Using an Improved Pain Scale for Your Facility: Overview

Measuring pain is an important way to assess how patients are responding to treatments. Pain scales are evidence-based tools that clinicians can use to help patients express their experience of pain, often for the purpose of determining interventions. For decades, these tools have been used to help monitor changes in pain levels and severity. But since pain is a subjective experience that is notoriously difficult to quantify, health experts have often questioned whether there’s a need for an improved pain scale or better implementation practices.

Various pain scales have been developed over the years, and using one that’s best suited to your patient population is key. In this guide, we’ll discuss how and when clinicians use these assessment tools in practice. We’ll also provide pain scale examples and descriptions, and give you tips on how to improve use of these tools with your patients.

What Is a Pain Scale?

Healthcare providers use a variety of measurement tools to quantify or qualify different aspects of patient pain, such as duration, intensity, or tolerability. Pain scales in particular are unidimensional tools that patients use to self-report their pain levels in care situations requiring swift assessment.

For example, nurses often ask patients to rate their pain on a scale of 1 to 10 before administering “as-needed” pain medications like Advil. This allows them to quickly gauge whether a patient needs medications, or if their pain levels have improved from the last dose.

Pain scales are designed to be quick measurement tools, and it’s important to differentiate them from longer multidimensional assessments, such as the McGill Pain Questionnaire (MPQ). These assessments are used in scenarios where a more comprehensive pain evaluation is required. In this guide, we’ll focus on unidimensional pain scales.

3 Pain Scale Types

While many different variations of pain level scales have been developed over the years, they generally fall under three broad categories. Here’s an overview of these categories, the pros and cons of each, and some common pain scale examples.

1. Numeric Pain Rating Scales

Numeric pain rating scales display numbers that patients use to “score” the level of pain that they’re feeling. The most commonly administered and validated tool under this category is the Numerical Rating Scale (NRS), which asks patients to rate their pain intensity on a scale of 0 to 10 — with 0 meaning no pain and 10 meaning the most severe pain that a patient can feel.

Another example is the Functional Pain Scale (FPS), which alternatively asks patients to rate their pain tolerability. This tool uses a scale of 0 to 5, with 0 indicating no pain and 5 being the most intolerable pain.

2. Visual or Face Pain Scales

Visual/face rating scales typically have pictures or a graphic continuum that patients can use to rate their pain. The most widely used tool in this category is the Visual Analog Scale (VAS), which is a horizontal pain scale with descriptions at each end of a line. The left end signifies “no pain” while the right end signifies “severe pain.” Patients are tasked with marking the general area on the line that best represents their pain level.

Additionally, the Wong-Baker FACES Scale is a visual pain scale chart developed for use with children. This tool displays a range of faces, from a happy face (no pain) to a crying face (worst pain), and patients can point to the face that represents how they’re feeling. Though this scale, sometimes called the happy face pain chart, was created for use with children, it is now widely used with patients of all ages who relate better to images than numbers.

3. Verbal Rating Scales

Verbal rating scales provide specific adjectives that patients can choose from to describe their pain level. The most popularly used scale under this category — appropriately named the Verbal Rating Scale (VRS) — typically uses five descriptors: no pain, mild, moderate, severe, and very severe. With this pain scale, descriptions are simple and concrete, facilitating ease for patients who think verbally.

Is There an Improved Pain Scale?

Traditional pain scales can serve as helpful tools in certain clinical settings, but they’ve also proven to be somewhat meaningless or misleading in others. For example, some health experts believe that poor pain management in veteran and military patients is partially tied to inaccurate pain assessments.

The Defense and Veterans Pain Rating Scale (DVPRS) was created in 2010 in light of concerns that simple measures of pain intensity/tolerability didn’t accurately capture the complexity of chronic pain in these populations. The tool includes a colorful, numeric pain scale chart with examples of facial expressions and descriptive phrases that correspond to each level. By enhancing and combining different elements of traditional pain scale types, the DVPRS allows for more comprehensive assessments in military and veteran personnel.

So, while there are population-specific adaptations of traditional tools, there’s no universally endorsed improved pain scale that’s right for all settings. It’s important that facilities adopt pain assessment policies that have been well-researched and validated in context of their specific patients’ needs.

General Tips for Improved Pain Scale Usage

There may not be a one-size-fits-all scale for pain levels that patients experience, but there are ways to optimize the use of the tools that are available. Follow these three tips to improve pain scale usage at your facility.

1. Select Patient-Centered Pain Scales

Beyond using validated tools, it’s important to select ones that are best suited for your patient population. Be sure to account for factors such as a patient’s age, reading level, language preference, and goals for treatment.

2. Ensure Patient Understanding

Since pain level scales are self-report tools, patients must be thoroughly educated on how to use them on first administration. Beyond describing what the tool is, be sure to explain what each score, number, or visual means so that patients can more accurately rate their pain levels.

3. Provide Staff Training

Provide pain scale training to staff to support consistency in how scores are interpreted and ensure they’re on the same page about how these tools should be used. For improved pain scale accuracy, it’s important that staff conduct meaningful assessments that inform appropriate care decisions.

Discover More Ways to Enhance the Patient Experience

Adopting improved pain scale practices can lead to better treatment decisions and a higher quality of life for your patients. Looking for more ways to level-up the services you offer? Our healthcare tips and strategies help leaders like you facilitate safe, high-quality nursing care.