What is a pain scale?

A pain scale is the tool that allows the patient to express their pain to healthcare workers, whether they are doctors or nurses.

Doctors usually use pain scales to understand a certain aspect of the patient’s pain. Some of these aspects include severity, type, and duration of the pain.

Depending on how high or low the pain scale rating is, doctors will then interpret those results into an accurate diagnosis and treatment plan tailor-made to every patient.

Not only are pain scales used by individuals of every age, from toddlers to seniors, but they are also used by patients with impaired communication skills.

What kind of pain scales are there?

The most common pain scales are known as unidimensional pain scales, meaning they measure pain on a singular number line and not multiple at the same time.

Unidimensional Pain Scales

Unidimensional Pain scales are the most common and simple scales used in practice. They use words, images as well as descriptors to measure the patient’s pain. Unidimensional Pain Scales include:

• Numeric Rating Scales (NRS):

  This Pain scale is the one that is most commonly used in medicine. It involves the patient having to rate their pain from 0 to 5 or from 0 to 10. It is used both at the beginning of a consultation, and over time, to assess the progress of one’s pain.

  
  

  What do the numbers mean?

  When expressing pain on the NRS scale

  • 1-3 is considered mild,

  • 4-6 is considered moderate,

  • 7-10 is considered severe.

  
  

  What are the NURSE's pros?

  • It takes minimal time to complete.

  • It takes minimal time to analyze.

  • It can be used orally or in writing, making it a scale that can be used for all ages.

  • It can be used internationally and breaks any language barrier.

  
  

  What are the NURSE's cons?

  • It only factors the pain experienced in the last 24 hours.

  • It does not take into consideration fluctuation in pain.

  • It focuses solely on pain severity without taking into consideration other aspects. It doesn’t allow the healthcare workers to determine if the pain is tolerable or unbearable, and doesn’t address the qualities of the pain: is it pulsating or sharp?

• Visual Analog Scales (VAS)

  X marks the spot! This scale requires the patient to draw an X on the printed pain scale. The VAS is a 10 cm line, delimited by anchors on either side of the line: At one end, “no pain” and at the other end, “worst pain”. This type of scale is used in a wide range of clinical settings, from labor pain to neuropathic pain and even the patient’s quality of life.

  
  

  What do the numbers mean?

  Being 10 cm / 100 mm from the “no pain anchor'' to the “worst pain anchor”, the VAS offers scores from 0-100. The higher the score, the greater the pain intensity.

  
  

  When expressing pain on the VAS scale:

  • 0-4 mm is considered no pain,

  • 5-44 mm is considered mild pain,

  • 45-74 mm is considered moderate pain,

  • 75-100 mm is considered severe pain.

  
  

  What are the VAS’s pros?

  • It is quick to complete and analyze.

  • It does not require any training other than how to use a ruler.

  • It demands minimal effort from the ill patients.

  • It has minimal translation difficulties since there are no words involved.

  • It is very sensitive and receptive to change in the patient’s mood or symptoms.

  
  

  What are the VAS’s cons?

  • It is highly subjective.

  • Since it is administered by pen and paper, there is always the human error factor to take into consideration.

  • Photocopying the paper may have an effect on the length of the line.

  • This method is considered too abstract to some patients, who are not able to translate a feeling onto a linear format.

  • Older patients, or patients with cognitive impairments, might have difficulties understanding and completing the scale.









• Categorical Scales

  Categorical Scales are ones that use words, colors, or numbers to get data from their client. These types of scales are usually used for children or patients with communication impairments. There are many types of scales that fit into this category, but two of the main ones are:

  
  

  • Wrong-Baker Faces pain scale:

    The Wrong-Baker Faces pain scale combines faces and numbers to properly diagnose the patient. It presents the patient with 6 different facial expressions as well as a numerical rating from 0-10. 0 For younger patients, pointing to a face is easier to help determine the pain level, as for older patients, having the numbers as well as the faces to correlate them to each other makes the whole self-diagnosing process easier.

