Pain scale

Pain is a complex experience with both sensory and emotional elements that typically indicates a potential issue in the nervous system. It alerts organisms to potential injuries and medical conditions requiring medical assistance. The sensation of pain is an unpleasant or discomforting feeling that can manifest as sensations such as pricking, tingling, burning, stinging, shooting, aching, or electric. Pain can vary in intensity, from very mild to very severe; duration, short-lived to chronic; and location, one localized area or all over the body.{{Cite web |title=Pain |url=https://medlineplus.gov/pain.html |access-date=2024-04-04 |website=medlineplus.gov}}

There are three different types of pain based on the duration of the sensations: acute, episodic, and chronic. The most common are acute and chronic. Acute pain occurs suddenly, is sharp, and goes away once the issue is treated. Acute pain is caused by things like broken bones, childbirth, strained muscles, or burns.{{Cite web |title=Pain {{!}} National Institute of Neurological Disorders and Stroke |url=https://www.ninds.nih.gov/health-information/disorders/pain |access-date=2024-04-04 |website=www.ninds.nih.gov |language=en}} Episodic pain occurs irregularly from time to time. Underlying medical conditions may cause it or can come out of nowhere. Chronic pain is pain that is consistent for at least 3 months. Acute pain can become chronic; however, there usually is no known cause for chronic pain. Chronic pain can have adverse effects on relationships, daily living, work, extracurricular activities, etc.

The experience of pain is unique for an individual, for all people feel pain differently. As a result of this, self-reporting is the best and most common practice for describing pain to medical personnel.

The practice of measuring pain has been a topic in research since the late 1800s. There were many methods used for assessing the intensity of pain, in humans as well as animals, using electrical, mechanical, and heat stimuli. Over time these methods have evolved; however, there were limitations to these historical methods. The limitations were in addressing the dimensions of pain duration, modality, locus, and response type. The main focus at the time was on acute pain rather than chronic pain. Researchers and clinicians are more interested in information on chronic pain due to its longevity. The locus of pain also differs between clinical and experimental settings; clinical pain is usually deeper while experimental pain is superficial. Furthermore, the response type to pain can contribute to further challenges for interpretation in both preclinical and clinical research.{{Cite web |title=Pain {{!}} National Institute of Neurological Disorders and Stroke |url=https://www.ninds.nih.gov/health-information/disorders/pain |access-date=2024-04-04 |website=www.ninds.nih.gov |language=en}}{{Cite journal |last=Mogil |first=Jeffery |title=The History of Pain Measurement in Humans and Animals |journal=Frontiers in Pain Research |date=2022 |volume=3 |doi=10.3389/fpain.2022.1031058 |doi-access=free |pmid=36185770 |pmc=9522466 }}

The Dolorimeter, created in 1940 at Cornell University, was one of the first methods used to gather information on pain threshold and tolerance. The instrument applied steady pressure, heat, or electrical stimuli to measure sensations of pain. Beecher was one of the first to suggest something other than the dolorimeter; he suggested that clinical pain be measured by its relief using subjective ratings. Numerical rating scales (NRS), verbal rating scales (VRS), and visual analog scales (VAS) on a 10-cm continuum are the scales used to attain these ratings. Melzack and Torgerson developed the McGill Pain Questionnaire which rates pain quantitatively by sensory, evaluative, and affective descriptors. These are things like burning, shooting, and agonizing.

There have been many methods developed that use observational techniques where pain is evaluated by others. Such a method, for example, is the FLACC scale. It is for young children who are too young to be able to tell anyone how they feel. It measures facial expressions, leg position, activity, crying, and concealability on a 0–2 scale.

There are many different instruments used to assess both the intensity of pain as well as the effect of pain. A few are listed below:

The Numeric Rating Scale (NRS-11) is an 11-point scale for patient self-reporting of pain. It is based solely on the ability to perform activities of daily living (ADLs) and can be used for adults and children 10 years old or older.{{Cite web |date=July 2003 |title=Pain Intensity Instruments |url=http://painconsortium.nih.gov/pain_scales/NumericRatingScale.pdf |url-status=dead |archive-url=https://web.archive.org/web/20111215212528/http://painconsortium.nih.gov/pain_scales/NumericRatingScale.pdf |archive-date=2011-12-15 |publisher=National Institutes of Health – Warren Grant Magnuson Clinical Center}}

Pain interferes with a person's ability to perform ADLs. Pain also interferes with a person's ability to concentrate, and to think. A sufficiently strong pain can be disabling on a person's concentration and coherent thought, even though it is not strong enough to prevent that person's performance of ADLs. However, there is no system available for measuring concentration and thought.

