| Chronic Pain The Purpose Of Pain Scales 
The Purpose of Pain Scales These easy-to-use tools offer valuable insight into the experience of pain. By Rhonda B. Graham
InteliHealth Staff Writer Pain is best defined as an uncomfortable or unpleasant feeling that tells you something may be wrong in your body. It's one way your body sends a warning to your brain. The spinal cord and nerves serve as passageways through which pain messages travel to and from your brain and the other parts of your body. But sometimes it's difficult to put the pain you feel into words. Telling your doctor where and how long something hurts is only part of the information needed to diagnose your condition and determine your treatment. You need to be able to describe your pain in a way that gives your doctor clues to your state of health. Pain scales are tools that can help your doctor diagnose or measure your pain's intensity. In some cases, the information provided can help your doctor choose the best treatment. The most widely used scales are visual, verbal, numerical or some combination of all three forms. - Visual. Visual scales have pictures of human anatomy to help you explain where your pain is located. A popular visual scale — the Wong-Baker Faces Pain Rating Scale — features facial expressions to help you show your doctor how the pain makes you feel. This scale is particularly useful for children, who sometimes don't have the vocabulary to explain how they feel.
- Verbal. Verbal scales contain commonly used words such as "low," "mild" or "excruciating" to help you describe the intensity or severity of your discomfort. Verbal scales are useful because the terminology is relative, and you must focus on the most characteristic quality of your pain.
- Numerical. Numerical scales help you to quantify your pain using numbers, sometimes in combination with words.
To be most accurate, pain scales are best used as the pain is occurring. Over time, with treatment, your doctor can use pain scales to record how your pain is changing and to see if treatment is having the intended effect. If you suffer from chronic pain, print out one of the scales provided to help you describe or rate your discomfort for your doctor. Ask your doctor if he or she prefers one of these pain scales or a different one.
Designed for children aged 3 years and older, the Wong-Baker Faces Pain Rating Scale is also helpful for elderly patients who may be cognitively impaired. If offers a visual description for those who don't have the verbal skills to explain how their symptoms make them feel. 
From Wong D.L., Hockenberry-Eaton M., Wilson D., Winkelstein M.L., Schwartz P.: Wong's Essentials of Pediatric Nursing, ed. 6, St. Louis, 2001, p. 1301. Copyrighted by Mosby, Inc. Reprinted by permission.
To use this scale, your doctor should explain that each face shows how a person in pain is feeling. That is, a person may feel happy because he or she has no pain (hurt), or a person may feel sad because he or she has some or a lot of pain. - Face 0 is very happy because he or she doesn't hurt at all.
- Face 1 hurts just a little bit.
- Face 2 hurts a little more.
- Face 3 hurts even more.
- Face 4 hurts a whole lot.
- Face 5 hurts as much as you can imagine, although you don't have to be crying to feel this bad.
You should point to each face using the words to describe the pain intensity. You should then choose the face that best describes how you feel.
With a verbal scale, you can describe the degree of your discomfort by choosing one of the vertical lines that most corresponds to the intensity of pain you are feeling. This is a good way to explain early postoperative pain, which is expected to diminish over time. Your doctor can use this scale to determine if your recovery is progressing in a positive direction. 
A numerical pain scale allows you to describe the intensity of your discomfort in numbers ranging from 0 to 10 (or greater, depending on the scale). Rating the intensity of sensation is one way of helping your doctor determine treatment. 
From Margo McCaffery, RN,MS, FAAN and Chris Pasero, RN MSNc: Pain Clinical Manual, 2nd Edition, 1999, p. 63. Copyrighted by Mosby, Inc. Reprinted by permission.
Numerical pain scales may include words or descriptions to better label your symptoms, from feeling no pain to experiencing excruciating pain. Some researchers believe that this type of combination scale may be most sensitive to gender and ethnic differences in describing pain.
Last updated March 23, 2009
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