    
    

    What do the numbers and faces mean?

    The faces go from a smiling face to a frowning one and ends with a crying face which indicates the most pain.

    • Smiling face is associated with no pain.

    • Frowning is associated with 6-8, so it hurts a lot.

    • Crying is associated with the worst pain.

    As for the numbers:

    • 0: No hurt

    • 2: Hurts a little

    • 4: Hurts a little more

    • 6: Hurts even more

    • 8: hurts a lot

    • 10: Hurts worst

    Since the numerical pain scales are very close to each other, having the faces helps distinguish between each feeling.

    
    

    What are the Faces pain scale pros?

    • It does not require high cognitive abilities, so can be used by young patients as well.

    • It can be used in the case of language barriers, since everyone understands pictures better than words.

    • The presence of both numbers and pictures will help older patients put their pain into emotion.

    
    

    What are the Faces pain scale cons?

    • The facial expressions are all very similar, which might confuse younger patients.

    • For older patients, the faces might be identified as being happy or sad rather than an indication of pain levels.

  • FLACC Scale:

    FLACC stands for: Face – Legs- Activity – Crying and consolability. What this pain scale consists of is a set of mini scales for each of the letters of FLACC that the doctors will observe and rate. This scale is used for children who are too young to communicate verbally or adults who are unable to communicate. This scale is useful for recording pain periodically, since healthcare workers can determine if the points awarded are rising or decreasing.

    
    

    What do the numbers mean?

    The FLACC scale is based on observations, with points ranging from 0-2 for each of the five areas. After the assessment, the overall score is calculated.

    
    

    When expressing pain on the FLACC scale:

    • 0 usually indicates relaxed facial expressions, relaxed limbs, no activity and that the child is not crying.

    • 1 usually indicates an uneasy, whimpering child with tense limbs and can be easily consoled.

    • 2 usually indicates a child with a tense jaw that is trembling and kicking around and that cannot be consoled: Tantrum mode!

    
    

    As for the overall score:

    • 0 is considered relaxed and comfortable

    • 1-3 is considered as mild discomfort

    • 4-6 is considered as moderate pain

    • 7-10 is considered as severe discomfort/pain

    
    

    What are FLACC's pros?

    • It can easily monitor change in a child’s behavior.

    • The symptoms are visible to the naked eye, making it easy for the doctors to diagnose.

    • It is a reliable scale since it uses observation from physical activities as well as vocal characteristics.

    
    

    What are FLACC's cons?

    • It does not take into consideration any external factors such as stress or weather or hunger cues.

    • Since the diagnosis depends on observations done by the doctor and his naked eye, there is the concern of reliability and human error.

I’m X years old, what pain scale should I use?

• NRS: Usually used for children between 7-17 years old. It is also loved amongst elderly patients

• VAS: Since it requires a certain level of imagination and advanced cognitive abilities, patients aged 7 years or older. This technique requires abstract thought and sensory, motor, as well as perceptual abilities. This makes it harder for elderly people or people with cognitive difficulties or poor education to understand the concept of the VAS.

• Categorical Scales: Both Wrong-Bakes Faces and FLACC are effective for younger children. Wrong-Bakes Faces is best for children over the age of 3 while FLACC is usually used for children between the ages of 2 months and 7 years, as well as individuals that are unable to communicate their pain or who have communication difficulties.

Outlook

While each method has its pros and cons, there is no one particular pain scale that is said to be considered ideal or better than the others. Trust your doctor’s choice of test, but don’t hesitate to voice any concerns if the test that was picked is incomprehensible or if you feel more comfortable with other scales than the one that was picked.

It is also important to note that pain scales are not objective, but a subjective measure of pain. So, your definition of severe pain might be someone else’s definition of mild pain.

If you or anyone you know is suffering from pain, you need to be familiar with the pain scale. Call us today on (469) 562 4188 to book an appointment with our expert doctors.