Pain Scales – what they are and why you need them

What is a Pain scale?

Pain is the most common symptom in many ailments and is often an indicator of how far the disease has progressed. Pain can also be the outcome of treatment for a condition. A further pain can be genuine, psychogenic, or phantom. Genuine pain is as a result of the ailment or its treatment. Psychogenic pain is the result of various behaviours, actions taken or mood experienced by the patient. And phantom pain is imagined pain in an organ or limb that has been removed recently.

This introduces various complexities for healthcare providers while using pain to understand the progression of the disease. To make it easy for them, different pain scales have emerged in the last hundred years to make the understanding of pain more objective.

Why do you need Pain Scales?

Pain, as an outcome of an ailment of its treatment, is not a constant. It varies from person to person. The intensity or type of pain depends on the age of the person, the ailment in question, its specific symptoms, various physical conditions such as the weather, time of the day, and the action/activity the person is undertaking. Finally, it depends on co-morbidities or other health conditions present before. This makes pain a multidimensional aspect of an ailment.

At the same time, pain is an important factor while understanding the progression of the ailment and the treatment options that must be considered. That is why pain scales are required to document the level or intensity of pain correctly, the conditions leading to or arising out of the pain, and various techno-medical information. Pain scales are an excellent tool to begin an investigation into an ailment, arrive at the correct diagnosis, and to factor while designing the course of treatment.

Also Read: The Role of the Anaesthesiologist — from Surgical Anaesthesia to Critical Care Medicine and Pain Medicine

Types of Pain Rating Scales (PRS)

At the time of writing this article, there are over a hundred pain scales – to address different age groups of patients and to simplify or elaborate the details. One of the criticisms against pain scales in the early years was that they oversimplify the understanding of pain. To overcome this, many complicated and multidimensional pain scales have emerged in the last few decades. Further, there are pain scales for specific conditions such as cancer, orthopaedic ailments, and even palliative care. Also, most of these scales are initially designed in English. But your doctor or nurse may have versions of the same translated into your local language.

For the sake of this article, we will consider the most common Pain Rating Scales (PRS) used in India and abroad.

Numerical PRS: The patient has to choose a number between 0 and 10 where 0 indicates no pain and 10- the worst possible pain. They are used for adults.
Visual Analog Scale (VAS): A variation of Numerical PRS, in this, a 100 mm horizontal (HVAS) or vertical (VVAS) line is used, with 0 representing no pain to 100 representing worst possible pain. Various words are used to describe numbers in between, and the patient has to choose one of them.
Wong-Baker PRS: This consists of 6 numbers – 0, 2, 4, 6, 8, and 10. However, each number is denoted by the image of a face, which illustrates how the patient is feeling. This is ideal for children below 10 years of age.
Verbal Pain Intensity scale: Similar to Wong-Baker PRS but here the faces are replaced by phrases such as mild, moderate, severe, etc.
FLACC PRS: This is a 5 x 3 matrix where 5 parameters – Face (facial expressions), Legs (position or movement of the legs), Activity (actions shown by the patient), Cry (signs of crying), and Consolability are observed and matched against 3 levels which are clearly documented in the scale. Again, this is used for children between 2 and 7 years of age.
CRIES PRS: Used for infants, this scale considers 5 parameters, such as Crying, Oxygenation, Vital signs, Facial expressions, and Sleeplessness.
COMFORT PRS: A 9 x 5 matrix where 9 parameters are given a rating from 1 to 5. These parameters are Alertness, Calmness, Respiratory Distress, Crying, Physical Movement, Muscle Tone, Facial Tension, Blood Pressure, and Heart Rate.
McGill Pain Questionnaire: A detailed questionnaire where the patient can choose up to 78 common words to describe the experience of pain. Each word is given a score, and then the final tally is made, which depends on the number of words used. This is equally useful for both adults and children. In addition to diagnosis, this questionnaire can be used for post-procedural therapies and rehabilitation.
ColorAnalog Scale: This scale consists of a coloured band ranging from green on one side, indicating no pain, to red on the other, indicating the worst possible pain. There is a cursor attached to the scale at the top or bottom. The patient can slide the cursor along the coloured band to indicate the level of pain.
Mankoski PRRS: This is an 11 x 3 matrix with 11 levels of pain from 0 for no pain to 10 for the worst possible pain. Each number has a description for the same along with recommended action to be taken by a doctor or nurse.
Brief Pain Inventory: A questionnaire with 15 questions that covers various aspects of the pain and how it affects your sleep, walking, interaction with other people, etc.
Descriptor differentiator scale of Pain Intensity: Here, 12 descriptive phrases are provided along with a scale for each of them. The scale shows – (minus) and + (plus) on the 2 ends. The patient must indicate how poorly or how accurately does that phrase describe his/her condition by pointing on the scale.
Stanford or Comparative PRS: This consists of a 10 x 3 matrix with elaborate descriptions and descriptive names for each level of pain ranging from 0 for no pain to 10 for worst possible pain.

Pain Scale – a Handy Tool for Healthcare Providers

Pain scales are a handy tool in the hands of doctors, nurses, and any category of a healthcare provider. If you or any of your near and dear ones are shown a pain scale during diagnosis or course of treatment, do not be surprised. Instead, acknowledge the quality of healthcare being provided by that institution. Co-operate with the doctor or nurse, and provide clear answers to their questions. This will help the doctor assess your condition precisely and design a course of treatment that results in quick recovery and rehabilitation.

Kauvery Hospital is globally known for its multidisciplinary services at all its Centers of Excellence, and for its comprehensive, Avant-Grade technology, especially in diagnostics and remedial care in heart diseases, transplantation, vascular and neurosciences medicine. Located in the heart of Trichy (Tennur, Royal Road and Alexandria Road (Cantonment), Chennai, Hosur, Salem, Tirunelveli and Bengaluru, the hospital also renders adult and pediatric trauma care.

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