The verbal rating scale (VRS) is a pain measurement tool that uses adjectives to express various levels of pain. The scale is rated similarly from no pain at all to the most extreme pain ever felt. When doing clinical trials there is usually a four-to six-point VRS. There are a few limitations to this scale. Some people might find it hard to accurately express their pain with the limited number of options to choose from. Interpretation of the options is also a potential issue, as people could interpret them all differently.{{Cite journal |last1=Haefelfi |first1=Mathias |last2=Elfering |first2=Achim |title=Pain Assessment |journal=European Spine Journal |date=2005 |volume=15 |issue=Suppl 1 |pages=S17–S24 |doi=10.1007/s00586-005-1044-x |pmid=16320034 |pmc=3454549 }}

The visual analog scale is a visual scale that has two endpoints: "no pain" and "pain is as bad as it could be". When it was first created people had to physically write their answers on the scale. There are mechanical ones now to make the scoring of them easier.

• Alder Hey Triage Pain Score{{cite journal |vauthors=Stewart B, Lancaster G, Lawson J, Williams K, Daly J |title=Validation of the Alder Hey Triage Pain Score |journal=Arch. Dis. Child. |volume=89 |issue=7 |pages=625–630 |date=July 2004 |pmid=15210492 |pmc=1720010 |doi= 10.1136/adc.2003.032599}}
• Behavioral Pain Scale (BPS){{Cite journal | last = Payen | first = JF |author2=Bru O |author3=Bosson JL | title = Assessing pain in critically ill sedated patients by using a behavioral pain scale | journal = Critical Care Medicine | volume =29 | issue = 12 | pages = 2258–2263 | year = 2001 | doi=10.1097/00003246-200112000-00004| pmid = 11801819 | s2cid = 7656090 }}
• Brief Pain Inventory (BPI){{cite journal

|vauthors=Cleeland CS, Ryan KM |title=Pain assessment: global use of the Brief Pain Inventory |journal=Ann. Acad. Med. Singap. |volume=23 |issue=2 |pages=129–38 |date=March 1994 |pmid=8080219

}}

• Checklist of Nonverbal Pain Indicators (CNPI){{Cite journal | last = Feldt | first = KS | title = The Checklist of Nonverbal Pain Indicators (CNPI) | journal = Pain Management Nursing| volume = 1 | issue = 1 | year = 2000| pages = 13–21 | doi = 10.1053/jpmn.2000.5831 | pmid = 11706452 | s2cid = 23917628 }}
• Clinical Global Impression (CGI){{cite journal|last1=Bourdel|first1=N.|last2=Alves|first2=J.|last3=Pickering|first3=G.|last4=Ramilo|first4=I.|last5=Roman|first5=H.|last6=Canis|first6=M.|title=Systematic review of endometriosis pain assessment: how to choose a scale?|journal=Human Reproduction Update|volume=21|issue=1|year=2014|pages=136–152|issn=1355-4786|doi=10.1093/humupd/dmu046|pmid=25180023|doi-access=free}}
• COMFORT scale{{Cite journal|last=Ambuel|first=B|author2=Hamlett KW|author3=Marx CM|author4=Blumer JL|year=1992|title=Assessing distress in pediatric intensive care environments: the COMFORT scale|journal=Journal of Pediatric Psychology|volume=17|issue=1|pages=95–109|doi=10.1093/jpepsy/17.1.95|pmid=1545324}}
• Color Scale for Pain{{Cite web|url=https://www.reliasmedia.com/articles/12205-use-color-coded-scale-to-assess-children-s-pain|title=Use color-coded scale to assess children's pain|website=www.reliasmedia.com|language=en|access-date=2019-03-20}}
• Critical-Care Pain Observation Tool (CPOT){{Cite journal | last = Gélinas | first = C |author2=Fillion L |author3=Puntillo KA |author4=Viens C |author5=Fortier M | title = Validation of the Critical-Care Pain Observation Tool in adult patients | journal = American Journal of Critical Care | volume = 15 | issue = 4 | pages = 420–427 | year = 2006 | doi = 10.4037/ajcc2006.15.4.420 | pmid = 16823021 }}
• Dallas Pain Questionnaire{{cite web | title=Dallas Pain Questionnaire | publisher=Workforce Safety |url=https://www.workforcesafety.com/sites/default/files/providers/Dallas_0.pdf | access-date=21 May 2017}}{{cite journal

