Pain Rating Scales — Adult
A patient rates their pain as 4/10 but is grimacing and guarding — do you document the 4 or override their self-report? The answer depends on which scale you're using and why.
Core Concept
For adults who can self-report, the patient's own rating is the gold standard — pain is whatever the patient says it is. The Numeric Rating Scale (NRS, 0–10) is the most widely used: 0 means no pain, 1–3 mild, 4–6 moderate, 7–10 severe. The Visual Analog Scale (VAS) uses a 10-cm line where the client marks their pain intensity; it's more precise for research but less practical bedside. The Wong-Baker FACES scale, though designed for children, is appropriate for adults with cognitive or language barriers — it does not require numeracy. The Verbal Descriptor Scale uses words (none, mild, moderate, severe) and suits clients uncomfortable with numbers. Selection depends on the client's cognitive status, literacy, language, and developmental level. Whichever scale you choose, you must use the same scale consistently across reassessments so trends are meaningful. Document the scale used, the score, and the time. Reassess after intervention — typically 30 minutes after oral analgesics and 15 minutes after IV — using the same tool to evaluate effectiveness.
Watch Out For
Don't confuse the NRS (0–10 verbal number) with the VAS (mark on a measured line) — they look similar but VAS requires physical marking and ruler measurement. Students often think behavioral cues override self-report in alert adults; they don't — self-report always takes priority. The FACES scale is not exclusively pediatric; it's valid for any adult with communication or cognitive limitations.
Clinical Pearl
Same patient, same scale, every time. Switching scales mid-shift turns your pain trend data into meaningless noise.
Test Your Knowledge
3 quick questions — see how well you understood Pain Rating Scales — Adult