical Center

The FLACC pain scale was developed to help healthcare providers gauge the pain of anyone who can't communicate. It's based on the providers' observations.

FLACC stands for:

  • Face
  • Legs
  • Activity
  • Crying
  • Consolability (whether you can be comforted)

Zero to two points are assigned for each of the five categories. Then the overall score is tallied. The score means:

  • 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 Pain Scale

NIH / Warren Grant Magnusen Clinical Center

The CRIES pain scale assesses: 

  • Crying
  • Oxygenation
  • Vital signs
  • Facial expression
  • Sleeplessness

It's often used for babies 6 months and younger. It's widely used in neonatal intensive care units (NICU).

This assessment tool is based on a healthcare provider's observations and objective measurements. In each category:

  • A rating of 0 means you're showing no signs of pain.
  • A rating of 2 means you're showing signs of extreme pain.

COMFORT Pain Scale

NIH / Warren Grant Magnusen Clinical Center

The COMFORT Scale is another pain scale designed for people who can't describe or rate their pain, such as:

  • Children
  • Adults with cognitive impairments
  • Adults whose are temporarily impaired by medication or illness
  • People who are sedated in an intensive care unit (ICU) or operating room

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

  • Alertness: 1 for deep sleep, 2 for light sleep, 3 for drowsiness, 4 for alertness, and 5 for high alertness
  • Calmness: 1 for complete calmness, higher ratings for increased anxiety and agitation
  • Respiratory distress: How much your breathing indicates pain, with higher ratings for agitated breathing
  • Crying: 1 for no crying, higher scores for moaning, sobbing, or screaming
  • Physical movement: 0 for no movement (a sign of less pain), 1 or 2 for some movement, and higher scores for vigorous movements (e.g., thrashing in pain)
  • Muscle tone: A score of 3 for normal, lower scores for diminished muscle tone, and higher scores for rigid muscles
  • Facial tension: 1 for a completely normal, relaxed face, and higher ratings for signs of strain
  • Blood pressure and heart rate: Rated according to your baseline; 1 means they're below baseline (abnormally low), 2 is baseline, higher scores are for elevated or or abnormally high levels 

McGill Pain Scale

NIH / Warren Grant Magnusen Clinical Center

The McGill Pain Questionnaire consists of 78 words that describe pain. You rate your own pain by marking the words that best match your feelings.

Some examples of the words used are:

  • Tugging
  • Terrifying
  • Cold
  • Sharp
  • Wretched

Once you've made your selections, the provider figures out a numerical score with a maximum rating of 78 based on how many words you marked.

This scale is helpful for adults and children who can read.

Color Analog Pain Scale

Pain scale

BSIP / Getty Images

The color analog pain scale uses colors:

  • Red: Severe pain
  • Yellow: Moderate pain
  • Green: Comfortable

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 specific descriptions of pain to ensure your healthcare provider understands your pain.

Descriptions are detailed. They include phrases such as:

  • Very minor annoyance
  • Occasional minor twinges
  • Cannot be ignored for more than 30 minutes

After reading the descriptions, you tell the provider which number best fits your pain level.

Brief Pain Inventory

Brief pain inventory

RamiNaif / Researchgate

The pain scale called the brief pain inventory is a worksheet made up of 15 questions.

You're asked to numerically rate the effect of your pain in categories such as:

  • How you relate with other people
  • How well you can walk
  • How you've slept over the last 24 hours

Descriptor Differential Scale of Pain Intensity

DDSI Scale

Ratologydisabled

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

Each line has a minus sign at the start and a plus sign at the end.

  • First, you find the line with the descriptor that best matches your pain.
  • For less intense pain, you mark somewhere on the minus side.
  • For more intense pain, you mark someone on the plus side.

Defense and Veterans Pain Rating Scale

Department of Defense pain scale includes a color-coded bar graph along with faces and descriptions of each number.

U.S. Department of Defense

The United States Department of Defense in 2021 announced it was using a new pain scale called the Defense and Veterans Pain Rating Scale (DVPRS).

According to a news release, it's the response to dissatisfaction with other pain scales from both healthcare providers and patients. Rather than a simple scale, it includes:

  • Faces: Expressions range from smiling to highly distressed
  • Colors: Green for no pain, then moving through the spectrum to red for the worst possible pain
  • Numbers: 0 for no pain, 10 for the worst possible pain
  • Descriptors: These include "hardly notice pain," "hard to ignore, avoid usual activities," and "can't bear the pain, unable to do anything"

Combining aspects of many other pain scales may give your healthcare provider more information to work from.

Summary

Pain scales can help healthcare providers determine how much pain you're in and its impact on you. They can also help define your pain in mutually understood terms.

The medical community uses several kinds of pain scales. Some use pictures or colors, others use numbers or words, and some use combinations of these.

A provider can choose which scale to use based on your ability to read or communicate and what they want to learn.

A Word From Verywell

Some doctors regularly use a pain scale. Some hospital rooms even have them posted on their walls.

If you're not asked to use a pain scale and are having a hard time clearly communicating with a healthcare provider, ask for one. They're a useful tool for improving diagnosis and treatment.

Frequently Asked Questions

  • What is the FLACC scale?

    The FLACC scale is a pain scale based on observation by a healthcare provider. They evaluate your:

    • Facial expression
    • Leg tension or relaxation
    • Activity (still or squirming with pain)
    • Crying
    • Consolability (whether you can be comforted)

    Each category is scored from zero to two points based. It was originally created for evaluating young children, but can also be used with adults who can't 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 and numbers from zero to 10.

  • What are the different types of pain?

    You can have 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 or recurrs for longer than six months, such as headaches, arthritis, and back pain
    • Neuropathic pain: Caused by damaged peripheral nerves 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.

14 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. U.S. Department of Defense: Health.mil. Your pain on a scale of 1-10? Check out a new DOD way to evaluate pain.

  12. Cleveland Clinic. Acute vs. chronic pain.

  13. Cleveland Clinic. Neuropathic pain.

  14. 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

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