Patient-reported pain severity

Patient-reported pain severity provides insight into the patient’s experience of pain. c_agg7-c02-s1.html#agg7-c02-s1__tagg7-c02-tbl2 lists questions that can help the patient describe their pain severity. Patient-reported pain severity is subjective. When taken alone, it is not a reliable measure on which to base diagnosis or management strategies (despite historically having been used for this purpose). Rather, it must be interpreted in the context of the patient’s presentation—understanding the context behind self-reported pain severity is crucial when assessing and formulating pain.

If patient-reported pain severity is not consistent with other assessment findings (eg physical function, examination findings), it is important to explore the patient’s perception of their pain, and determine which sociopsychobiomedical factors (eg anxiety, underlying pathology) are contributing to their pain experience. Anecdotally, older people may underreport pain, and people with known or suspected substance misuse may have an atypical pain experience; see Additional considerations when assessing pain in older people and Additional considerations when assessing pain in people with known or suspected substance misuse for advice.

Unidimensional pain scales can be used by a patient to rate their pain severity (most severe, least severe, usual severity) over a period of time. They can also be used to rate current pain severity. Examples of unidimensional pain scales include:

• verbal descriptor scales—ask the patient to rate their pain using the descriptors ‘no pain’, ‘mild pain’, ‘moderate pain’, ‘severe pain’, ‘worst-ever pain’
• numerical rating scales—ask the patient to rate their pain from 0 (no pain) to 10 (worst pain imaginable). Alternatively, a visual form with numbers 0 to 10 may be used
• visual analogue scale—ask the patient to mark their pain severity on a 10 cm horizontal line labelled at opposite ends with ‘no pain’ and ‘worst pain imaginable’. The pain score is determined by measuring the distance from the left-hand side of the scale (ie ‘no pain’) to the mark made by the patient
• Faces Pain Scale-Revised—ask the patient to point to the face on the scale that matches their pain severity. The result from the scale can be converted to a numerical value. This scale is used in younger children (older than 4 years) or in adults who are unable to use other scales (eg people with mild to moderate cognitive impairment).

Because unidimensional pain scales rely on self-report, they cannot be used by patients who cannot reliably self-report pain severity (eg nonverbal or cognitively impaired people, young children). For these patients, surrogate measures of pain severity (eg observations of the patient’s behaviour) are commonly used instead. For example, the FLACC behavioural scale¹ estimates a child’s pain severity by scoring behavioural observations.

Patient-reported pain severity is a component of multidimensional pain scales such as the PEG scale² and the Brief Pain Inventory. These scales contextualise self-reported pain severity with measures of the pain’s impact on the patient’s social, psychological and physical function.