The first step in assuring quality pain care is good and appropriate pain assessment. Caregivers are often on the frontline in tracking and reporting pain information to their loved one’s health care provider. Assessing pain in older adults is often difficult, especially in individuals with limited cognitive abilities. One tool to assist caregivers in gathering this valuable information is the use of a pain assessment tool, in combination with the use of a Pain Diary (see “FAST FACT: How to Use a Pain Dairy”) the Caregiver can assist the healthcare team to have a clear understanding of the individual’s pain reports over a given period.

This FAST FACT reviews the types, purposes, and uses of Pain Assessment Tools.

  • Numeric Rating Scale
    Numeric Rating Scale

    • PURPOSE: To assess pain intensity in persons who are able to self-report pain.
    • WHO CAN USE: with individuals who can point or state the number that reflects their current pain level on a 0-10 scale (0=No pain/10=Worst possible pain).
    • HOW TO USE: Have the patient point to or state the number that best shows how bad his/her pain is NOW.




  • Verbal Descriptor Scale (VDS) or PAIN THERMOMETER SCALE
    Pain Thermometer Scale

    • PURPOSE: Used to access pain intensity in persons able to self-report. Research indicates this is the best choice for most older adults.
    • WHO CAN USE: Good for use with any patient, including those with moderate to serve cognitive impairment or who have difficulty communicating verbally.
    • HOW TO USE: Ask older adult to point to the words on the thermometer to show how bad or severe their pain is right now. Compare the words chosen after each use to the previous works to evaluate if pain has increased or decreased.



  • FACES Pain Scale Revised (PRS-R)

    • PURPOSE: 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.
    • WHO CAN USE: To assess pain intensity in persons who are able to self-report but are unable to use a numeric rating scale (NRS). Some studies show African Americans and Asians prefer the Faces Pain Scale.
    • 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."
    • NOTE: This tool is not to be used by the Caregiver to look at your loved one’s facial expression and pick a face.

Faces Pain Scale
  • FINAL Comments on Pain Assessment Tools

    • Select a pain assessment tool that is appropriate for your loved one and use it each time you assess their pain level.
    • Document pain information using a Pain Diary and review with your loved one’s healthcare provider on a regular basis.

PDF iconFAST FACTS - Caregivers: Pain Assessment Tools