|doi=10.1097/00007632-200208150-00018

|vauthors=Ozguler A, Guéguen A, Leclerc A, Landre MF, Piciotti M, Le Gall S, Morel-Fatio M, Boureau F |title=Using the dallas pain questionnaire to classify individuals with low back pain in a working population|year=2002|pmid=12195072

|volume=27

|issue=16

|pages=1783–9

|journal=Spine

|s2cid=24544669 }}

• Descriptor differential scale (DDS){{cite journal |vauthors=Gracely RH, Kwilosz DM |title=The Descriptor Differential Scale: applying psychophysical principles to clinical pain assessment |journal=Pain |volume=35 |issue=3 |pages=279–88 |date=December 1988 |pmid=3226757 |doi= 10.1016/0304-3959(88)90138-8|s2cid=9801177 |url= https://zenodo.org/record/1258467

}}

• Dolorimeter Pain Index (DPI){{cite book

| author = Hardy, J.D. | author2= Wolff, H.G. | author3= Goodell, H. | year = 1952 | title = Pain Sensations and Reactions | publisher = The Williams & Wilkins Co | location = Baltimore |asin=B0006ASZ92

}}

• Edmonton Symptom Assessment System{{cite journal |vauthors=Bruera E, Kuehn N, Miller MJ, Selmser P, Macmillan K |title=The Edmonton Symptom Assessment System (ESAS): a simple method for the assessment of palliative care patients |journal=J Palliat Care |volume=7 |issue=2 |pages=6–9 |year=1991 |pmid=1714502 |doi= 10.1177/082585979100700202|s2cid=26165154 }}{{cite journal |vauthors=Nekolaichuk C, Watanabe S, Beaumont C |title=The Edmonton Symptom Assessment System: a 15-year retrospective review of validation studies (1991--2006) |journal=Palliat Med |volume=22 |issue=2 |pages=111–22 |date=March 2008 |pmid=18372376 |doi=10.1177/0269216307087659 |s2cid=41926711 }}{{cite journal |vauthors=Richardson LA, Jones GW |title=A review of the reliability and validity of the Edmonton Symptom Assessment System |journal=Curr Oncol |volume=16 |issue=1 |pages=55 |date=January 2009 |pmid=19229371 |pmc=2644623 |doi= 10.3747/co.v16i1.261}}
• Face Legs Activity Cry Consolability scale
• Faces Pain Scale – Revised (FPS-R){{cite journal

|vauthors=Hicks CL, von Baeyer CL, Spafford PA, van Korlaar I, Goodenough B |title=The Faces Pain Scale-Revised: toward a common metric in pediatric pain measurement |journal=Pain |volume=93 |issue=2 |pages=173–83 |date=August 2001 |pmid=11427329 |doi= 10.1016/S0304-3959(01)00314-1|s2cid=31086827 }}[http://painsourcebook.ca/docs/pps92.html Instructions in many languages and images]

