Understanding Pain Scales and How to Use Them

Pain scales help your healthcare provider understand and treat your pain.

Medically reviewed by Mary Josephine Hessert, DO

When you see a healthcare provider about a pain you’re having, you’ll probably describe the kind, intensity, and location of the pain. At some point, your healthcare provider may ask how you rate the pain, usually on a scale of one to ten with ten being the worst pain you’ve ever had.

A pain scale is a way to rate or measure your pain so you can describe it in a simple way to a healthcare provider. But there are other types of pain scales. Find out what they are and how they are used.

How Do Pain Scales Measure Pain?

Pain is a common complaint making you seek medical attention. The pain can be acute, or short-term, or chronic, or long-term, from an ongoing medical issue. If your pain is severe and lasts more than three months, it’s considered chronic.

Pain is subjective, meaning only the person experiencing the pain can describe how bad the pain is and what it feels like, so it’s hard for someone else to know exactly how your pain feels.

Your rating of pain may be different from how someone else feels about the same pain. The pain you rate as a level four out of 10 may be another person’s rating of seven. You may also describe pain differently than someone else. What feels like a stabbing pain to you might feel like a throbbing pain to another person.

This is where using pain scales helps your healthcare provider in figuring out how to treat your pain. 

Why Use Pain Scales?

Depending on the type of pain scale used to describe your pain, your healthcare provider may figure out where your pain is coming from or what is causing it. The kind of pain you’re having will determine how your healthcare provider will treat the pain. Your pain might be localized to one area, like when you break a bone, or it might be widespread or in different parts of your body, which is what happens with fibromyalgia.

If your pain is acute, say, from a sprained ankle, ibuprofen might give you pain relief. But if your pain is chronic, like it can be from neuropathy due to diabetes, you might benefit more from a medication designed specifically for neuropathy.

Pain scales allow your healthcare provider to understand how good or bad your pain is from one visit to the next. This is one way to measure the effectiveness of a medication or treatment plan for acute and chronic pain by seeing how your pain is or isn’t changing over time. If your response to a pain scale hasn’t changed much between visits to your healthcare provider, the medication or treatment plan is not giving you pain relief.

Using pain scales can also track the progression of your medical condition, especially those that cause chronic pain. If your pain has gotten worse or changed in the kind of pain you’re having, your disease or disorder may be getting worse.

Using a combination of pain scales can help your healthcare provider make this clearer.

Types of Pain Scales

There are two general categories of pain scales: Patient-reported scales and provider-reported scales. You will most likely only see the patient-reported scales because these are the ones where you answer the questions. In provider-reported scales, your healthcare provider answers the questions about your pain based on their observations of you. 

There are many types of patient-reported pain scales, and they fall into three categories.

Numerical Rating Scale (NRS)

Numerical Rating Scale-type scales are the most commonly used pain scale and use numbers to rate your pain. Typically, they are an 11-point scale going from zero (no pain) to 10 (the worst pain possible). They may include words to describe your pain, such as mild, moderate, or severe. 

Visual Analog Scale (VAS)

A Visual Analog Scale (VAS) is a scale that uses pictures, sometimes with colors, to match your pain.

A common one is the Wong-Baker Faces Pain Scale, which combines pictures of cartoon faces with numbers to rate your pain. It uses six faces with different expressions, with zero showing a smiling face (no pain) and 10 showing a crying, agonizing face (worst pain). 

Verbal Rating Scale (VRS)

But knowing the level of pain you’re having sometimes isn’t enough. Your healthcare provider may need to know the kind of pain you’re feeling to get a better idea of what’s causing your pain. This is where a Verbal Rating Scale (VRS) is more helpful because it uses words or phrases to describe your pain, like mild, moderate, severe, very severe, and unbearable.

The number of questions varies and may include pictures or drawings, but typically, there are five to seven questions.

How to Use a Pain Scale

If your healthcare provider uses a NRS or VAS, you’ll be asked to look at a chart or drawing to decide what number or picture best represents your pain. If the drawing is a representation of the body, you may be asked to circle or mark where your pain is on the drawing.

If a VRS is used, you might answer the questions on paper or a tablet, or your healthcare provider might read the questions and answer choices to you.

When examining non-verbal children and adults, a healthcare provider will observe and record where the pain is and what physical signs there may be from the pain.

Ratings from pain scales are still subjective, which is why your healthcare provider will probably use a combination of pain scales to get an accurate measure of your pain. You’ll also most likely have to answer the same questions at each visit. By using the same scales over time with you, your healthcare provider will be able to judge if your pain is improving.

Living With and Managing Pain

Experiencing frequent bouts of pain can be uncomfortable. But, pain can also tell you a lot about your health. Learn more about your pain levels and get personalized tips on how to manage your physical health by taking the quiz below.

Quiz medically reviewed by Soma Mandal, MD.

A Quick Review

Physical pain is something everyone experiences at some point. It is subjective, meaning only the person experiencing the pain can describe it. But in order to get help in relieving the pain, your healthcare provider has to know the kind of pain and location. Location is simple enough to point at, but describing the pain is more complicated.

Pain scales are a universal way to describe your pain in simple ways using numbers, pictures, and words or phrases. Pain scales are also a way to measure if a medication or treatment plan is working to relieve your pain. Using the same pain scales at every time you see your healthcare provider is also a way of tracking your progress of a medical condition.

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