Pain scale

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Pain scale

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Pain scales are tools that can help health care providers diagnose or measure a patients pain's intensity. The most widely used scales are visual, verbal, numerical or some combination of all three forms.

Many pain scales include a use of cartoon faces with different expressions. These are often useful when used with children.

In 1999, the Veteran's Administration adopted the slogan "Pain is the fifth vital sign", and encouraged greater use of pain scales in initial diagnoses.

One of the most common pain scale is the Wong-Baker Faces Pain Rating Scale. The Wong-Baker scale goes from 0 to 5:

Not all scales are measured on a single axis. For example, the "Brief Pain Inventory" is performed in interview form to identify how pain affects different aspects of the patient's life.

Incomplete list of pain measurement scales

  • Visual analog scale (VAS)[1] An observational study concluded "the minimum clinically significant change in patient pain severity measured with a 100-mm visual analog scale was 13 mm."[2]
  • McGill Pain Questionnaire (MPQ)[3]
  • DDS[4]
  • Faces Pain Scale (FPS)[5][6]
  • Pediatric Pain Questionnaire (PPQ)
  • Faces Pain Scale - Revised (FPS-R) (Hicks, C., scale is from 1-10)
  • Faces, Legs, Activity, Cry, Consolability (FLACC)
  • Premature Infant Pain Profile (PIPP)
  • Numerical 11 point box (BS-11)[7] Pain may be quantified on a pain numeric rating scale (NRS) that ranges from 0-10 points (0 means no pain); however, the accuracy of such as scale (using a cut point of 4 or more) for predicting pain that interferes with functioning is:[8]
  • 10 and 21 point scales[9]
  • Schmidt Sting Pain Index
  • Starr sting pain scale
  • Verbal Rating Scale (VRS)
  • Simple Descriptive Pain Scale (SDS)
  • Wong-Baker Pain Faces Rating Scale (PFS)[10]
  • Numerical Pain Scale (NPS)
  • Numeric Rating Scale (NRS-11)[11]
  • Eland Scale
  • Modified Eland Scale
  • Cube Test
  • Faces Scale
  • Modified Faces Scale
  • Brief Pain Inventory (BPI)
  • Mankowski Pain Scale (SKIP), from 0 to 10
  • Dolorimeter Pain Index (DPI)
  • The Walid-Robinson Index (WRI) = Pain intensity upon admission (from 0 to 10) X Length of pain suffering (in months)


  1. Huskisson EC. Measurement of pain. J Rheumatol 1982; 9:768-769.
  2. Todd KH, Funk KG, Funk JP, Bonacci R (1996). "Clinical significance of reported changes in pain severity". Ann Emerg Med. 27 (4): 485–9. PMID 8604867. Unknown parameter |month= ignored (help)
  3. Melzack R. The McGill pain questionnaire: major properties and scoring method. Pain 1975; 1:277-299.
  4. Measurement of pain., Katz J, Melzack R. , Surg Clin North Am. 1999 Apr;79(2):231-52. PMID: 10352653
  5. The Faces Pain Scale - Revised (English, French and twenty-four other languages), Carl L von Baeyer, August 2005.
  6. Bieri D, Reeve R, Champion GD, Addicoat L and Ziegler J. The Faces Pain Scale for the self-assessment of the severity of pain experienced by children: Development, initial validation and preliminary investigation for ratio scale properties. Pain 1990;41:139-150.
  7. Jensen MP, Karoly P, O’Riordan EF, Bland F Jr & Burns RS (1989) The subjective experience of acute pain. An assessment of the utility of 10 indices. Clin J Pain 5: 153–159.
  8. Krebs, Carey, and Weinberger, “Accuracy of the Pain Numeric Rating Scale as a Screening Test in Primary Care,” Journal of General Internal Medicine 22, no. 10 (October 21, 2007): 1453-1458, doi:10.1007/s11606-007-0321-2 (accessed September 28, 2007)
  9. Jensen MP, Turner JA & Romano JM (1994) What is the maximum number of levels needed in pain intensity measurement? Pain 58: 387–392.
  10. Wong DL, Baker C. Pain in children: comparison of assessment scales. Pediatr Nurs 1988;14:9-17.
  11. The Numeric Rating Scale for Clinical Pain Measurement: A Ratio Measure?, Craig T. Hartrick, Juliann P. Kovan, Sharon Shapiro, Pain Practice 3 (4), 310–316 doi:10.1111/j.1530-7085.2003.03034.x, Dec. 2003

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