What the Pain Scale Really Means

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Editor’s Note:  This article was originally published in 2015, and its message is as timely today as it was then. As Karen originally stated, “Because pain is subjective, it is difficult to explain what you’re feeling to another person—even your own doctor. The pain scale may not be ideal, but it’s the best tool we have right now.” 

As a fibromyalgia patient, you’ve probably had doctors or nurses ask you, “How would you rate your pain on a scale of 0 to 10, with 0 being no pain and 10 being the worst pain you can imagine?” That sounds like a reasonable question—except for the fact that no one ever tells you what those numbers mean.

When faced with that question, often panic sets in and your mind starts racing. What number should I say? If the number is too low, he won’t understand how much I’m hurting; but if it’s too high, he’ll think I’m just trying to get drugs. How can I be sure that what he thinks the number means is the same as what I think it means?

In an effort to help remedy this situation, I researched several interpretations of the pain scale and have compiled what seems to be the most commonly accepted description of each number on the scale. If you want to be sure you and your doctor are speaking the same language, give him a copy of this pain scale so he knows exactly what you mean when you rate your pain.

THE PAIN SCALE

0 – Pain free.

Mild Pain – Nagging, annoying, but doesn’t really interfere with daily living activities.

1 – Pain is very mild, barely noticeable. Most of the time you don’t think about it.

2 – Minor pain. Annoying and may have occasional stronger twinges.

3 – Pain is noticeable and distracting, however, you can get used to it and adapt.

Moderate Pain – Interferes significantly with daily living activities.

4 – Moderate pain. If you are deeply involved in an activity, it can be ignored for a period of time, but is still distracting.

5 – Moderately strong pain. It can’t be ignored for more than a few minutes, but with effort you still can manage to work or participate in some social activities.

6 – Moderately strong pain that interferes with normal daily activities. Difficulty concentrating.

Severe Pain – Disabling; unable to perform daily living activities.

7 – Severe pain that dominates your senses and significantly limits your ability to perform normal daily activities or maintain social relationships. Interferes with sleep.

8 – Intense pain. Physical activity is severely limited. Conversing requires great effort.

9 – Excruciating pain. Unable to converse. Crying out and/or moaning uncontrollably.

10 – Unspeakable pain. Bedridden and possibly delirious. Very few people will ever experience this level of pain.

Avoiding the Pitfalls

When rating their pain, the most common mistake people make is overstating their pain level. That generally happens one of two ways:

  • Saying your pain is a 12 on a scale of 0 to 10.
    While you may simply be trying to convey the severity of your pain, what your doctor hears is that you are given to exaggeration and he will not take you seriously.
  • Smiling and conversing with your doctor, then saying that your pain level is a 10.
    If you are able to carry on a normal conversation, your pain is not a 10—nor is it even a 9. Consider the fact that natural childbirth (no epidural or medication) is generally thought to be an 8 on the pain scale. Just as with the first example, your doctor will think you are exaggerating your pain and it is probably not nearly as bad as you say.
If you want your pain to be taken seriously,
it’s important that you take the pain scale seriously.

Because pain is subjective, it is difficult to explain what you’re feeling to another person—even your own doctor. The pain scale may not be ideal, but it’s the best tool we have right now. Researchers are working on developing tests that one day may be able to objectively measure the degree of pain we’re experiencing. But until those tests are perfected and become widely available and affordable, we’ll have to make the best use of what we have.

Download a free, printable version of the pain scale right here

 

Pain Scale Infographic

 

Sources:
Comparative Pain Scale.” Lane Medical Library, Stanford Medicine. December 2008.
Medical Pain Scale.” The Spine Center. Retrieved 4/7/15.

_______________

Karen Lee Richards is ProHealth’s Editor-in-Chief, as well as being the Editor of both the IBS and Weight Loss HealthWatch newsletters. A fibromyalgia patient herself, she co-founded the nonprofit organization now known as the National Fibromyalgia Association (NFA) in 1997 and served as its vice-president for eight years. She was also the executive editor of Fibromyalgia AWARE magazine. After leaving the NFA, Karen served as the Guide to Fibromyalgia and Chronic Fatigue Syndrome for the New York Times website About.com, then worked for eight years as the Chronic Pain Health Guide for The HealthCentral Network before coming to ProHealth.

