Understanding the PAIN Scale

Understanding the PAIN Scale

“Is it painful?” Is a question I ask multiple times daily to various patients. “No, it hurts.” Or “Yes, it is sore”, is an answer I get a lot. 

To try understanding a patients’ pain, we make use of scales and questions.

A few interesting facts about pain:

  • All of us experience pain differently.
  • Our description of pain differs and changes all the time.
  • Pain is a sensory and emotional experience.
  • Although usually not life-threatening, pain should never be ignored.

Why do we experience pain?

We need the sensation of pain to let us know when our bodies need extra care. It’s an important signal. When we sense pain, we pay attention to our bodies and can take steps to fix what hurts. Pain also may prevent us from injuring a body part even more.

This is what happens in our body when we feel something painful:



There are many ways that we, as physios, try to understand someone’s physical pain:

1)      VAS or Visual Analogue Pain scale:

Understanding the PAIN Scale

This is the most common pain scale that we use.


  • VAS is more sensitive to small changes than are simple descriptive ordinal scales in which symptoms are rated, for example, as mild or slight, moderate, or severe to agonizing.
  • These scales are of most value when looking at change within individuals.
  • The VAS takes < 1 minute to complete.
  • Easy to use with routine treatment.
  • No training is required to determine a score.
  • Minimal translation difficulties have led to an unknown number of cross-cultural adaptations.


  • This assessment is highly subjective.
  • Are of less value for comparing across a group of individuals at one-time point.
  • It could be argued that a VAS is trying to produce interval/ratio data out of subjective values that are at best ordinal.
  • VAS is administered as a paper and pencil measure or digitally administered.

This is a simple, although subjective measuring tool to quantify a person’s pain intensity/severity.

When you are asked to complete the VAS, please keep the following in mind:

Mild pain may be annoying and noticeable, but it doesn’t keep you from performing normal activity:

  • At level 1, pain may be barely noticeable and easily ignored.
  • Level 2 pain is annoying and may flare into occasional stronger twinges.
  • Pain at level 3 is distracting, but you can learn to adapt to it.


Moderate pain begins to get in the way of your daily life:

You may be able to push level 4 pain aside for periods while involved in a task, but it is still very distracting.

  • Level 5 pain can’t be ignored for more than a few minutes, but you can push through it with effort.
  • At level 6, the pain may make it hard for you to concentrate on regular tasks.

Severe pain can render you unable to perform normal activity:

  • At level 7, the pain demands your attention and keeps you from performing tasks. It may even interfere with your sleep.
  • Level 8 pain is intense, limiting physical activity and even making conversation difficult.
  • Pain at level 9 leaves you unable to converse. You may just be moaning or crying uncontrollably.
  • The greatest pain, level 10, leaves you bedridden or even delirious.

If you are in pain, please contact your physio to understand your pain better, change it, resolve, and relieve it. Maybe together we can even transform your pain into performance.