The first step in assuring quality pain care is appropriate pain assessment. While pain is highly subjective, if able to self-report, you are always in the best position to provide the most accurate information about your pain.  It is important to gather information about several aspects of the pain experience including pain severity/intensity, location, duration, aggravating and alleviating factors that impact pain and the impact of pain on activities (such as ADL’s, physical or psychological functioning, etc.). Assessing pain in older adults can be difficult, one tool to assist you to gather valuable information to share with your healthcare team is the use of a pain assessment tool used in combination with a Pain Diary (see “FAST FACT - Patients: Using a Pain Diary”).  You can then share this with your healthcare team to provide key information for development and ongoing review of your pain treatment plan.

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: Individuals who can point or state the number that reflects current pain level on a 0-10 scale (0=No pain/10=Worst possible pain).
    • HOW TO USE: Point to or state the number that best shows how bad or severe your pain is NOW.

PDF iconClick here for the larger image of NRS

  • Verbal Descriptor Scale (VDS) or PAIN THERMOMETER SCALE
    • PURPOSE: To assess pain intensity in persons able to self-report. Research indicates this is the best choice for most older adults.
      Pain Thermometer Scale
    • WHO CAN USE: Good for use with any person, including those with moderate to serve cognitive impairment or who have difficulty communicating verbally.
    • HOW TO USE: Select the words on the thermometer to show how bad or severe pain is right now. Compare the words chosen to the previous words chosen to evaluate if pain has increased or decreased.

PDF iconClick here for the larger image of VDS

  • FACES Pain Scale Revised (FPS-R)
    • PURPOSE: To assess pain intensity in persons who are able to self-report pain, 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 level.
    • WHO CAN USE: Good for use with any person, including those with moderate to severe cognitive impairment or who have difficulty communicating verbally.  Some studies show African Americans and Asians prefer the Faces Pain Scale.
    • HOW TO USE: The faces in the image 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.

FPS-R Scale and resource

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  • PEG Scale Assessing Pain Intensity and Interference (Pain, Enjoyment, General Activity)
    • PURPOSE: Pain intensity and interference rating scale. This scale requires either verbal ability or ability to point to the number that most closely represents your pain.
    • WHO CAN USE: To assess pain intensity and impact of pain in persons who are able to self-report and use a numeric rating scale (NRS).
    • HOW TO USE: Answer the three questions on the pain assessment tool then total the PEG score as outlined below.
      • Computing the PEG Score: Add the three questions, then divide by three to get a mean score (out of 10) on overall impact of points.
      • Using the PEG Score: The score is best used to track your changes over time. The initiation of therapy should result in the PEG score decreasing over time.

PEG Score

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  • FINAL Comments on Pain Assessment Tools
    • Select a pain assessment tool that is appropriate for you and use it each time you assess your pain.
    • Document pain information using a Pain Diary  and review with your healthcare provider on a regular basis.

PDF iconFAST FACTS - Patients: When to Use Pain Assessment Tools - PDF Version