Pain intensity rating scale useful for all older adults, including those with mild to moderate cognitive impairment. Some older adults will find this tool easy to use, and may prefer it over the Numerical Rating Scale. This scale requires either verbal ability or the ability to point to the image on the scale that most closely represents their pain.

Purpose: To assess pain intensity in persons who are able to self report1 but are unable to use a numeric rating scale (NRS). Some studies show African Americans and Asians prefer the Faces Pain Scale.

When to use: Use the FACES Pain Scale

  • At initial intake/admission to services
  • For an older adult in pain, assess at least every 8 hours
  • Any time a change in pain status is reported
  • One hour following a pain intervention to assess effectiveness
  • For older adults residing in long term health care settings, assessments should be completed at each quarterly review

How to use:

Say to the older adult something like - "I'd like you to tell me about the intensity of any pain you are having. I'm going to show you some pictures of some faces. The faces show how much pain or discomfort one is feeling. The face on the left shows no pain. Each face shows more and more pain up to the last face that shows the worst pain possible. Point to the face that shows how bad your pain is right NOW.”

Then score the chosen face 0, 2, 4, 6, 8, or 10, counting left to right, so '0' = 'no pain' and '10' = 'very much pain.'

NOTE: This tool is not to be used by the health care provider to look at the resident's facial expression and pick a face.

The scoring numbers are for clinician use only. Do not show the numbers to the person being assessed.

Documentation: Document/record all scores in a location that is readily accessible by other health care providers.

Note: To use as a pocket guide, print the FPS-R and directions document front to back on card stock paper to create two tools. Cut to size and laminate for increased durability.


Pain Manag Nurs. 2006 Sep; 7(3):117-25.Evaluatio of the Revised Faces Pain Scale, Verbal Descriptor Scale, Numeric Rating Scale, and Iowa Pain Thermometer in older minority adults.

Used with permission from IASP. For clinical, educational, or research purposes, use of the FPS-R is free of charge, and permission for use is not needed, provided that the scale is not modified or altered in any way. ​ (Access to multiple languages on download link)


1 Self-report of pain is defined as the ability to indicate presence and/or severity of pain verbally, in writing, or by other means such as finger span, pointing, head movement, or blinking eyes to answer yes or no questions.

PDF iconFPS Instructions  - PDF Version