How to Measure Chronic Pain

Pain is intrinsic. Pain is subjective. No one but you really knows how much pain you are in, but you. That’s why doctors and nurses ask you to rate your pain on various scales.

The National Institute of Health’s Pain Consortium uses six pain intensity scales to measure both the intensity of a patient’s pain and monitor the effectiveness of treatment methods. Your doctor may ask you to use one or more of these pain rating scales when asking about your chronic pain level.

Numerical Scale: A commonly used pain rating scale by health care professionals, this scale measures your pain from zero to 10. Zero represents an absence of pain, while 10 represents the worst, unbearable pain.

Wong-Baker Faces Pain Rating Scale: The Wong-Baker Faces scale is another commonly used pain rating scale, particularly for children or people who have mild cognitive impairments. Like the numerical scale, this scale uses faces labeled one through 10, with corresponding images representing pain levels. For example, a smiling face (labeled zero) represents no pain, whereas a crying face (10) means it hurts worst.

COMFORT Scale: The COMFORT scale is typically used in operative and critical care settings where children or adults are unable to use the numeric or faces pain scales. To measure pain and distress levels in ventilated or unconscious individuals, medical personnel observe and rate the patient’s discomfort on nine indicators: facial tension, alertness, respiratory distress, calmness, muscle tone, physical movement, crying, heart rate baseline, and blood pressure baseline. Each indicator is rated on a scale of 1 – 5. Scores ranging from 17 to 26 typically indicate that the patient has adequate pain and sedation control.

CRIES Pain Scale: Frequently used in a neonatal health care unit, the CRIES scale is an observer-rated pain assessment tool. CRIES uses a scale of 0 to 2 to rate crying, requires oxygenation levels, increased vital signs (blood pressure and heart rate), expressions, and sleeplessness.

FLACC Scale: The FLACC scale, which stands for face, legs, activity, cry, and consolability, is used on infants, toddlers, and children from the ages of 2 months through seven years, who are unable to accurately describe the severity or quantity of their pain.

Checklist of Non-Verbal Indicators (CNVI): Designed to measure pain levels in behavioral health or cognitively impaired people who cannot use the numerical or faces rating scale, the CNVI scale assesses the patient’s vocal complaints, facial winces and grimaces, bracing, restlessness, and rubbing. The indicators are measured both when the patient is moving and when at rest.

Pain rating scales are a useful tool for patients to communicate their pain level, but more importantly, they are essential for clinicians to assess pain levels and monitor treatment effectiveness.