Pain Rating Scales
Overview
Pain is whatever the patient says it is — self-report is the single most reliable indicator of pain. The nurse's job is to match the validated rating tool to the patient's developmental level, cognition, language, and ability to communicate, then use that SAME tool at every reassessment so the trend is meaningful. Self-report tools (Numeric Rating Scale, Visual Analog Scale, Wong-Baker FACES, Verbal Descriptor Scale) are first-line whenever the patient can reliably report. Behavioral-observation tools (FLACC, NIPS, CPOT) are reserved for patients who cannot self-report. Always document the tool used, the score, and the time.
Indications
Choose the tool by who the patient is, not by the diagnosis.
Interpretation
Self-report supersedes behavioral observation in the alert, oriented patient — document the patient's number even if behavioral cues seem inconsistent. NRS bands: 0 none, 1-3 mild, 4-6 moderate, 7-10 severe.
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Technique
Patient Teaching
Clinical Pearl
When the patient can talk, believe the number — self-report is the gold standard. When they can't, the tool changes: under 3 observe (FLACC/NIPS), over 3 let them point (FACES), over 8 let them number it (0-10).