SCALES FOR PAIN
ASSESSMENT
By- Dr. Poonam Patil
DEFINITION
Pain is an unpleasant sensory and emotional experience
associated with actual or potential tissue damage or described in
terms of such damage.
Pain is a distressing feeling often caused by intense or damaging
stimuli, such as stubbing a toe, burning a finger, putting alcohol
on a cut.
IMPORTANCE OF PAIN ASSESSMENT SCALE
To determine the severity and duration of underlying pathology.
To determine the nature of the pain whether continuous or
episodic in occurrence.
To know the type of pain (Throbbing, Prickling, Shooting,
Tingling, etc).
To establish a suitable treatment protocol.
To keep a comparative record of whether the treatment is headed
to a positive result or not.
TYPES
Numeric Pain Rating Scale (NPRS).
Visual Analog Scale (VAS).
Chronic Pain Grade Questionnaire.
McGill-Melzack Pain Questionnaire.
Wong-Baker FACES Pain Rating Scale.
Behavioral Pain Scale (BPS).
Verbal Rating Scale (VRS).
Leeds Assessment Of Neuropathic Symptoms And Signs Pain
Scale (LANSS)
Numeric Pain Rating Scale
The NPRS is a unidimensional measure of pain intensity in
adults.
It is a segmented numeric version of the VAS.
The patient selects a whole number (0-10 integers) that best
reflects the intensity of his/her pain.
The 11-point numeric scale ranges from “0” representing one
pain extreme (e.g. “no pain”) to “10” representing the other pain
extreme (e.g. “pain as bad as you can imagine” or “worst pain
imaginable”).
MERITS
Time saving (takes less than a minute).
Easy to administer and score.
Minimal Language Translation Difficulties.
Can be administered both verbally and in writing.
DEMERITS
Evaluates only 1 component of the pain experience and
intensity, and therefore does not capture the complexity of
the pain.
VISUAL ANALOG SCALE
VAS is a unidimensional measure of pain intensity which is
widely used.
The most simple VAS is a straight horizontal line of fixed length,
usually 100mm (the ends are the extremes).
MERITS
Time saving, (takes less than a minute)
Easy to use
Minimal translation difficulties
DEMERITS
The VAS is administered as a paper and pencil measure. As a result
it cannot be administered verbally or by phone
McGill-Melzack Pain Questionnaire
The McGill Pain Questionnaire is a scale of rating pain developed
at McGill University by Melzack and Torgerson in 1971.
It consists primarily of 3 major classes of word descriptors;
1. Sensory
2. Affective
3. Evaluative
It also consists of a 4th Miscellaneous component.
MERITS
The Principle merit of this scale is the wealth of researches and
studies supporting its reliability and validity and the fact that it is a
powerful tool for obtaining data on the qualitative and quantitative
aspects of pain.
It is one of the few tools that can successfully address the
multidimensionality of pain.
DEMERITS
The long term version is complex, demands intense concentration
from patients, and requires up to 30 mins assessment time.
Also, some patients find difficulty in understanding some words that
express the pain.
Test-retest Reliability:
Excellent test-retest reliability (literate) r = 0.96
Excellent test-retest reliability (illiterate) r = 0.95
Wong-Bakers FACES Pain Rating
Scale
It was developed by Donna Wong and Connie Baker.
The scale shows a series of faces ranging from a happy face at 0,
“No Hurt” to a crying face at 10, “Hurts Worst”.
The patient must choose the face that best describes how they are
feeling.
This is used mostly in pediatric population.
This pain scale was originally developed for children. However it
can be used with all patients age 3 and above. It is useful for
children because they may not understand rating their pain on a
scale of 0-10, but are able to understand the cartoon faces and the
emotions they represent, and point to the one that "best matches
their level of pain". This pain scale is also appropriate for patients
who do not know how to count, and those who may have
impaired brain function.
MERITS
Easy To use
Time saving
Can be used on children who generally don’t respond well to other
written scales.
DEMERITS
Provides very superficial results.
Verbal Rating Scale
The VRS comprises a list of adjectives to denote increasing pain
intensity.
The most common words used are “no pain, mild pain, moderate
pain, and severe or intense pain.
For ease of recording these adjectives are assigned numbers.
MERITS
The VRS is a simple, easy to use and time saving scale.
It can be administered on phone hence has a communication
advantage.
DEMERITS
Due to less number of options, a detailed review cannot be obtained
from the patient.
The patient may sometimes unknowingly give false answers due to
limited options which are not much differentiated.
THANK YOU
