Pain Scale

Listing of potential instruments

Comparative Pain Scale
	0	No pain. Feeling perfectly normal.
Minor Does not interfere with most activities. Able to adapt to pain psychologically and with medication or devices such as cushions.	1 Very Mild	Very light barely noticeable pain, like a mosquito bite or a poison ivy itch. Most of the time you never think about the pain.
	2 Discomforting	Minor pain, like lightly pinching the fold of skin between the thumb and first finger with the other hand, using the fingernails. Note that people react differently to this self-test.
	3 Tolerable	Very noticeable pain, like an accidental cut, a blow to the nose causing a bloody nose, or a doctor giving you an injection. The pain is not so strong that you cannot get used to it. Eventually, most of the time you don't notice the pain. You have adapted to it.
Moderate Interferes with many activities. Requires lifestyle changes but patient remains independent. Unable to adapt to pain.	4 Distressing	Strong, deep pain, like an average toothache, the initial pain from a bee sting, or minor trauma to part of the body, such as stubbing your toe real hard. So strong you notice the pain all the time and cannot completely adapt. This pain level can be simulated by pinching the fold of skin between the thumb and first finger with the other hand, using the fingernails, and squeezing real hard. Note how the simulated pain is initially piercing but becomes dull after that.
	5 Very Distressing	Strong, deep, piercing pain, such as a sprained ankle when you stand on it wrong, or mild back pain. Not only do you notice the pain all the time, you are now so preoccupied with managing it that you normal lifestyle is curtailed. Temporary personality disorders are frequent.
	6 Intense	Strong, deep, piercing pain so strong it seems to partially dominate your senses, causing you to think somewhat unclearly. At this point you begin to have trouble holding a job or maintaining normal social relationships. Comparable to a bad non-migraine headache combined with several bee stings, or a bad back pain.
Severe Unable to engage in normal activities. Patient is disabled and unable to function independently.	7 Very Intense	Same as 6 except the pain completely dominates your senses, causing you to think unclearly about half the time. At this point you are effectively disabled and frequently cannot live alone. Comparable to an average migraine headache.
	8 Utterly Horrible	Pain so intense you can no longer think clearly at all, and have often undergone severe personality change if the pain has been present for a long time. Suicide is frequently contemplated and sometimes tried. Comparable to childbirth or a real bad migraine headache.
	9 Excruciating Unbearable	Pain so intense you cannot tolerate it and demand pain killers or surgery, no matter what the side effects or risk. If this doesn't work, suicide is frequent since there is no more joy in life whatsoever. Comparable to throat cancer.
	10 Unimaginable Unspeakable	Pain so intense you will go unconscious shortly. Most people have never experienced this level of pain. Those who have suffered a severe accident, such as a crushed hand, and lost consciousness as a result of the pain and not blood loss, have experienced level 10.

Neuropath ic Pain Scale

Other important Pain scales

The Breakthrough Pain Questionnaire (Portenoy et al, 1999) – an instrument with explicit questions identifying patients with breakthrough pain.

City of Hope Mayday Pain Resource Center Pain Audit Tools - including a chart review component, a patient interview component, and a chart review for surgical service.

Descriptor Differential Scale (Gracey 1988) - measures the sensory and affective components of pain using a magnitude ratio scale.

Integrated Pain Score (Ventafridda 1983) - an instrument designed to take into account both pain intensity and duration.

McGill Pain Questionnaire (Melzack 1975) and Short-Form McGill Pain Questionnaire (Melzack 1987) - questionnaires incorporating a series of adjectives to describe the characteristics and intensity of pain. The longer version of this instrument was used by Kane and colleagues to evaluate a clinical trial of hospice care (Wales 1983).

Memorial Pain Assessment Card (Fishman 1987) – a two-sided card that measures pain intensity and the patient’s mood on one side, and has a modified version of the Tursky Pain Description Scale on the other.

Numerical Rating Scale – various authors have commented on a scale where the patient is asked to rate the pain from 0 to 10 (or 0 to 100). This measure is simple with a high rate of completion. See Karoly and Jansen 1987.

Pain as assessed in the Medical Outcomes Study (Hays 1990) – pain is measured in terms of its severity, duration, frequency, and impact on behavior and mental well being.

Pain Disability Index (Tait et al. 1987) - is an instrument designed to measure the impact of chronic pain on various daily activities.

Pain Management Index (Cleeland et al. 1994) – compares the most potent analgesic with reported level of pain. The PMI has been employed in a study examining treatment for chronic cancer pain (de Wits et al. 1999).

Pain Perception Profile (Tursky 1976) - an instrument measuring the affective, sensory and intensity dimensions of pain.

Patient Outcome Questionnaire (American Pain Society 1995) - questionnaire designed as part of the APS’s guidelines for pain treatment. The instrument measures pain severity, interference, satisfaction with pain control, and various aspects of pain treatment and medication.

Verbal Rating Scale – There are many forums of verbal rating scales. See Lasagna, 1988 for a discussion.

Visual Analogue – various authors have utilized a VAS to record various aspects of pain control. They usually are 100mm lines with two words that anchor different end of the spectrum (e.g., pain as bad as it can be, … no pain).

West Haven-Yale Multidimensional Pain Inventory (Kerns 1985) - a 52 item chronic pain inventory.

Wisconsin Brief Pain Questionnaire (Daut 1983) – a self-administered questionnaire which measures pain at its worst, its least, average, and right now. Additionally, it uses a check list of adjectives to characterize the pain and information is collected on the impact of treatment and the impact of pain on function.