Clinical Concepts — Pain Assessment Tools

Pain scales and checklists offered in this section are useful for clinically assessing how intensely patients are feeling pain and for monitoring the effectiveness of treatments at different points in time. These essential tools for pain management practice are variously designed for different age groups, as well as individuals who do not speak English and/or cannot verbalize responses.

For additional documents discussing pain assessment in general see the Guidelines section
<Click Here> (Use the ‘Find’ function in your browser – usually Ctrl+F – to search on “assessment”).

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Pain Intensity Scales Used by the National Institutes of Health

From: NIH Pain Consortium. Reviewed 2007.

See: http://painconsortium.nih.gov/pain_scales/

These 5 pain intensity scales are commonly used for adults and children by researchers at the NIH Clinical Center. In addition, a checklist of nonverbal indicators is used to assess pain intensity in patients who are unable to communicate verbally.

Reviewer: Winnie Dawson, MA, RN, BSN. Access checked October 4, 2007.

Pain Rating Scales For Children

From: Texas Children's Cancer Center.

See: http://www.childcancerpain.org/content.cfm?content=assess07

In addition to 3 assessment tools for children and infants, 5 additional methods are described for various assessment needs. A guide to effective questioning for pain evaluation during a history and physical is presented; and, additionally, the key elements in the use of behavioral observations and physical measures of pain are discussed.

Reviewer: Winnie Dawson, MA, RN, BSN. Access checked October 4, 2007.

Multi-Language FACES Pain Rating Scales

These sites provide 3 links for the FACES Pain Scale in languages other than English. An individual script can be read by anyone capable of communicating the language to a child and others for whom the FACES Pain Scale is an appropriate assessment tool. It may be beneficial to print a copy of these scripts for quick access at the nurse’s station.

Reviewer: Winnie Dawson, MA, RN, BSN. Access checked September 25, 2007.

From: Pediatric Pain Sourcebook (English and French – includes FACES worksheet).
Download PDF at: http://painsourcebook.ca/pdfs/pps92.pdf

From: Pediatric Pain Sourcebook (text scripted in 31 languages – use FACES worksheet from link above).
Download PDF at: http://painsourcebook.ca/pdfs/fps-r-multilngual-instructions-aug07.pdf

From: Wong's Essentials of Pediatric Nursing (scripted in 10 languages – includes FACES for each).
See: http://www3.us.elsevierhealth.com/WOW/facesTranslations.html

From: Promoting Excellence in End-of-Life Care and Bristol Bay Area Health Corporation
(scripted for Alaskan Natives).

Download PDF at: http://www.promotingexcellence.org/files/public/grantee_tools/bb5.pdf

Multi-Language NUMERICAL Pain Rating Scales

The pain assessment tool provided by the British Pain Society is a 6-question instrument using a 0-10 numerical scale and it is available in 16 languages. The PainKnowledge.org website provides one single question in 18 languages – 'Please point to the number that best describes your pain.'

Reviewer: Winnie Dawson, MA, RN, BSN. Access checked September 25, 2007.

From: The British Pain Society (Scroll to the bottom of the web page for 16 language options and select the appropriate language to download a PDF of the scale).
See: http://www.britishpainsociety.org/members_pain_scales.htm

From: PainKnowledge.org (instructions and one level-of-pain question in 18 languages).
Download PDF at: http://www.painknowledge.org/physiciantools/opioid_toolkit/components/Multi_language.pdf

The Assessment of Pain in Older People

From: Royal College of Physicians of London. October 2007.

Download PDF at: http://britishpainsociety.org/book_pain_older_people.pdf

This concise, 17-page guideline was developed in conjunction with the Royal College of Physicians, the British Pain Society, and the British Geriatrics Society. They reviewed current evidence in the literature to produce sound guidance for all practitioners in assessing the presence of pain in the elderly. Numerous pain rating scales and other tools especially applicable to this population of patients are provided.

Reviewer: Stewart B. Leavitt, MA, PhD. Access checked December 20, 2007.

Assessing Pain in Older Adults With Dementia

From: John A. Hartford Institute for Geriatric Nursing and the Alzheimer’s Association. Revised 2007.

Download PDF at: http://www.hartfordign.org/publications/trythis/assessingPain.pdf

This 2-page best-practice publication discusses issues related to effective pain assessment in the patient with advanced dementia and provides an assessment tool. The Pain Assessment in Advanced Dementia Scale (PAINAD) is a 5-item observational tool that is easy to implement -- detailed descriptions of relevant patient characteristics in each category are provided to aid the scoring process.

Reviewer: Winnie Dawson, MA, RN, BSN. Access checked September 25, 2007.

Pain Assessment in the Nonverbal Patient

From: American Society for Pain Management Nursing [Pain Management Nursing. 2006(June);7(2):44-52].

 PDF available for download at: http://www.aspmn.org/Organization/documents/Nonverbal/JournalFINAL.pdf

This position statement with clinical practice recommendations addresses pain assessment in patients who cannot communicate pain or discomfort due to cognitive, developmental, or physiologic limitations.

Reviewer: Stewart B. Leavitt, MA, PhD.  Access checked September 25, 2007.

Neuropathic Pain Scale

From: PainEdu.com. 2006.

 PDF available for download at: http://www.painedu.org/Downloads/tools/ NeuropathyPainScale.pdf

Scale created by Drs. Galer and Jensen, provides a 10 question survey specifically assessing neuropathic pain in terms of essential qualities, such as intensity, heat, sharpness, sensitivity, and others.

Reviewer: Stewart B. Leavitt, MA, PhD.  Access checked September 25, 2007.

Pain, Suffering, and Spiritual Assessment

From: City of Hope. 2006.

Download PDF at: http://prc.coh.org/pdf/Suffering-FF-Nov%2006.pdf

This 1-page assessment provides 18 questions as a discussion guide to help the patient identify personal emotional and spiritual attitudes as they relate to pain and suffering. While this tool would be very beneficial in a palliative-care setting, it could be utilized in any situation where a patient experiencing chronic pain could benefit from a reminder or an examination of their spiritual beliefs.

Winnie Dawson, MA, RN, BSN. Access checked September 25, 2007

Psychosocial Pain Assessment

From: City of Hope.

Download PDF at: http://prc.coh.org/pdf/Psychosocial%20Pain%20Assessment%20Form.pdf

This 7-page interview form provides questions that can guide an interviewer through an evaluation of the impact of pain in 5 areas of a patient's life – economic, social support, activities of daily living, emotional, and coping behaviors – as perceived by the interviewer, patient, and significant other. The completed assessment can provide valuable information for each of the patient's caregivers, but evaluation by a social worker may provide the most comprehensive appraisal of the overall impact of pain on the patient's life.

Reviewer: Winnie Dawson, MA, RN, BSN. Access checked September 25, 2007.

Brief Pain Inventory (BPI)

The Brief Pain Inventory (BPI) is commonly used in clinical research to assess the severity of pain and the impact of pain on daily functions. This tool has demonstrated consistent reliability in both the short (9 questions) and the long form (32 questions). It can be used in clinical practice for assessment and/or comparative analyses of outcomes in similar populations as presented in published literature.

Reviewer: Winnie Dawson, MA, RN, BSN. Access checked September 25, 2007.

From: MD Anderson Cancer Center (2-page short form).
Download PDF at: http://www.mdanderson.org/pdf/bpisf.pdf

From: MD Anderson Cancer Center (6-page long form).
Download PDF at: http://www.mdanderson.org/pdf/bpilong.pdf

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