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30 thoughts on “What the Pain Scale Really Means”

  1. bearcat says:

    I feel this is the most important information you have ever posted on this web site. This verbal
    scale has the capability of totally changing the communication between the patient and doctor
    For thirty years I have tried to understand how a number can reflect my pain level and experience.
    Only recently did I see this clarifying scale when participating in a National clinical trial. The relief
    and understanding I felt in being able to express more clearly my experience of pain was truly
    amazing. This scale should be required as a national standard in all medical cases where levels of pain are being evaluated.

  2. Joyslp73 says:

    I think more of a question than statement. Can you use a pain scale after or during the period of time that you are utilizing pain medication? Because if so, then at times even with pain meds I’m at a 7.

    1. ProHealth-Editor says:

      Hi Joyslp73 – Yes, you can still use the Pain Scale when you’re taking pain medication but I would be sure to tell the doctor that the number you give is with the use of pain meds.

      I like the way my doctor does it. She asks me what my pain level is without medication and what it is with pain medication. That does two things: it helps her see how much the medication is helping and it provides justification for giving me pain meds in case the DEA ever checks on her. I hope that helps you. – Karen

    2. Slash#1 says:

      Since every doctors office seems to have a different scale at least with my experience. A couple actually said you would have to be passed out to be a 10. A nurse said so you couldn’t possibly ever been a 10,I proceeded to tell her I had twice before and the last time was in the lobby of the emergency room but today I’m a 6. Hopefully I can use this print out and it will be acceptable. I’m ready for the the other test they are working on honestly, I will be so happy not to see those circle faces again.

    3. 32paws says:

      While it is good to have a better description of a 1-10 pain scale than the 1 with a happy face and a 10 with a crying face, I disagree with this one for several reasons. First, everybody has a different level of pain tolerance. Two people could have the same thing with the same symptoms and one says a 2 and one says a 6. Is my 2 pain level less because I’m used to tolerating it for so many years than the person who claims a 6? No. Second, those of us with chronic pain, especially long term chronic pain, don’t even take certain things into consideration. Some of the aches, pains, discomfort, loss of concentration, etc. are a way of life, and when trying to describe pain, are missed. I’ve had a doctor tell me I was just changing my story when I agreed to something he said because I didn’t write it down in my original description of symptoms. I didn’t think of it as a symptom at that point but part of my life. I also can’t have the amount of pain I have because I haven’t lost my strength. That is because I’ve tried to work very hard to keep what little strength I have by exercising. Third, when you constantly take multiple drugs for multiple issues, some of which cause symptoms that others are treating, in my case 24 different meds, how do you rate pain with and without medication? I can’t just stop taking it for a week or two and then give an answer. When taking this much medication and asking for something for “break through pain” when I’m “only at a 6 or 7” my doctor looks at me like I’ve lost my mind and says with everything I’m taking I “shouldn’t have break through pain”. Well then maybe I’m really a 10 and need to pass out. I don’t think chronic pain is taken seriously in the medical community because it is not taught or discussed, therefore, the 99% of doctors who know nothing about it and think they are God anyway dismiss it. Something needs to be done, and not just a new pain scale.

    4. GinnyIckle says:

      I’ve been in a lot of pain for a very long time. I’ve had to recalibrate my pain scale a few times, and finally decided it needed to be logarithmic.
      When my foot was broken and I had to walk on it, that was a seven.
      When my back was really really really bad and I had severe burning neuropathic pain, among others, plus point tenderness in spine, plus agony if moved wrong, and couldn’t bend over to son my shoes, plus had a bad bad migraine that ended up lasting better than half a year … Well, it was curl up in a ball and die (which did have a lot of appeal) or call up all the movement and meditation training I could recall and try to function (a little) anyway. Anyway, I wasn’t very coherent maybe (from pain, not meds; I had no insurance then), but I was conversing. I made funny little sounds and the world whited out if I twisted or bent at all, and tears were streaming down my face some of the time, but I got a little.bit done then, anyway.
      Personally, I think of that as a nine. Though usually, I think of nine as pukinh and maybe passing out from the pain, and nine and a half as coming to, from the pain.

    5. willowlemont says:

      Thank you for this information! I went to a chiropractor and I put 10 on everything. The nurse said 10 I’m surprised you are not in the hospital. I didn’t understand why she said that. Thanks to you I do understand now.
      To me my pain was a 10 all day every day. After reading the scale and all of the comments I can now say I am at 6.

