Types of Pain Scales
Healthcare providers have at least 11 types of pain scales to choose from. They generally fall into one of three categories:
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.
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 ScaleNIH / Warren Grant Magnusen Clinical CenterThe Numerical Rating Scale (NRS) is designed for anyone over age 9. It is one of the most commonly used pain scales in health care.To use it, you just say the number that best matches the level of pain you are feeling; you can also place a mark on the scale itself.Zero means you have no pain, while 10 represents the most intense pain possible.
Numerical Rating Pain Scale
NIH / Warren Grant Magnusen Clinical Center
The Numerical Rating Scale (NRS) is designed for anyone over age 9. It is one of the most commonly used pain scales in health care.
To use it, you just say the number that best matches the level of pain you are feeling; you can also 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 ScaleNIH / Warren Grant Magnusen Clinical CenterThe 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.
Wong-Baker Faces Pain Scale
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
FLACC stands for:
Zero to two points are assigned for each of the five categories. Then the overall score is tallied. Scores are interpreted as follows:
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 ScaleNIH / Warren Grant Magnusen Clinical CenterThe CRIES Pain Scale assesses:CryingOxygenationVital signsFacial expressionSleeplessnessIt’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.
CRIES Pain Scale
The CRIES Pain Scale assesses:
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:
COMFORT Pain Scale
The COMFORT Scale is another pain scale designed for people who can’t describe or rate their pain, such as:
The COMFORT Scale provides a pain rating between nine and 45 based on nine different parameters. Each is rated from 1 to 5:
McGill Pain Questionnaire
Some examples of the words used are:
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 pain scale is helpful for adults and children who can read.
Color Analog Pain ScaleBSIP / Getty ImagesThe Color Analog Scale (CAS) uses colors to represent different levels of pain on a pain scale:Red:Severe painYellow:Moderate painGreen: ComfortableThe 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.
Color Analog Pain Scale
BSIP / Getty Images
The Color Analog Scale (CAS) uses colors to represent different levels of pain on a pain scale:
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 ScaleValisThe 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 annoyanceOccasional minor twingesCannot be ignored for more than 30 minutesAfter reading the descriptions, you tell the provider which number best fits your pain level.Somatic and Visceral Pain: What’s the Difference?
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:
After reading the descriptions, you tell the provider which number best fits your pain level.
Somatic and Visceral Pain: What’s the Difference?
Brief Pain InventoryRamiNaif / ResearchgateThe Brief Pain Inventory (BPI) 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 peopleHow well you can walkHow you’ve slept over the last 24 hoursThis pain scale captures more nuance in terms of how your pain is affecting your day-to-day life.
Brief Pain Inventory
RamiNaif / Researchgate
The Brief Pain Inventory (BPI) is a worksheet made up of 15 questions.
You’re asked to numerically rate the effect of your pain in categories such as:
This pain scale captures more nuance in terms of how your pain is affecting your day-to-day life.
Descriptor Differential Scale of Pain IntensityRatologydisabledThis 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.
Descriptor Differential Scale of Pain Intensity
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.
Defense and Veterans Pain Rating ScaleU.S. Department of DefenseThe 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 anews 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 distressedColors: Green for no pain, then moving through the spectrum to red for the worst possible painNumbers: 0 for no pain, 10 for the worst possible painDescriptors: 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.
Defense and Veterans Pain Rating Scale
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 anews release, it’s the response to dissatisfaction with other pain scales from both healthcare providers and patients. Rather than a simple scale, it includes:
Combining aspects of many other pain scales may give your healthcare provider more information to work from.
SummaryPain 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.Abnormal Pain TypesSome 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.Assessing Someone Else’s Pain Level
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.
Abnormal Pain Types
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.
