10 Common Types of Pain Scales

Numerical Rating Pain Scale

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

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

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

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

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

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

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

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

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

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.