What are the equivalent charts to a pain chart for assessing pain levels in patients?

Pain Assessment Chart Equivalents

For patients who can self-report, use the 0-10 Numeric Rating Scale (NRS) in visual format as your primary tool; for patients unable to self-report, use the Behavioral Pain Scale (BPS/BPS-NI) or Critical-Care Pain Observation Tool (CPOT) based on observable behaviors. 1

Self-Report Pain Scales (For Communicative Patients)

Primary Recommendation: Numeric Rating Scale (NRS)

• The 0-10 NRS Visual (NRS-V) in horizontal format achieves the highest success rate (91%) among critically ill adults and demonstrates superior sensitivity, negative predictive value, and accuracy compared to all other self-report scales. 1
• The NRS-V significantly outperforms the Visual Analog Scale (VAS) (66% success rate) and Verbal Descriptor Scale (VDS), with p-values <0.001 for both comparisons. 1
• Patients overwhelmingly favor the NRS-V for ease of use over oral numeric rating or analog scales. 1

Alternative Self-Report Options

• Verbal Descriptor Scale (VDS): Use this for patients unable to comprehend numerical scales; includes descriptors "no pain," "mild pain," "moderate pain," "severe pain," and "extreme pain." 1
• Verbal Rating Scale (VRS): Six-descriptor scale preferred by some cardiovascular surgery patients over the 0-10 NRS. 1
• Visual Analog Scale (VAS): 10-cm line with "no pain" and "most intense pain imaginable" anchors; less successful than NRS-V but validated. 1, 2
• Faces Pain Scale-Revised (FPS-R): Validated for children aged 4-12 years with strong correlation to VAS (r=0.93); scored 0-10 with six faces showing progressive pain intensity. 3, 4
• Faces Pain Thermometer (FPT): Validated in postoperative cardiac surgery patients with good correlation to VDS; rated favorably for ease of use. 1

Critical Pitfall to Avoid

• Do not use the Wong-Baker FACES scale in adults—it produces artificially elevated pain scores compared to the 0-10 NRS, likely due to confounding pain intensity with emotional affect through smiling/crying anchor faces. 1, 4

Behavioral Pain Scales (For Non-Communicative Patients)

Primary Recommendations: CPOT and BPS

• The Critical-Care Pain Observation Tool (CPOT) and Behavioral Pain Scale (BPS) demonstrate the strongest psychometric properties with scores of 16.7 and 15.1 out of 20, respectively, making them the most robust validated tools for assessing pain in critically ill adults unable to self-report. 1
• The BPS-NI (nonintubated version) achieves a psychometric score of 14.8, providing good validity for spontaneously breathing patients. 1
• Both CPOT and BPS have been extensively validated across medical, surgical, trauma, and brain-injured ICU populations. 1
• A CPOT score ≥2 indicates presence of pain requiring intervention. 5

Specialized Populations

• For elderly patients with severe dementia: Use Pain Assessment in Advanced Dementia (PAINAD), Functional Pain Scale, or Doloplus-2 over other behavioral tools. 1
• For pediatric patients aged 2 months to 7 years: The FLACC scale (Face, Legs, Activity, Cry, Consolability) is recommended, with scores 1-3 indicating mild pain, 4-6 moderate pain, and 7-10 severe pain. 5

Observable Pain Behaviors to Assess

When using behavioral scales, systematically evaluate these six domains: 1

• Facial expressions: Grimacing, wrinkled forehead, closed/tightened eyes, rapid blinking, distorted expressions
• Vocalizations: Moaning, groaning, grunting, calling out, noisy breathing
• Body movements: Rigid posture, guarding, fidgeting, restricted movement, gait changes
• Interpersonal interactions: Aggression, resisting care, decreased social interaction, withdrawal
• Activity pattern changes: Refusing food, increased rest periods, cessation of routines, increased wandering
• Mental status changes: Crying, increased confusion, irritability, distress

Geriatric-Specific Considerations

Assessment Approach

• Pain intensity in older adults equals that of younger patients for equivalent injuries (fractures, dislocations), yet 42% of patients over age 70 receive inadequate analgesia despite reporting moderate-to-high pain levels. 1, 2
• Select the pain scale based on the patient's specific ability to read, hear, and understand the tool's instructions. 1, 2
• Obtain collateral information from family members or caregivers about usual pain behaviors and baseline function, particularly valuable even in verbal patients. 2

Common Pitfall in Geriatric Care

• Age bias leads to systematic undertreatment—one in three older adults with non-operative fragility pelvic fractures receive zero analgesia during prehospital and ED care. 1

Implementation Algorithm

For verbal, oriented patients:

1. Start with 0-10 NRS Visual format 1, 2
2. If patient cannot use numbers, switch to Verbal Descriptor Scale 1
3. For children 4-12 years, use Faces Pain Scale-Revised 3, 4

For non-verbal or cognitively impaired patients:

1. Use CPOT or BPS in ICU settings 1, 5
2. Use PAINAD, Functional Pain Scale, or Doloplus-2 for severe dementia 1
3. Use FLACC for children 2 months to 7 years 5
4. Supplement with systematic observation of the six pain behavior domains 1

Reassess pain regularly after interventions to ensure adequate relief, as this represents the most accurate marker of treatment efficacy. 2