Has a doctor ever asked you to rate your pain from 1 to 10, or pointed at colorful faces, asking you to pick one?
Well, those are pain scales, and sometimes they make us angry, don’t they?
Have you ever thought about what number to pick, just to realize you have no idea how to express the level of pain you’re in? Yes, me too…
What is the Pain Scale?
Pain scales are tools, used mostly by medical professionals and parents, to get a better idea of someone’s level of pain. They don’t just apply to physical pain, but also to emotional pain. Emotional scales are mostly used for children for them to learn how to express their feelings more accurately, something a lot of adults are in desperate need of.
The accuracy of pain scales is very important when it comes to diagnosis, since it can rule out some illnesses, while bringing others to the table.
When it comes to physical pain, the most commonly used scales are the 1 to 10 numeric scale, and the one where little colorful emoji-like faces are in a row, and their expressions and colors gradually change from content to very upset, often crying. We will look into these further in the article…
Types of Pain Scales
There are four main categories of pain scales:
- Numerical: uses numbers to express the level of pain, or pain index.
- Visual: the patient points to the image on the scale, which better represents their pain.
- Categorical: uses words to describe the pain, incorporating numbers, colors and location.
- There is a fourth category of scales which are not used by the patient, but applied by a healthcare professional or parent when the patient is unable to communicate. Though they can also belong to the three other categories.
Pain Scale Examples
Within these categories, there are several different methods that healthcare professionals and some parents use in order to get an idea of someone’s level of pain. There are a few of these you might know, but most will probably be new to you:
Numerical Rating Pain Scale:
This is the most commonly used pain chart and is only meant to be used on people over the age of 9. I think we have all been asked to rate our pain from one to ten at some point by doctors, nurses, physical therapists, and other healthcare professionals. It is simple, and doesn’t require any visuals or forms, you just say a number, which is usually incredibly inaccurate. Today, I could rate my pain as a 4 because I’m cheerful, but yesterday I was frustrated, annoyed, and not doing well at all, so I rated it a 7… Also, 10 is supposed to be the most intense pain possible, but how can you know how that feels?
Wong-Baker Faces Pain Scale
This pain chart uses both images and numbers. It ranges from 1 to 10, and is accompanied by drawings of faces, each one looking more upset than the one before. It’s meant to be used for people over the age of three. The patient points to the face that, in their opinion, best represents their level of pain and discomfort, and the number is meant to correspond with it.
Color Analog Scale
As it sounds, it’s a color scale. In it, extreme pain is usually represented by red, while lack of pain by blue or green. It is linear and relatively simple to use, but can be too simple when it comes to chronic pain and complex conditions.
Descriptor Differential Scale of Pain Intensity
This one gives the patient 12 words that describe the intensity of pain, and the idea is for them to recognize which one describes it better, so the professional can get an idea of it.
McGill Pain Scale
This is a method where the patient rates their own pain index by selecting different words that describe pain from a list. The list relates words to numbers, which result in a final score with a maximum of 78. It can be used by adults and children who can read well.
Mankoski Pain Scale
This is a more detailed numerical scale. It uses the simple 1 to 10 levels of pain and adds descriptions to every number, making it easier to select, not to mention a lot more accurate.
Chronic Pain Grade Scale
It is a 7-item questionnaire which grades chronic pain from 1 to 5. It differentiates between the pain felt at the moment of the application of the questionnaire, and at other times, as well as how much daily life has been affected by it.
Brief Pain Inventory
This is a pain chart with 15 questions, where the patient numerically rates the effect that pain has had on their daily life activities, such as sleep, work, walking, socializing, among others. This is an interesting method, since rather than focusing on rating the pain itself, it rates how much pain affects your life.
Critical Care Pain Observation Tool (CPOT)
This scale is meant to be used by healthcare professionals, not by the patients themselves. It is used for critically ill patients who don’t have the ability to communicate because they are sedated, unconscious, or their condition doesn’t allow it.
