Table of ContentsView AllTable of ContentsWhat Is Pain?Intensity/SensationsUsing Pain ScalesPalliation/ProvocationCommunicating Pain
Table of ContentsView All
View All
Table of Contents
What Is Pain?
Intensity/Sensations
Using Pain Scales
Palliation/Provocation
Communicating Pain
Pain is a distressing sensation commonly experienced with injuries, infections, and disease. Pain is often difficult to assess, particularly in terms of its nature and intensity, because it is largely based on an individual’s perception of how “bad” the pain is.
There are several tools, however, that can help your healthcare provider better understand how you are experiencing pain as an individual. This includes pain scales and charts commonly used after major surgery or when managing chronic pain conditions.
Whether your pain isacute(sudden and severe) orchronic(persistent or recurrent), communicating your experience of pain can help your healthcare provider prescribe the best possible treatments for your type and level of pain.
This article describes the various tools used to assess pain in children and adults.
Understanding What Pain Is
Pain can be categorized in different ways:
Many of these types of pain can co-occur or overlap, such as generalized hyperalgesia or chronic radicular pain.
Communicating Pain Intensity and Sensations
What is harder to describe is theintensityof pain because pain is ultimately an individual experience.Some refer to this in terms of a person’s “pain threshold,” or how much pain they can experience before it is considered “bad” or “intolerable.” As such, some people are said to have “high pain thresholds” or “low pain thresholds.”
Wherein people tend to feel less pain when they are happy or frightened (due to the release of “feel-good” hormones likeendorphinsor stress hormones likecortisol), they tend to feel pain more when they are depressed, frustrated, anxious, or angry.This is because negative emotions can make your perceptions about everything worse, including pain.
Equally hard to describe are pain sensations that people will describe using adjectives like:
As generalized as these descriptions may seem, they provide important clues as to the type and intensity of pain you are experiencing.
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4 Pain Scales and How They Are Used
The first step in assessing pain is to find out how bad it is. This is done with tools called “pain scales” that subjectively evaluate how a person experiences pain in different ways.
Self-reporting is the most reliable measure of pain.Even if a person “catastrophizes” and their response to pain is exaggerated, it is still how they genuinely experience pain.Without a self-report, a healthcare provider may underestimate the severity of pain and treat people based on how they “should” be feeling.
These are four pain scales commonly used in nursing and chronic pain management:
These pain scales are useful as they take less than a minute to administer. The scales are relatively easy for people to understand and don’t require much, if any, translation when used for the appropriate patient.
Numeric Pain Rating Scale
The Numeric Pain Rating Scale (NPRS-11), also known as the Numerical Pain Rating Scale, is an 11-point scale for self-reporting your pain experience. It is used to describe the intensity of pain (referred to as unidimensional pain) in adults and children over 6 years of age.
The patient selects a number between 0 and 11, with 0 meaning no pain to 10 meaning the worst possible pain.
The NPRS-11 is often categorized as follows:
Although the NPRS-11 is thought to be one of the more accurate ways to assess pain intensity, it has limitations as the categories do not necessarily reflect the patient’s true meaning. Even so, the NPRS-11 may be useful in assessing the effectiveness of pain management therapies over time.
EgudinKa / Getty Images
Wong-Baker FACES Pain Scale
The Wong-Baker FACES Pain Rating Scale is used to subjectively assess an individual’s experience of pain based on a series of six faces ranging from a happy face (indicating “no pain”) to a crying face (indicating “hurts worst”).
Signs and symptoms that a person may exhibit if they are in pain:
The Wong-Baker Pain Scale is useful for children over 3 years of age and people withintellectual disabilities. It may be less helpful in other groups as the interpretations are very generalized.
FLACC Scale
The FLACC Pain Scale is used for children over 2 months and others who are nonverbal. Rather than using a self-report, the FLACC Scale is assessed through observation of a child’s face, legs, activity, crying, and consolability. The child is assessed for two to five minutes if awake and five minutes or more if asleep.
The FLACC Scale ranges from 0 to 2, the value of which is assigned to each of the five domains.
The scores are then added up and interpreted as follows:
The FLACC Scale is considered a valuable tool for children with mild to severe cognitive impairments, developmental delays, orcerebral palsy.
Verbal Rating Scale
The Verbal Rating Scale (VRS), also known as the Verbal Descriptor Scale, is a self-report consisting of statements designed to describe pain intensity and duration.
The VRS is assessed on a scale of 0 to 4 using different adjectives to describe extremes in pain. It is intended for adults and children 10 years and over who have a grasp of the terminology.
Based on a characteristic of pain, such as pain intensity or duration, different descriptions are ascribed to each value. Examples include:
The VRS aims to characterize the nature of pain. There are many variations of VRS, some with different questions and others with scales ranging from 0 to 10 or 0 to 15.
The VRS may be less useful in young children, people with language barriers, or intellectually disabled individuals who may underestimate or overestimate their pain experiences.
Pain Scales: Types of Scales and Using Them to Explain Pain
Role of Palliation and Provocation
Palliation and provocation are important tools used to assess pain. First, a healthcare provider will want to know what makes your pain better (or palliates it). Then, they will want to determine what makes the pain worse (or provokes it).
The purpose of palliation is to not only determine what eases pain but also how much or little palliation is needed. This may include things like pain medications, changing positions, or lying only on one side of the body.
Palliation is especially important when prescribing drugs. The goal ofpain medicationsis to prescribe the lowest possible dose of the safest drug to achieve sustained control.Overtreating pain exposes a person to a greater risk of side effects and, withopioid drugsespecially, a greater risk of addiction.
During a physical exam, the healthcare provider will often manipulate a limb to see if pain is provoked. These insights can help narrow the possible causes of pain and or direct the appropriatephysical therapy plan.
Overview of Pain Management
Communicating With Your Doctor
One of the most important things you can do for the person you are caring for is to keep an accurate record of their pain and their pain treatments. Once you assess their pain, record the severity and location, as well as any medications or treatments that you give them.
Take note of whether the medications or treatments were effective. Also, write down anything they may have told you about what makes it feel better or worse. This is a great way to team up with your healthcare professionals to provide the best palliative care possible.
Your pain log doesn’t need to be detailed, but a few components will help your healthcare providers better assess both the location and severity of pain, as well as treatments that are or are not effective.
The table below is an example of a pain log for someone who has abdominal pain:
Summary
Assessing your pain accurately can help ensure you get the best treatment, neither undertreating the pain (and causing undue suffering) nor overtreating the pain (and causing avoidable side effects).
8 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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