    6. LakewolfWhitecrow says:

      I generally take hydrocodone and thee aspirin to start my day.

      I have spinal and bone issues (hydrocodone), muscle and nerve issues (Lyrica), and headaches (aspirin). If, after taking these, my pain level is a 4 or lower, I know I’m ok.
      If, however, my pain level is 5 or higher, I stay in bed that day, because the pain lets me know I’ve overdone it.

      My pain level reaches a 10 only when I’m in the throes of intestinal spasms. The last time this happened, my spouse thought I was being dramatic—until an MRI showed a bowel ulceration that was very close to bursting.

      Now I am taken seriously. Praise be to God that I didn’t die.

      I trust NO ONE to care for me in these situations…I’m better off alone so I can call 911 without hearing a load of crap—which I clearly am NOT at that time capable of defending myself verbally against…and my spouse is an RN.

    7. glandularmass says:

      People that live with pain on a daily basis are pros at pretending they aren’t in severe pain, and can and do smile and converse through it. You don’t know until you live with it.

      1. Grace0123 says:

        Wow I had no idea because I feel like my pain level is at 100 sometimes. I don’t think you can put a number on it sometimes. We learn to fake it sometimes that we aren’t hurting as much because we don’t want people looking at us feeling sorry for us.

        I will go by this chart. I don’t just suffer from Fibromyalgia though I suffer sciatica, osteoperosis in my right hip which is also the side that my sciatica is on. I have degenerative disc disease in my neck, and lower back. Buldging disc in my neck and my lower back and I believe in my thorasic back but they will not check on that part of my back. Constipation that presses on my sciatic nerve. Neuropathy pain. As you can tell I am having a hard time think of correct spelling. I am sitting here growning and holding my breath because of the pain. I use to exercise regularly before I got the fibromyalgia. It was my whole life for stress relief. Then I was studying to become a physical fitness/nutritionest and I couldn’t move my neck one day and then it spread down my shoulders and back and into the lower back with the sciatica. I had to spend 3 months going through traction for my neck because I had 0 mobility. My shoulder killed my more than child birth and it went down my arm and into my hand. The pain that I have suffered over the past 20 years has destroyed my life. I barely do anything because it is to hard to get out of the house before my back starts hurting so bad. That is enough of me complaining. Thanks for the the chart on how we are suppose to us the numbers

      2. maaji16 says:

        This is the single most helpful article on pain you have ever printed. At last I understand how to communicate my pain levels – sometimes up to 8. THank you.

      3. Fibrosux says:

        I agree with bearcat. This is very important. I’ve told my doc that I will never tell him I’m at a nine or ten. If it’s that bad I won’t be in his office. He will have to see my in the hospital. I don’t over exaggerate my pain. I do however sole and talk with my doc no matter how bad it is. I really should try not to do that I can see where that could be mistaken for me not really hurting that bad. I’ve just dealt with this for so long that I hide it well.

      4. pageyer says:

        The impact of chronic debilitating pain affects many individuals; damaging their quality of life. With this said, I believe all those in health care want to treat our patients; how becomes the issue. We know that more, as in ever increasing dosages and types of opioids, is not better. Use of opioids often does very little to improve functionality, which we must look at equally. The definitions of the scale represent this well. Thank you for this research.

      5. LunaNik says:

        If I had a dollar for every time someone said to me, “You don’t look like you’re in pain/disabled,” I’d be a wealthy woman. I usually respond, “Would you feel better if I complained constantly? Because I wouldn’t. Paying attention to my pain makes it more painful. And I wouldn’t be much fun to be around if I complained all the time, would I? Also, today happens to be a ‘good day.’ If I was flaring, you wouldn’t be seeing me. I’d be home crying.”

      6. Ribonan says:

        Where did you find a doc who specializes in Fibromyalgia? I live in MA.ive only heard of a few that treat everyone the same.

      7. HenrryB says:

        I have read other articles on this subject.

        Just as this article, they all fail to mention whether the scale is filled with the person having his everyday medication in him, or how the it would be without medication.

        Another issue; most of us Fibro patients have been on medication so long and around the clock; it would be hard to remember how it truly was without any medication.