• Global Pain Scale{{Cite web|url=https://paindoctor.com/global-pain-scale/|title=Global Pain Scale|last=Doctor|first=Pain|website=Pain Doctor|language=en-US|access-date=2019-03-20}}
• Lequesne algofunctional index: a composite measure of pain and disability, with separate self-report questionnaires for hip and knee OA (osteoarthritis):
• Original index (1987){{cite journal |vauthors=Lequesne M, Mery C, etal |title=Indexes of severity for osteoarthritis of the hip and knee|journal=Scand J Rheumatol|volume=65|issue=Supplement 65 |pages=85–89 |year=1987|doi=10.3109/03009748709102182|pmid=3479839|s2cid=13138269}}
• 1991 revision{{cite journal |author=Lequesne M |title=Indices of severity and disease activity for osteoarthritis|journal=Seminars in Arthritis and Rheumatism|volume=20 |issue=Supplement 2 |pages=48–54 |year=1991 |doi=10.1016/0049-0172(91)90027-w|pmid=1866630}}
• 1997 revision{{cite journal |author=Lequesne MG |title=The algofunctional indices for hip and knee osteoarthritis|journal=J Rheumatol|volume=24 |pages=779–781 |year=1997|issue=4|pmid=9101517}}
• Mankoski Pain Scale{{Cite web|url=http://members.upnaway.com/~poliowa/Pain%20Scale.html|title=Pain Scale|website=members.upnaway.com|access-date=2019-03-20}}
• McGill Pain Questionnaire (MPQ){{cite journal |author=Melzack R |title=The McGill Pain Questionnaire: major properties and scoring methods |journal=Pain |volume=1 |issue=3 |pages=277–99 |date=September 1975 |pmid=1235985 |doi= 10.1016/0304-3959(75)90044-5|s2cid=20562841 }}
• Multiple Pain Rating Scales{{cite web|url=https://www.painscale.com/|title=Multiple Pain Rating Scales - back, leg, neck, migraine|access-date=27 June 2017}}
• Neck Pain and Disability Scale –NPAD{{cite web |title=OARSI Initiatives, Pain Indexes |publisher=OARSI |url=http://www.oarsi.org/index2.cfm?section=OARSI_Initiatives&content=Pain_Radiological_Indexes#pain |access-date=1 March 2010}}
• Numerical 11 point box (BS-11){{cite journal |vauthors=Jensen MP, Karoly P, O'Riordan EF, Bland F, Burns RS |title=The subjective experience of acute pain. An assessment of the utility of 10 indices |journal=Clin J Pain |volume=5 |issue=2 |pages=153–9 |date=June 1989 |pmid=2520397 |doi= 10.1097/00002508-198906000-00005|s2cid=31102020

}}

• Numeric Rating Scale (NRS-11){{cite journal |vauthors=Hartrick CT, Kovan JP, Shapiro S |title=The numeric rating scale for clinical pain measurement: a ratio measure? |journal=Pain Pract |volume=3 |issue=4 |pages=310–6 |date=December 2003 |pmid=17166126 |doi=10.1111/j.1530-7085.2003.03034.x

|s2cid=40284276 }}

• Oswestry Disability Index
• Palliative Care Outcome Scale (PCOS){{cite journal |vauthors=Hearn J, Higginson IJ |title=Development and validation of a core outcome measure for palliative care: the palliative care outcome scale. Palliative Care Core Audit Project Advisory Group |journal=Qual Health Care |volume=8 |issue=4 |pages=219–27 |date=December 1999 |pmid=10847883 |pmc=2483665 |doi= 10.1136/qshc.8.4.219}}
• Roland-Morris Back Pain Questionnaire{{cite journal

|author1=Paul W Stratford |author2=Jill M Binkley |author3=Daniel L Riddle |author4=Gordon H Guyatt |title=Sensitivity to Change of the Roland-Morris Back Pain Questionnaire: Part 1

|journal=Phys Ther|volume=78|issue=11|pages=1186–1196|year=1998|pmid=9806623|doi=10.1093/ptj/78.11.1186 |doi-access=free}}{{cite journal|vauthors=Schulte TL, Schubert T, Winter C, Brandes M, Hackenberg L, Wassmann H, Liem D, Rosenbaum D, Bullmann V |title=Step activity monitoring in lumbar stenosis patients undergoing decompressive surgery|journal=European Spine Journal|publisher=swetswise.com|year=2010|pmid=20186442|pmc=2989265|doi=10.1007/s00586-010-1324-y|volume=19|issue=11|pages=1855–64

}}

• Support Team Assessment Schedule (STAS){{cite journal |vauthors=Higginson IJ, McCarthy M |title=Validity of the support team assessment schedule: do staffs' ratings reflect those made by patients or their families? |journal=Palliat Med |volume=7 |issue=3 |pages=219–28 |year=1993 |pmid=7505183 |doi= 10.1177/026921639300700309|s2cid=23476645 }}
• Wharton Pain and Impairment Numeric Scale (Wharton PAIN Scale){{Cite web |title=Wharton Impairment and Pain Scale |url=https://www.kotawharton.com/pain-scale/ |access-date= |website=|date=January 2023 }}
• Wong-Baker FACES Pain Rating Scale{{cite web |url=http://www.wongbakerfaces.org |title =Wong-Baker FACES Pain Rating Scale Foundation |access-date=6 December 2009}}
• Visual analog scale (VAS){{cite journal |author=Huskisson EC |title=Measurement of pain |journal=J. Rheumatol. |volume=9 |issue=5 |pages=768–9 |year=1982 |pmid=6184474 }}

