Pain scales in adults

Pain scales are used to determine the intensity of pain. Scales allow you to assess the subjective pain experienced by the pain patient at the time of the study. The most widely used are verbal, visual and digital scales or scales in which all three variants of evaluation are combined.

[1], [2], [3], [4]

Verbal Rating Scales for Pain Assessment

Verbal Rating Scale

Verbal rating scale allows you to assess the intensity of pain through qualitative verbal assessment. The intensity of pain is described by certain terms in the range from 0 (no pain) to 4 (the most severe pain). From the proposed verbal characteristics, patients choose the one that best reflects the pain experienced by them.

One of the characteristics of verbal rating scales is that the verbal characteristics of the description of pain can be presented to patients in an arbitrary order. This encourages the patient to choose exactly the gradation of pain, which is based on semantic content.

4-point verbal assessment of pain (Ohnhaus EE, Adler R., 1975)		5-point verbal scale of pain assessment (Frank AJ M., Moll J.M.H., Hort JF, 1982)
No pain	0	No pain	0
Mild pain	1	Mild pain	1
Pain of medium intensity	2	Pain of medium intensity	2
Strong pain	3	Strong pain	3
		Very severe pain	4

Verbal descriptive pain assessment scale

Verbal Descriptor Scale (Gaston-Johansson F., Albert M., Fagan E. Et al., 1990)

When using a verbal descriptive scale, the patient needs to find out if he is experiencing any pain right now. If there is no pain, then his condition is estimated at 0 points. If pain is experienced, you need to ask: "Could you say that the pain has intensified, go unimaginable, or is it the most painful pain you've ever experienced?" If so, then the highest score is 10 points. If there is no first or second option, then further it is necessary to clarify: "Can you say that your pain is weak, moderate (moderate, tolerant, not strong), strong (sharp) or very (particularly excessive) ".

Thus, there are six possible pain assessment options:

• 0 - there is no pain;
• 2 - mild pain;
• 4 - moderate pain;
• 6 - severe pain;
• 8 - very severe pain;
• 10 - unbearable pain.

If the patient experiences pain that can not be characterized by the proposed characteristics, for example between moderate (4 points) and severe pain (6 points), the pain is estimated by an odd number that is between these values (5 points).

A verbal descriptive pain assessment scale can also be used in children older than seven years who are able to understand and use it. This scale can be useful for assessing both chronic and acute pain.

The scale is equally reliable for both children of primary school age and older age groups. In addition, this scale is effective for various ethnic and culturological groups, as well as for adults with minor cognitive impairment.

Facial Pain Scale

Faces Pain Scale (Bien, D. Et al., 1990)

The facial scale of pain was created in 1990. Bieri D. Et al. (1990).

The authors developed a scale for the purpose of optimizing the assessment of pain intensity by a child, using a change in facial expression, depending on the degree of pain experienced. The scale is represented by the pictures of seven persons, while the first person has a neutral expression. The subsequent six persons depict the mounting pain. The child should choose the person who, in his opinion, best demonstrates the level of pain that he is experiencing.

The facial scale of pain has several features compared to other rating facial pain scales. First, it is more proportional to the scale, rather than the ordinal scale. In addition, the advantage of the scale is that it is easier for children to correlate their own pain with the figure of the person represented on the scale than with the face photograph. Simplicity and ease of use of the scale make it possible for its wide clinical application. The scale is not validated for work with children of preschool age.

[5], [6], [7], [8], [9]

Modified Facial Pain Scale The Faces Pain Scale-Revised (FPS-R)

(Von Baeyer, L. Et al., 2001)

Carl von Baeyer with students from the University of Saskatch-ewan (Canada), in collaboration with Pain Research Unit, modified the facial pain scale, which was called the modified facial pain scale. The authors, instead of seven persons, left six in their version of the scale, while retaining a neutral facial expression. Each of the images presented in the scale was digitally evaluated in the range from 0 to 10 points.