      8. TWWFTW70 says:

        I am interested in this site no-one had ever said to me what the pain numbers mean & when I have said a 10 I have been looked at in a strange way, now I know why. I want to be taken seriously, but I do push myself at times to just participate in activities and I always look well no matter how I am feeling. My doctor I saw yesterday commented on that because she knows what I have been through in surgeries etc. My old doctor once said I was a cheerful little thing (I am not very tall & she was about 80) in spite of all you are going through! I don’t want to moan & groan but sometimes it would be nice to be understood better. I sometimes feel the medication does nothing for the pain. I rest a lot in between actually doing a chore, its the only way I can cope as my back seems to seize up. I have a wonderful supportive husband so I am counting myself extremely lucky, he does all the things for me that I can’t do, but I try to help a bit as well as he is still working full-time and has funny odd shift hours. Thank you for listening

      9. DrRuchi says:

        Dear Mam
        Myself Dr Ruchi, MDS Endodontist from Chandigarh, India. I wish to use your pain scale for my randomised controlled trial on the topic “Calcium hydroxide pulpotomy as an alternative treatment option in irreversible pulpitis: a randomized controlled trial.”

        I request you to kindly allow me to use your scale for this study.

        Thanks
        Regards
        Dr Ruchi Juneja

        email: ruchijuneja1986@gmail.com

      10. ash123 says:

        Thank you so much for the descriptions here! I’m recovering from a TBI and really struggle to define my level of pain, nausea and fatigue. Is there any chance that you have something this descriptive for nausea, fatigue, and waking restfulness? I’ve been asked to record these but I’m stuck, I just can’t figure it out. Thank you!

      11. OkayAnnaJo says:

        Every time I get asked what my pain level is on a scale of 1 to 10 I never know what number to give it. I always say I can use words to describe it but I don’t know what number to give you, but they want a number. I’m now going to be able to give them a number that will more accurately reflect my level of pain. If they want patients to give a number for their pain then the #Pain Scale” should be posted on the walls of every medical facility. I consider myself a pretty intelligent person but not one person asking my level of pain on a scale of 1 to 10 has ever bothered to describe what the numbers mean to them. Consequently I would imagine that some of them thought I was way over exaggerating and didn’t take me as seriously.

      12. RobertWelch says:

        I wanted to mention a pain tracking app i use http://www.painscale.com for your readers to check out. It helps track and monitor pain and triggers of pain. Thanks RObert

      13. necurtis says:

        Hello,
        My name is Natasha Curtis RN and I would like to request permission to utilize you pain scale for my research study on how to better manage sickle cell pain.
        If you are ok with me utilizing your scale, I just need to to send me an email granting me permission.
        Thanks
        Regards
        Natasha Curtis RN

        email: NATASHA_E_CURTIS@HOTMAIL.COM
        832-768-4867

    8. BOOBOO5105 says:

      I totally agree… There needs to be a mutually agreed upon scale to convey how one is feeling daily… I have fibro & RA… it’s hard to put my pain into words and a number is easier now with this chart. Thank u!!

    9. yesse says:

      They describe childbirth as 8 but it should be a 9 lol
      9 – Excruciating pain. Unable to converse. Crying out and/or moaning uncontrollably.
      I had a baby with no medication given. I even ended up getting stitches. Yet after he was born I guess the endorphin kicked in and my pain became a 2 😉

      Yet with my fibromyalgia it has reach a 10. I just don’t go to a hospital because it would be a waste of time. They aren’t going to give me any more pain drugs. I always take my pain medication so I can only go by how I feel with it.

      Also as glandularmass mentioned we’re good at putting up a front and smiling as if we’re not in as much pain as we really are. After so many years of living with it.

      I’m fortunate I have a doctor who specializes in Fibromyalgia. He knows even if I smile at him my pain is still very high. I ignore the smiley faces.

    10. ConfusedPolarBear says:

      I am aware of how the pain scale works I and I know my body very well. My problem is I try to dismiss my pain because I think I’m a hypochondriac although I have been told I have fibromyalgia, complex pain syndrome and a bunch of other stuff. Three months ago I underwent surgery, a pelvic joint fusion. My pelvic joint was deteriorated due to severe arthritis. I also have arthritis in my knees, hips, and shoulders. I’ve been home for two and a half weeks now, I thought when I got home it would be just like when I left off but without such severe pain and fatigue. Well I was wrong (unless I’m just being a princess and exaggerating – my hypochondriac-ness coming out). I really try not to complain and just push on until I can’t push no more – sometimes until the pain is a 12 and that is no exaggeration. My biggest fear is that doctors think I am making up all this pain just for their attention and for medication. If I say my pain is at a 12 out of 10 then I really, really, really mean it.

