Pain assessment scales

Pain assessment scales

Achieving effective pain management requires careful assessment and regular review of the patient’s experience of pain. As pain is a subjective symptom, pain assessment tools are usually based on the patient’s own perception of his or her pain and its severity.

Many different pain scales are available, including those for infants, children, adults and patients with difficulties communicating. Below is a selection of pain scales that may prove useful to you and your patients.


Visual Analog Scale

The visual analog scale (VAS) is a unidimensional measure of pain intensity in adults. For this scale, patients indicate their current level of pain along a 10-cm line with ‘no pain’ at one end and ‘worst pain imaginable’ at the other.


Visual analog scale


Numeric Rating Scale

Like the VAS, the numeric rating scale (NRS) is a unidimensional measure of pain intensity. It is a segmented numeric version of the VAS. Patients rate their pain on a simple scale marked from 0 to 10, where 0 is ‘no pain’ and 10 is ‘worst pain imaginable’, either verbally or by placing a mark along a line.


Numeric Rating Scale


Wong-Baker FACES® Pain Rating Scale

The Wong-Baker FACES® Pain Rating Scale combines pictures and numbers to allow pain to be rated by the user. The faces range from a smiling face to a sad, crying face. A numerical rating is assigned to each face, of which there are 6 total. The Wong-Baker FACES® Pain Rating Scale is a self-assessment tool, so the patient must be able to understand the tool and be able to indicate which face most closely depicts the pain experience. The scale is used for people aged 3 and older. This is not the tool to use for unresponsive patients.

The Wong-Baker FACES® Pain Rating Scale is a copyrighted scale and licensing is required for use. Details are available here.


Faces Pain Scale – Revised

The Faces Pain Scale – Revised (FPS-R) is a self-report measure of pain intensity developed for pediatric use. It shows a series of six faces that illustrate increasing levels of pain, from the first face with no pain (0) and the last face showing the most severe pain (10). It is simple to use and requires no equipment except the photocopied faces.

No permission is needed to use the FPS-R for clinical, educational or research purposes, as long as it is not modified or altered in any way. Copies of the FPS-R and translations of the instructions in many languages can be downloaded here.


Brief Pain Inventory-Short Form

This short form of the Brief Pain Inventory questionnaire (BPI-SF) thoroughly assesses patients’ pain severity and its impact on daily functioning. It is widely used in clinical trials and takes about 5 minutes to complete. It is suitable for use by patients with pain from chronic diseases or conditions such as cancer, osteoarthritis and low back pain, or with pain from acute conditions such as post-operative pain. The BPI-SF has been validated and is available in many languages, including English, Chinese (Simplified), Chinese (Traditional), Filipino, Japanese, Korean, Malay, Thai and Vietnamese.

The BPI-SF can be used free of charge in individual clinical practice after obtaining permission from the copyright holder and complying with the copyright conditions. Samples of the 2-page form and details on obtaining copies of the form can be found here.


British Pain Society pain rating scales

The British Pain Society (BPS) has produced a series of pain scales in multiple languages to encourage improved assessment of pain in patients for whom English is not their first language. The pain scales presented by the BPS were considered to be easiest to use and best understood of the simple scales available for adults with no cognitive impairment. These scales assess different aspects of pain and pain relief.

The pain scales, in various languages, can be downloaded and printed free of charge from the BPS web site.


Pain Quality Assessment Scale (PQAS)

The Pain Quality Assessment Scale (PQAS) is a 20-item instrument developed to quantify the quality and intensity of pain associated with all types and categories of pain problems, including both nociceptive and neuropathic pain. The specific items added assess tender, numb, electrical, tingling, radiating, throbbing, aching, shooting, cramping and heavy pain qualities.

Copies of the instrument for use in individual clinical practice can be obtained free of charge from the Patient-Reported Outcome and Quality of Life Instruments Database (PROQOLID).


McGill Pain Questionnaire Short Form

The McGill Pain Questionnaire Short Form (SF-MPQ) is a multidimensional pain questionnaire that measures the sensory, affective and evaluative aspects of pain and pain intensity in adults with chronic pain of various etiologies. It can be used to discriminate among different pain syndromes and evaluate the response to treatment. It is interviewer-administered and takes about 2 to 5 minutes to complete.

Copies of the instrument for use in individual clinical practice can be obtained free of charge from the Patient-Reported Outcome and Quality of Life Instruments Database (PROQOLID).