It is based on the observation of facial expressions, movements, and muscle tension, and takes into account whether or not the patient is being ventilated. This scale is mostly used in the ICU.
Behavioral Pain Scale (BPS)
Like the previous one, the BPS scale is meant to be used by healthcare professionals in order to be able to identify the level of pain of critically ill patients who don’t have the ability to communicate, and it’s also mostly used for ICU patients.
It is specifically designed for intubated patients, and is based on the observation of facial expressions, upper limb movements, and how they are tolerating being intubated.
FLACC pain scale
It was developed for children who are too young to communicate or cooperate and is also used for adults who can’t communicate. This method is based on the observation of different behaviours, movements and responses, such as facial expressions, leg movement, level of activity, crying and how they respond to being reassured, patted, or hugged.
This one’s meant to be used for determining levels of pain in children 6 months old or younger. It’s based on the observation of crying, level of oxygenation (babies in pain will have lower oxygen saturation), vital signs, facial expressions and their ability to sleep.
This one can be used to identify the level of pain of children or adults who can’t communicate. It observes levels of alertness, calmness, respiratory distress, crying, physical movement, muscle tension, facial tension, blood pressure and heart rate. It’s more commonly used in hospitals or medical centers.
The issues with pain scales
The thing with pain scales is that none of them is ideal or perfect. It only helps medical professionals or parents get an idea of the person’s pain in order to better diagnose or treat it.
Most doctors use the simple 1 to 10 scale, or the Wong-Baker Faces, so it’s very frustrating and annoying when you’re sitting there, trying to explain how your knee feels like it has a nail stuck in it, and you need to pick a number…
For those who can’t explain…
The real challenge for healthcare professionals (hats off to you) is when the patient can’t even try to explain the pain. Although it seems hard to believe, unconscious patients can feel severe pain, and a lot of it. The issue with this pain is that it’s hard to identify, and it negatively affects the effectiveness of the treatment the person is receiving. Babies, critically ill patients, patients who are sedated or under strong medication, cannot use any scale to communicate their pain and, even if they could, it would be inaccurate. For them, doctors attempt to use the different methods that don’t rely on the patient, but on the observation of different factors.
There a few methods that can be used on children, and are based on their behaviour and how it might change due to pain. This is especially important for babies, since severe pain surely means something is really wrong.
For ICU patients, who are commonly intubated, sedated, or unconscious, the methods used are often “Critical Care Pain Observation Tool” and “Behavioral Pain Scale” which, as explained above, take into account whether or not they’re being ventilated. And, though these methods help immensely, they’re not entirely reliable.
When it comes to these methods, a study determined that BPS was more specific, but less sensitive, while the combination of both BPS and CPOT, improved the accuracy of the results, which is good news, since untreated pain in unconscious, tubed, or sedated patients can delay and significantly affect their treatment and healing process.
But when it’s chronic…
Chronic pain is hard to scale. Some days it can feel bearable, but some others it causes you to curl up in bed and cry all day, ignore calls, and punch the pillows every once in a while. So when you give your doctor a visit, you are likely to say something like “today, it’s a 5… but yesterday it was a 9.” The doctor might be confused, or think that you’re exaggerating, but it’s difficult to explain in numbers how you wanted to go to your friend’s birthday party, but you couldn’t even manage to walk out of your apartment because you were in severe pain…
After seeing how many pain scales are available out there, it seems a little discouraging that we’re almost always stuck with the same old “from 1 to 10, how much does it hurt?” We understand that it’s quicker and has no need for instructions, materials, or training; however, in some cases, like for patients who are seeking relief from chronic pain, a little extra time and energy invested into measuring and identifying it by using something like the Mankoski Pain Scale, the Chronic Pain Grade Scale, or the Brief Pain Inventory, could help health professionals understand the patient a little better in order to treat the pain and its side effects, accordingly.
We hope this was helpful!