Instructions for using the scale:

"Look carefully at this picture, where faces are drawn, which show how much pain you can have. This person (show the most left) shows a person who does not hurt at all. These faces (show each person from left to right) show people whose pain increases, grows. The face on the right shows the person who is unbearably sick. Now show me a face indicating how painful you are at the moment. "

Visual analog scale (VASH)

Visual Analogue Scale (VAS) (Huskisson, E. S., 1974)

This method of subjective assessment of pain is that the patient is asked to mark a point on the non-graded line, 10 cm long, which corresponds to the degree of pain. The left border of the line corresponds to the definition of "no pain", the right line - "the worst pain you can imagine." Typically, a paper, cardboard or plastic ruler with a length of 10 cm is used.

On the back of the line, centimeter divisions are marked, according to which the doctor (and in foreign clinics this is the responsibility of the average medical staff) marks the value obtained and enters it on the observation sheet. The absolute advantages of this scale include its simplicity and convenience.

Also, in order to assess the intensity of pain, a modified visual analogue scale can also be used, in which the intensity of pain is also determined by different shades of colors.

The disadvantage of VAS is its one-dimensionality, that is, on this scale the patient only notes the intensity of pain. The emotional component of the pain syndrome introduces significant errors in the VAS indicator.

With dynamic assessment, the change in pain intensity is considered objective and significant if the current value of the VAS differs from the previous one by more than 13 mm.

Numeric Pain Scale (CSB)

Numeric Pain Scale (NPS) (McCaffery M., Beebe A., 1993)

According to the principle stated above, another scale is constructed-the numerical scale of pain. A ten-centimeter interval is broken by marks corresponding to centimeters. According to it, it is easier for a patient, in contrast to VAS, to estimate the pain in digital expression, it determines its intensity on a scale much more quickly. However, it turned out that in repeated tests, the patient, remembering the numerical value of the previous measurement, subconsciously reproduces the not really existing intensity

Pain, but tends to stay in the area of the previously named quantities. Even with a sense of relief, the patient tries to recognize a higher intensity, in order not to provoke a doctor to reduce the dose of opioids, etc., - the so-called symptom of fear of repeated pain. Hence the desire of clinicians to move away from digital values and replace them with verbal characteristics of the intensity of pain.

Scale of Pain Bloechle et al.

Pain scale of Bloechle et al. (Bloechle C., Izbicki JR et al., 1995)

The scale was developed to assess the intensity of pain in patients with chronic pancreatitis. It includes four criteria:

1. Frequency of bouts of pain.
2. Intensity of pain (pain rating on the VAS scale from 0 to 100).
3. The need for analgesics for pain relief (the maximum degree of expression is the need for morphine).
4. Lack of efficiency.

NB !: The scale does not include such characteristics as the duration of the attack of pain.

Symptom	Characteristic	Evaluation
Frequency of bouts of pain	No	0
	Several times during the year (2-12 times / year)	25
	Several times a month (24-50 times / year)	50
	Several times a week (100-200 times a year)	75
	Daily (more than 300 times / year)	100
Intensity of pain	No	0
	The Unbearable	100

Symptom	Characteristic	Evaluation
Need for analgesics for pain relief	No	0
	Aspirin	1
	Tramadol	15
	Buprenorphine	80
	Morphine	100
Duration of disability during the past year, due to pain	No	0
	1-7 days	25
	Up to 1 month	50
	Up to 365 days a year	75
	Constantly	100

If more than one analgesic is used, the need for analgesics for pain relief is equated to 100 (maximum score).

In the presence of continuous pain, it is also estimated at 100 points.

Score is made by summing up estimates for all four characteristics. The pain index is calculated by the formula:

Overall assessment by scale / 4.

The minimum score on the scale is 0, and the maximum score is 100 points.

The higher the score, the more intense the pain and its impact on the patient.

Scale of assessment of pain in the ICU based on observation

Critical Care Pain Observation Tool (CROT) (Gelinas S., Fortier M. Et al., 2004)

The AMR scale can be used to assess pain in adult patients in the ICU. It includes four characteristics, which are presented below:

1. Facial expression.
2. Motor reactions.
3. Tension of the muscles of the upper limbs.
4. Speech reactions (in non-intubated) or resistance to the ventilator (in intubated) patients.