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12 Assessment of pain
n Pain assessment tools
In clinical practice, the most commonly used rating scale is the verbal
numeric rating scale. Application of this scale simply entails asking the
patient to rate pain level from 0 to 10, with 0 being no pain, and 10 being
the worst pain imaginable. (Different approaches have been taken to the
wording at the “top” end of pain scales; the most important caveat is that
the pain descriptor be realistic.) The advantages of the verbal numeric
rating scale include ease of administration and high agreement with the
visual analog scales (illustrated) used in most clinical pain management
studies in acute care. 24
No pain
Worst pain
imaginable
Typical instructions. Explain the line, which should be 10 cm in
length, as representing the patient’s current pain level ranging from “no
pain” to “worst pain imaginable.” Some versions of the scale have
intermediate labels such as slight, mild, moderate, and severe, between
the two end labels. Have the patient mark the point on the line
corresponding to their pain. If repeat assessments are made, a new
(unmarked) scale should be used.
Example of a visual analog scale.
Although the available literature leaves room for debate, it appears that in
some cases basing therapy on a verbal pain descriptor (e.g. mild, moderate,
severe), rather than a numerical rating, may suffice in the ED. Studies in both
“healthy” patients and those being treated for pain find consistent correspondence
between pain categorization levels (i.e. no pain, mild pain, etc.)
and ranges for 0–10 verbal numeric ratings. 25
In some patient populations, the limitations of numeric scales necessitate
the use of alternative approaches. Younger patients are one group for whom
verbal numeric ratings scales perform suboptimally. 26 For children, visual
tools such as the FACES scale, color scales, and visual pain “thermometers”
or similar VASs have been used. Most of these tools have been found to