Pain scale

A pain scale measures a patient's pain intensity or other features. Pain scales are a common communication tool in medical contexts, and are used in a variety of medical settings. Pain scales are a necessity to assist with better assessment of pain and patient screening. Pain measurements help determine the severity, type, and duration of the pain, and are used to make an accurate diagnosis, determine a treatment plan, and evaluate the effectiveness of treatment. Accurately measuring pain is a necessity in medical settings, especially if the pain measurement is going to be used as a screening tool, either for potential diseases or medical problems, or as a type of triage to determine urgency of one patient over another.[1] Pain scales are based on trust, cartoons (behavioral), or imaginary data, and are available for neonates, infants, children, adolescents, adults, seniors, and persons whose communication is impaired. Pain assessments are often regarded as "the 5th Vital Sign".[2]

A Chinese pain scale diagram, rating pain on a scale of 1 to 10

It is important to understand what features of pain scales are most useful, least useful, and which aid in understanding. In fact, a patient's self-reported pain is so critical in the pain assessment method that it has been described as the "most valid measure" of pain.[3][4] The focus on patient report of pain is an essential aspect of any pain scale, but there are additional features that should be included in a pain scale. In addition to focusing on the patient's perspective, a pain scale should also be free of bias, accurate and reliable, able to differentiate between pain and other undesired emotions, absolute not relative, and able to act as a predictor or screening tool.[3]

Examples of pain scales
Self-report Observational Physiological
Infant — Premature Infant Pain Profile; Neonatal/Infant Pain Scale —
Child Faces Pain Scale – Revised;[5] Wong-Baker FACES Pain Rating Scale; Coloured Analogue Scale[6] FLACC (Face Legs Arms Cry Consolability Scale); CHEOPS (Children's Hospital of Eastern Ontario Pain Scale)[7] Comfort; Wharton Impairment and Pain Scale
Adult Visual Analog Scale (VAS); Verbal Numerical Rating Scale (VNRS); Verbal Descriptor Scale (VDS); Brief Pain Inventory Wharton Impairment and Pain Scale Wharton Impairment and Pain Scale

Partial list of pain measurement scales

Specialized tests
  • Abbey pain scale for people with end-stage dementia[41]
  • AUSCAN: Disease-Specific, to assess hand osteoarthritis outcomes.[25]
  • Colorado Behavioral Numerical Pain Scale (for sedated patients)[42]
  • CPOT For those who can't self report[43]
  • Osteoarthritis Research Society International-Outcome Measures in Rheumatoid Arthritis Clinical Trials (OARSI-OMERACT) Initiative, New OA Pain Measure: Disease-Specific, Osteoarthritis Pain[25]
  • Oucher Scale for Pediatrics[44]
  • Pain Assessment in Advanced Dementia (PAINAD)
  • Pediatric Pain Questionnaire (PPQ)[45] for measuring pain in children
  • Premature Infant Pain Profile (PIPP)[46] for measuring pain in premature infants
  • Schmidt Sting Pain Index[47] and Starr sting pain scale[48] both for insect stings
  • WOMAC : Disease-Specific, to assess knee osteoarthritis outcomes.[25]

Numeric rating scale

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.[49]

RatingPain Level
0No Pain
1–3Mild Pain (nagging, annoying, interfering little with ADLs)
4–6Moderate Pain (interferes significantly with ADLs)
7–10Severe Pain (disabling; unable to perform ADLs)

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.

In endometriosis

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.[12]

See also

Notes
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