• Abbey pain scale for people with end-stage dementia{{Cite journal|last=Abbey|first=Jennifer|date=January 2004|title=The Abbey pain scale: a 1-minute numerical indicator for people with end-stage dementia.|journal=International Journal of Palliative Nursing|volume=10|issue=1|pages=6–13|pmid=14966439|doi=10.12968/ijpn.2004.10.1.12013}}
• AUSCAN: Disease-Specific, to assess hand osteoarthritis outcomes.
• Colorado Behavioral Numerical Pain Scale (for sedated patients){{cite journal|author=Salmore R|year=2002|title=Development of a new pain scale: Colorado Behavioral Numerical Pain Scale for sedated adult patients undergoing gastrointestinal procedures|journal=Gastroenterol Nurs|volume=25|issue=6|pages=257–62|doi=10.1097/00001610-200211000-00007|pmid=12488689|s2cid=22569187}}
• CPOT For those who can't self report{{Cite web|url=https://www.mdcalc.com/critical-care-pain-observation-tool-cpot|title=Critical Care Pain Observation Tool (CPOT)|website=MDCalc|language=en|access-date=2019-03-20}}
• Osteoarthritis Research Society International-Outcome Measures in Rheumatoid Arthritis Clinical Trials (OARSI-OMERACT) Initiative, New OA Pain Measure: Disease-Specific, Osteoarthritis Pain
• Oucher Scale for Pediatrics{{Cite web|url=http://www.oucher.org/the_scales.html|title=How to use the Oucher|website=www.oucher.org|access-date=2019-03-20}}
• Pain Assessment in Advanced Dementia (PAINAD)
• Pediatric Pain Questionnaire (PPQ){{cite journal |vauthors=Varni JW, Thompson KL, Hanson V |title=The Varni/Thompson Pediatric Pain Questionnaire. I. Chronic musculoskeletal pain in juvenile rheumatoid arthritis |journal=Pain |volume=28 |issue=1 |pages=27–38 |date=January 1987 |pmid=3822493 |doi= 10.1016/0304-3959(87)91056-6|s2cid=246622 }} for measuring pain in children
• Premature Infant Pain Profile (PIPP){{cite journal |vauthors=Ballantyne M, Stevens B, McAllister M, Dionne K, Jack A |title=Validation of the premature infant pain profile in the clinical setting |journal=Clin J Pain |volume=15 |issue=4 |pages=297–303 |date=December 1999 |pmid=10617258 |doi= 10.1097/00002508-199912000-00006}} for measuring pain in premature infants
• Schmidt Sting Pain Index{{cite book |author1=Schmidt, Justin O. |author2=Evans, David |title=Hymenopteran venoms: striving toward the ultimate defense against vertebrates; chapter in Insect defenses: adaptive mechanisms and strategies of prey and predators |publisher=State University of New York Press |location=Albany, N.Y |year=1990 |pages= 387–419 |isbn=0-88706-896-0 }} and Starr sting pain scale{{cite journal | author = Starr, C.K. | year = 1985 | title = A simple pain scale for field comparison of Hymenopteran stings | journal = Journal of Entomological Science | volume = 20 | issue = 2 | pages = 225–231| doi = 10.18474/0749-8004-20.2.225 }} both for insect stings
• WOMAC : Disease-Specific, to assess knee osteoarthritis outcomes.

The most common pain scale for quantification of endometriosis-related pain is the visual analogue scale (VAS). A review came to the conclusion that VAS and numerical rating scale (NRS) were the best adapted pain scales for pain measurement in endometriosis. For research purposes, and for more detailed pain measurement in clinical practice, the review suggested use of VAS or NRS for each type of typical pain related to endometriosis (dysmenorrhea, deep dyspareunia and non-menstrual chronic pelvic pain), combined with the clinical global impression (CGI) and a quality of life scale.

• SOCRATES (pain assessment)
• Pain management in children

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{{Pain scales}}

{{Pain}}

{{General symptoms and signs}}

Category:Pain