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Other Methods of Rating Pain

The main alternative methods that patients can use to assess their own level of pain is summarized at

The Faces of Pain Scale seems wonderfully simple and is widely available. The only problem is that is not at all sensitive and is seriously misleading in key ways.

Look critically at the visual choices again and it becomes clear why this tool is far too limited to measure the sorts of changes that patients might experience on a daily or even weekly basis.

For a start, the first two faces (labeled 0 and 1) don't indicate pain at all - thus making it at best a 4 choice scale.

Then the third, neutral face (#2) is not likely to apply to anyone actively seeking to monitor changes in their pain levels. The tool thus offers at best a 3 choice scale.

Then there is some ambiguity about the final crying face (drawn by a child we are told) Adults rarely cry even in intense physical pain so someone who was in great pain but not crying might have problems deciding which of the two right hand faces represents their condition.

Just to make it more confusing, the words used to try to clarify the pictures do not really match what the visual expressions show. It is hard to see the smiley face #1 as indicating a "hurts a little bit" for example. It is almost as if the words are added to try and spread the range of choices that the visual scales portray.

In summary, we believe that the Faces of Pain does not give enough sensitivity to be useful for monitoring most of the small but important changes that occur with on-going pain evaluations.


Verbal Pain Scales

There are a variety of verbal descriptors that can help the doctor rate the level of pain that the patient is feeling.

However, we know that even with people of the same race and language, there are huge differences in meaning in similar descriptive words used to describe risks (see Thus we consider that verbal descriptors present difficulties for a patient to choose appropriate words to indicate changes in progress. However, words are a far more useful communication tool compared to the overly simple Faces but they are highly variable in communicating levels of pain experience between different people.


Numerical Pain Scales

This method also overcomes some of the extreme simplicity of the faces scale. The patient is invited to mark on a linear scale rather like a ruler what number they feel matches their current pain level.

The challenge here is that in essence, the patient looks at a series of numbers ("in essence a left brain experience") and tries to equate their pain level (a right brain experience) to a number on the ruler. Such scales are good but we think that our pain Scale for Patients improves upon the numeric ruler.

In essence, all those methods that ask patients to put a number to the level of pain or let them mark on ruler showing numbers fail for a simple reason.

In our view, you can't measure right brain experiences (such as pain) with a left-brain instrument - like estimating numbers.




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