Pain Scales: From Faces to Numbers and Everywhere In Between

By: Mario Ramirez, MD

Reading Time: 5 minutes

In Medscape’s article “Talk About Pain,” R. Morgan Griffin states, “One of the hardest things about chronic pain is that only you know how bad the pain feels. There's no blood test that can show much you're suffering. There's often no outward sign, like a bandage or a cast. There's just the pain." 'Pain is always personal,' says F. Michael Ferrante, MD, director of the UCLA Pain Management Center in Los Angeles. 'It's invisible to other people looking at you -- and that can lead to a lot mistrust and difficulties in relationships.'"

Find the full Medscape article here

Practicing in today’s world of medical economics that's heavily focused on patient outcomes, changing prescribing guidelines and the heavy cloud of the opioid epidemic looming over our nation, providers have numerous tools to utilize during the pain evaluation process. AffirmHealth has complied a listing of some of the more common pain scales as a resource to prescribers. Check back as this evolves and expands.

To learn more about pain scales and how they are used we found this resource helpful.

Numeric Rating Scale: NRS 11

The Numeric Rating Scale (NRS-11) is an 11-point scale for patient self-reporting of pain. It is for adults and children 10 years old or older.



Stanford Pain Scale

The Stanford Pain Scale is an adapted approach to the most common pain scale, the numeric 0-10 ranking. The Stanford version includes tangible descriptions assigned to each numeric value. This added component attempts to clarify pain measurements for both physicians and patients.

Stanford Comparative Pain Scale


BPI: Brief Pain Inventory

The BPI was developed by the Pain Research Group of the World Health Organization (WHO) Collaborating Center for Symptom Evaluation in Cancer Care. It is now also used as a generic pain questionnaire for other chronic pain conditions. It is available in a short (nine items) and long (17 items) form. The BPI focuses on two different aspects of pain: intensity and interference.

The BPI short form is more frequently used and is what is referred to when the BPI is cited in research. MD Anderson Cancer Center recommends the BPI Short Form for patient ease of use.

See MD Anderson’s BPI information page for more information.

A detailed BPI summary can be found here.


Brief Pain Inventory


Wong-Baker Faces

Originally developed to be utilized to communicate with children in pain by Connie Baker and Dr. Donna Wong, it is now a tool used globally for patients 3 years of age and older. The Wong-Baker Faces scale utilizes six faces, each assigned a rating from 0 (no hurt) to 10 (hurts worst).

Find Wong-Baker resources here.

Wong Baker Faces


Global Pain Scale

The GPS focuses on both the physical pain scale and how that pain has affected a patient’s life. The GPS is a comprehensive assessment evaluating pain, emotions, clinical outcomes, and daily activities.

Available for download here.

Find a detailed summary study here.

Global Pain Scale


Visual Analog Scale (VAS)

The Visual Analog Scale (VAS) is a unidimensional measure of pain intensity, which is utilized in diverse adult populations.

It is a continuous scale comprised of a horizontal (HVAS) or vertical (VVAS) line. It is usually presented as a 100-mm horizontal line on which the patient’s pain intensity is represented by a point between the extremes of “no pain at all” and “worst pain imaginable” it is anchored by 2 verbal descriptors, one for each symptom extreme.

A great summarizing resource is available here: VAS 

Visual Analog Scale


McGill Pain Index

The McGill Pain Questionnaire, also known as McGill Pain Index, is a scale of rating pain developed at McGill University by Melzack and Torgerson in 1971. Instead of ranking pain intensity numerically, it compares pain to other injuries or types of pain. A review can be found here.

McGill Pain Index



So where do these resource leave you as the clinician, the patient, or the payer?

It's a challenging question. Aching, throbbing, searing, excruciating – pain is difficult to describe and impossible to see. So how can doctors truly tell how much it hurts? John Walsh examined agony in his piece for the Independent asking where we are going in determining "How Bad Does It Hurt?:  The Methods Used By Doctors to Measure Pain." 

We know, categorically, that acute pain usually comes on suddenly and is caused by a specific action or injury. The pain subsides and life for the patient typically continues on as before the pain started. It's an inconvenience that’s been overcome.

However,  chronic pain which is typically defined as pain lasting greater than three months, has the potential to limit a person’s movements, which can reduce flexibility, strength, and stamina. This difficulty in carrying out important and enjoyable activities can lead to disability, unemployment, depression and despair. 

AMA Wire, Staff Writer Troy Parks writes, “Chronic pain is “common and complicated. ” He continues, “In the United States, one in three people suffer from chronic pain and one in 12 struggle to cope with moderate to severe pain, the module notes. And complaints of pain account for up to 20 percent of outpatient visits with a price tag of more than $600 billion in health care expenses, lost income, decreased productivity and several other expenses every year.”

The challenges of treating pain are as muti-dimensional as pain itself. 


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