How the Pain Scale Works

Self-reporting Pain Scales
Adults typically use numerical pain-reporting scales, while children tend to be better off with pictures or colors.
Adults typically use numerical pain-reporting scales, while children tend to be better off with pictures or colors.

If a doctor or nurse has ever asked you to rate your pain, you've used a self-reporting scale. This can be done in many different ways: with numbers, pictures, descriptive words or even a simple mark drawn on a spectrum. One of the most important factors influencing a physician's choice of scale is age because people communicate differently depending on their stage of life.

Children can better conceptualize pain visually, so the scales commonly recommended for them use pictures or colors to represent different levels of discomfort. One popular scale is Wong-Baker FACES, which is recommended for children ages 3 and older. It consists of six faces that are lined up horizontally and drawn to convey increasing levels of pain. The face on the left is smiling, with the number "0" and the phrase "no hurt" written under it, while the face on the right is crying, with the number "10" and the phrase "hurts worst" written beneath it. The faces in the middle are similarly labeled. Children are asked to indicate which one is most like the pain they feel [source: Wong-Baker].

Another common scale is the color analog scale, which consists of a color spectrum that fades from dark red, which is labeled with the words "most pain," to white, which is labeled with the phrase "no pain." Children are asked to rate their pain on the scale using a sliding line, which corresponds with a number on the flip side of the tool so the ratings can be easily recorded and tracked [source: Bulloch et al.].

Adults, on the other hand, are much better at describing their pain with words or numbers. One common scale, the numerical rating scale, is often administered to patients by asking them to rate pain from 0 to 10, though some go as high as 20 or even 100. In this scenario, the "0" represents "no pain" while the high number represents "worst imaginable pain." The verbal scale, on the other hand, suggests adjectives of increasing intensity that patients can use to describe their pain. Common phrasing is "no pain," "mild pain," "moderate pain" and "severe pain." Finally, the visual analog scale consists of a 4-inch (10-centimeter) line with the phrase "no pain" on one end and "worst pain imaginable" on the other. Patients then mark their pain level on the line, which doctors measure with a millimeter ruler for recording purposes [source: Williamson and Hoggart].