    11. LunaNik says:

      I’ve had fibro for 15 years now. After struggling to choose a number, about 10 years ago, I began answering the question, “Where are you on the pain scale?” with the answer, “I don’t know.” My answer elicited a confused expression from my rheumatologist until I explained, “After 5 years of chronic pain, I no longer have a frame of reference. I don’t know what zero is like, so I can’t choose a number on YOUR pain scale. My life has no zero anymore.”

      He said it was the best answer he’d ever heard. I went on to describe and define my personal pain scale. My zero means I slept well, woke up relatively refreshed, managed to shower, and tolerated the pain enough to accomplish daily chores and errands (in short increments, taking breaks in between). My ten means I barely slept, woke up fatigued and in agony, and maybe moved from my bed to the couch, but maybe not (and probably took a long nap).

      I wish I had a memory of what zero pain feels like. Even just the memory would be awesome.

  3. beamummy says:

    Wow after reading that,it’s made me think about my pain a lot more. Thanks for putting things into prospective now.ot also has helped me explain to my husband and family.

  4. SpeshlK says:

    I am so crazy blessed to have found this scale. For about 20yrs I have been using that 1-10 little face scale. I have pain just about every where, from neuropathy in both legs, to chronic back pain (DDD), to arthritis etc… By looking here my 10 plus days were no more than a 6 maybe 7, but not even a ten plus. I’ve had some sobbing days but not many. This not only gave me an epiphany but as I’ve applied it to my days with pain I’ve went from every 4 hrs to every 8 hrs. I’m no longer afraid that my pain can’t be controlled in a more efficient way. I think the little faces not only make Dr and nurses lives quicker than an elaborate explanation, and or pt won’t or can’t understand etc… It’s much easier to point etc… No offense to medical personnel truly they may not have any idea this type of explanation is available. Thank you so much for this. I’m living in a nursing facility and on a list to move out on my own again. I’m only in early 50s. The pain issue was one of the biggest reasons I’ve been worried thinking that it might not be possible. There is hope. Thanks for this.

  5. SigridBlom says:

    This is a useful article. However, while useful, I don’t believe the Pain Scale was ever intended to be used by those who live in chronic pain. I take particular issue with the author’s “pitfall” of smiling and conversing with our doctor. Smiling and conversing does not, in any way, equate an absence of pain.
    Every person I’ve ever come across who lives in chronic pain has become adept at FAKING being well. Why? Because today’s society is not sensitized to deal with people who live in such agony. Our medical system is not equipped to even be compassionate, much less have a frame of reference when it comes to chronic pain and how to measure it. There are so many factors and all of them are subjective. To try to squeeze a measurement of pain that we endure into the small and convenient packaging of The Pain Scale is compartmentalizing and exclusionary, and does not address a person’s experience as a whole.
    What is more important than using The Pain Scale accurately and to your advantage is to develop a healthy relationship with a medical team who recognizes the patient not as someone who must PROVE they live in pain, rather as someone who deserves to live as pain free as possible with as much ease as possible.
    While a useful article, I find that the author, with her “avoid the pitfalls” concept is reinforcing the negative stigma that those of us living in chronic pain must battle every day, ON TOP of the physical pain we must live with while doing our best at feeling like a contributing member of society (something that we struggle to feel WITHOUT being subjected to the judgement of others who do not live in chronic pain).

  6. Kelda S says:

    Thank you for this article. A lot of the comments are helpful too. I have had Fibromyalgia for so long, I hardly know how NOT to converse through pain. I’m a mom and I will make sure everyone else is fine, before I give in to the pain. I like how one comment or said they had to re calibrate the scale. My doctor just suggested this to me. Because she knows I can shut out the pain. I have had sciatica, and it was a normal back ache to me. I have pinched a nerve in my spine and it was bad. But I could converse through clenched jaw, until I knew my daughter had a ride, I was at the ER, and the doctor was in the room. Then, I let down my guard and let the pain have attention. Then, and only then was I unable to converse. But, this week, I could not take the guard down off my pain at will. If I have noticeable pain with muscle relaxers and pain relievers, it certainly must be bad. I will get to that re calibration.

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