Assessing Someone Else’s Pain Level
11 SourcesVerywell 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.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.2016.01466Wong-Baker Faces Foundation.Pain Rating Scale.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.2018.02.013New York Society of Physical Medicine and Rehabilitation.Pain Scales Assessment.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.569Bourdel N, Alves J, Pickering G, Ramilo I, Roman H, Canis M.Systematic review of endometriosis pain assessment: how to choose a scale?.Human Reproduction Update. 2015;21(1):136-152.doi:10.1093/humupd/dmu046Le 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.George Francis McMahon, I. I. I. (n.d.).Comparison of a numeric and a descriptive pain scale in the Occupational Medicine Setting.SJSU ScholarWorks.Lin, C, Poquet, N.The Brief Pain Inventory.Journal of Physiotherapy. 2016;62(52). doi:10.1016/j.jphys.2015.07.001Atkinson 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.0000000000000554U.S. Department of Defense.Your pain on a scale of 1-10? Check out a new DOD way to evaluate pain.Additional ReadingSarpangala M, Devasya A, George AL, Kumara A, Panicker P, Mathew M.Comparative evaluation of the efficacy of lignocaine containing topical anesthetic agents during extraction of deciduous anterior teeth.Minerva Stomatol. 2018;67(1):26-31. doi:10.23736/S0026-4970.17.04052-3
11 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.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.2016.01466Wong-Baker Faces Foundation.Pain Rating Scale.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.2018.02.013New York Society of Physical Medicine and Rehabilitation.Pain Scales Assessment.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.569Bourdel N, Alves J, Pickering G, Ramilo I, Roman H, Canis M.Systematic review of endometriosis pain assessment: how to choose a scale?.Human Reproduction Update. 2015;21(1):136-152.doi:10.1093/humupd/dmu046Le 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.George Francis McMahon, I. I. I. (n.d.).Comparison of a numeric and a descriptive pain scale in the Occupational Medicine Setting.SJSU ScholarWorks.Lin, C, Poquet, N.The Brief Pain Inventory.Journal of Physiotherapy. 2016;62(52). doi:10.1016/j.jphys.2015.07.001Atkinson 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.0000000000000554U.S. Department of Defense.Your pain on a scale of 1-10? Check out a new DOD way to evaluate pain.Additional ReadingSarpangala M, Devasya A, George AL, Kumara A, Panicker P, Mathew M.Comparative evaluation of the efficacy of lignocaine containing topical anesthetic agents during extraction of deciduous anterior teeth.Minerva Stomatol. 2018;67(1):26-31. doi:10.23736/S0026-4970.17.04052-3
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.
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.2016.01466Wong-Baker Faces Foundation.Pain Rating Scale.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.2018.02.013New York Society of Physical Medicine and Rehabilitation.Pain Scales Assessment.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.569Bourdel N, Alves J, Pickering G, Ramilo I, Roman H, Canis M.Systematic review of endometriosis pain assessment: how to choose a scale?.Human Reproduction Update. 2015;21(1):136-152.doi:10.1093/humupd/dmu046Le 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.George Francis McMahon, I. I. I. (n.d.).Comparison of a numeric and a descriptive pain scale in the Occupational Medicine Setting.SJSU ScholarWorks.Lin, C, Poquet, N.The Brief Pain Inventory.Journal of Physiotherapy. 2016;62(52). doi:10.1016/j.jphys.2015.07.001Atkinson 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.0000000000000554U.S. Department of Defense.Your pain on a scale of 1-10? Check out a new DOD way to evaluate pain.
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
Wong-Baker Faces Foundation.Pain Rating Scale.
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
New York Society of Physical Medicine and Rehabilitation.Pain Scales Assessment.
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
Bourdel N, Alves J, Pickering G, Ramilo I, Roman H, Canis M.Systematic review of endometriosis pain assessment: how to choose a scale?.Human Reproduction Update. 2015;21(1):136-152.
doi:10.1093/humupd/dmu046
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.
George Francis McMahon, I. I. I. (n.d.).Comparison of a numeric and a descriptive pain scale in the Occupational Medicine Setting.SJSU ScholarWorks.
Lin, C, Poquet, N.The Brief Pain Inventory.Journal of Physiotherapy. 2016;62(52). doi:10.1016/j.jphys.2015.07.001
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
U.S. Department of Defense.Your pain on a scale of 1-10? Check out a new DOD way to evaluate pain.
Sarpangala M, Devasya A, George AL, Kumara A, Panicker P, Mathew M.Comparative evaluation of the efficacy of lignocaine containing topical anesthetic agents during extraction of deciduous anterior teeth.Minerva Stomatol. 2018;67(1):26-31. doi:10.23736/S0026-4970.17.04052-3
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