Pain Scales: Types of Scales and Using Them to Explain Pain

Pain scales are used by healthcare providers to improve communication and understanding about the pain you may be experiencing. Pain is felt differently from one person to the next ranging from mild to severe and varying in type. Having a means of measuring your pain helps with:

• Diagnosing what may be the cause of your pain
• Tracking how your condition progresses
• Determining if treatment is working for you

Several types of pain scales are in use for acute, chronic, and neuropathic pain. Whether your pain comes on suddenly (acute), persists for several months (chronic), or is caused by nerve damage (neuropathic), the 11 common scales explored in this article can be tools that help you move through it.

Types of Pain Scales

Healthcare providers have at least 11 types of pain scales to choose from. They generally fall into one of three categories:

• Numerical rating scales (NRS): Uses numbers to rate pain
• Visual analog scales (VAS): Asks you to select a picture that best matches your pain level
• Categorical scales: Primarily uses words, possibly along with numbers, colors, or location(s) on the body
  

The scales may provide quantitative measurements, qualitative measurements, or both.

Quantitative scales answer the question, "How bad is your pain?" They're helpful for gauging your response to treatment over time.

Qualitative pain scales answer the question, "What does it feel like?" They can give your healthcare provider ideas about the cause of your pain, whether it's associated with any medical problems you have, or whether it's caused by the treatment itself.

No one particular pain scale is considered ideal or better than the others for every situation. Some of these tools are best suited for people of certain ages. Others are more useful for people who are highly involved in their own health care.

Numerical Rating Pain Scale

The Color Analog Scale (CAS) uses colors to represent different levels of pain on a pain scale:

The colors are usually positioned in a line with corresponding numbers or words that describe your pain.

The Color Analog Scale is often used for children and is considered reliable.

Mankoski Pain Scale

The Mankoski Pain Scale uses numbers and specific descriptions of pain to ensure your healthcare provider understands your pain.

Descriptions are detailed. They include phrases such as:

• Very minor annoyance
• Occasional minor twinges
• Cannot be ignored for more than 30 minutes

After reading the descriptions, you tell the provider which number best fits your pain level.

Brief Pain Inventory

The Brief Pain Inventory (BPI) is a worksheet made up of 15 questions.

You're asked to numerically rate the effect of your pain in categories such as:

• How you relate with other people
• How well you can walk
• How you've slept over the last 24 hours

This pain scale captures more nuance in terms of how your pain is affecting your day-to-day life.

Descriptor Differential Scale of Pain Intensity

This pain scale has 12 lines, each of which has a descriptor—such as faint, strong, intense, and very intense—placed in the middle of it.

Each line has a minus sign at the start and a plus sign at the end.

• First, you find the line with the descriptor that best matches your pain.
• For less intense pain, you mark somewhere on the minus side.
• For more intense pain, you mark someone on the plus side.

Defense and Veterans Pain Rating Scale

The United States Department of Defense in 2021 announced it was using a new pain scale called the Defense and Veterans Pain Rating Scale (DVPRS).

According to a news release, it's the response to dissatisfaction with other pain scales from both healthcare providers and patients. Rather than a simple scale, it includes:

• Faces: Expressions range from smiling to highly distressed
• Colors: Green for no pain, then moving through the spectrum to red for the worst possible pain
• Numbers: 0 for no pain, 10 for the worst possible pain
• Descriptors: These include "hardly notice pain," "hard to ignore, avoid usual activities," and "can't bear the pain, unable to do anything"

Combining aspects of many other pain scales may give your healthcare provider more information to work from.

Summary

Pain scales can help healthcare providers determine how much pain you're in and its impact on you. They can also help define your pain in mutually understood terms.

The medical community uses several kinds of pain scales. Some use pictures or colors, others use numbers or words, and some use combinations of these.

A provider can choose which scale to use based on your ability to read or communicate and what they want to learn.

Some doctors regularly use a pain scale. Some hospital rooms even have them posted on their walls.

If you're not asked to use a pain scale and are having a hard time clearly communicating with a healthcare provider, ask for one. They're a useful tool for improving diagnosis and treatment.

Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.

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By Erica Jacques
Erica Jacques, OT, is a board-certified occupational therapist at a level one trauma center.