Pain and Pain Scales

Prepared by Chahira Kozma, MD

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The International Association for the Study of Pain (IASP) defines pain as an unpleasant feeling which may be associated with actual or potential tissue damage and which may have physical and emotional components. Basically, pain tells us that there is something wrong with our body. Despite its association with suffering, pain is an important component of the body’s defense system. When the body is damaged by burn, cut, or fracture, pain is experienced. This is a warning sign that lets the body know that if nothing is done, the body is at risk. For example, when a very hot object is touched, pain ensues, leading to avoidance of touching extreme heat to prevent additional burns and damage certain neurological conditions where individuals do not feel pain (congenital insensitivity to pain), a variety of damage occurs to the skin, bones, and other tissues. In 1999, the Veterans Administration adopted the slogan "Pain is the Fifth Vital Sign” and encouraged greater use of pain scales in initial diagnoses. Because pain continues to be underdetected in acute health care facilities, the Joint Commission on Accreditation of Health Care Organizations (JCAHO) has developed standards to effectively report pain level in a consistent manner. For the past few years, most hospitals and acute care facilities have been using pain scales to diagnose and measure the intensity of the patient’s pain to provide for prompt treatment. As health care professionals working with individuals with developmental disabilities in acute care settings, in the community, or in residential facilities, we have an obligation to recognize and effectively manage their pain. Therefore, the use of a pain scale is encouraged as an objective measure of discomfort. Pain scales are tools that can help health care providers diagnose or measure the intensity of pain for a patient or client and such scales are now universally accepted in health care settings. The most widely used scales are visual, verbal, numerical, or some combination of all three forms. (See this article).

Verbal scale is a pain scale that uses words such as “low,” “mild,” or “severe or excruciating” to describe the intensity of pain.

Numerical scales use numbers from 0-10 to assess the intensity of pain. A 0 pain represents no pain and a 10 rating means that the individual has the worst imaginable pain. A score of 1-3 represents mild pain, a score of 4-6 moderate pain, and a score of 7-10 represents severe pain.

Visual scales have pictures of human faces to help explain where the pain is located because some individuals with developmental disabilities are either non-verbal or not able to effectively communicate their discomfort, thus the use of a visual scale is highly recommended in these circumstances. Visual scales are frequently used in the pediatric population. The Wong-Baker Faces Pain Rating Scales is a widely used visual scale to assess pain in pediatric patients and non-verbal individuals, for more information, click here.