Patient Education, Resources, Treatment

Pain Scales

A 1-10 ranking is the best way to express the severity of the pain, but it’s so subjective that I frequently question my own ratings. Is an 8 this week the same as it was a year ago, or even a month ago? How can I rate a headache higher than 9? Can my pain really be a 10? Am I tempting fate by rating a migraine 10 — couldn’t the pain get worse than it is?

The American Chronic Pain Association and Health Organization for Pudendal Education both offer great pain scales. I particularly like the one from HOPE, so I’ve included it below.

Perhaps more important that using one of these pain scales is to create your own Everyone experiences pain from their own perspectives, so a scale can be highly subjective. Having your own scale helps identify the pain relative to recent months or years. It’s also helpful to share your own scale with your doctor, who may then better understand what you’re going through.

Interestingly, a doctor that I’m friends with told me that ER patients tend to rate their pain as a 3 or a 10. This may contribute to the skepticism headache sufferers encounter in the ER.

Comparative Pain Scale (from HOPE)

0: No pain. Feeling perfectly normal.

1: Very mild = Very light barely noticeable pain, like a mosquito bite or a poison ivy itch. Most of the time you never think about the pain.

2: Uncomfortable = Minor pain, like lightly pinching the fold of skin between the thumb and first finger with the other hand, using the fingernails. (Note that people react differently to this self-test)

3: Tolerable = Very noticeable pain, like an accidental cut, a blow to the nose causing a bloody nose, or a doctor giving you a shot. The pain isn’t so strong that you can’t get used to it. Eventually, most of the time you don’t notice the pain. You’ve adapted to it.

4: Distressing = Strong, deep pain, like an average toothache, the initial pain from a bee sting, or minor trauma like stubbing your toe real hard. So strong that you notice the pain all the time and can’t completely adapt. This level of pain can be simulated by pinching the fold of skin between the thumb and first finger with the other hand, using the fingernails and squeezing really hard. Not how the simulated pain is initially piercing but becomes dull after that.

5: Very distressing = Strong, deep, piercing pain, such as a sprained ankle when you stand on it wrong, or mild back pain. Not only do you notice the pain all the time, you are now so preoccupied with managing it that your normal lifestyle is curtailed. Temporary personality disorders are frequent.

6: Intense = Strong, deep, piercing pain, so strong that it seems to partially dominate your senses, causing you to think somewhat unclearly. At this point you begin to have trouble holding a job or maintaining normal social relationships. Comparable to a bad non-migraine headache combined with several bee stings or a bad back pain. (The person who posted this scale on the forum said that her migraine diary indicates this as her average pain on most days. I reach this level almost every day, but usually rate it a 3 or 4.)

7: Very intense = Same as 6 except that the pain completely dominates your senses causing you to think unclearly about half the time. at this point you’re effectively disabled and frequently can’t live alone. Comparable to an average migraine headache.

8: Utterly horrible = Pain so intense that you can no longer think clearly at all, and have often undergone severe personality change if the pain has been present for a long time. Suicide is frequently contemplated and sometimes tried. Comparable to childbirth or a real bad migraine.

9: Excruciating unbearable = Pain so intense that you can’t tolerate it and demand pain killers or surgery, no matter what the side effects or risk. If this doesn’t work, suicide is frequent since there is no more joy in life whatsoever. Comparable to throat cancer. (It’s scary to think about, but this was me for at least a year before I got my stimulator. Thus I was willing to give up a lot of money and mobility for an unproven treatment.)

10: Unimaginable unspeakable = Pain so intense that you will go unconscious shortly. Most people have never experienced this level of pain. Those who have suffered a severe accident, such as a crushed hand, and lost consciousness as a result of the pain rather than the blood loss, have experienced level 10.

15 thoughts on “Pain Scales”

  1. Your post was very helpful to me this morning. Prior to finding it, I gauged my headache today of 8/10 just by my own feeling then wondered if I was over reacting… It started a month ago and pain killers were only touching the tip of the headache so I stopped them as my kidneys and liver are so sore. I decided to Google “how to rate headache pain out of 10” this morning as I am becoming particularly irritated by everything. Your comments were SPOT ON. I have been having lots of suicidal thoughts in recent weeks but having been through 8 years of chronic illness with Lyme disease, 2 years of pure hell with a 91 year old narcissistic mother who developed dementia, a Quadruple Bypass in February due to all the stress and her subsequent passing 5 weeks ago. I am unable to grieve over her passing which is so wrong. I still cry over my father’s passing from 2002. I imagine that is why I am so intolerant of things at the moment. Lots of heartache and anger to work through. I will seek help and also keep a headache diary now. Thank you.

    1. Hi Pam, I’m sorry to hear you’re going through so much. It sounds emotionally exhausting! I’m so glad you’re seeking help. And the headache diary should help you spot some patterns. Best wishes in your search for relief.

      Take care,

  2. I was wondering if this works for everyday pain such as headaches and backaches etc. Is it OK I could write this scale down so I could keep track in my Headache journal.

  3. Great scale. I’ve often in the apst two years agonized over this question in the docs office. With two years into a horrid Frozen Shoulder/Impingement syndrome issue, everytime I get asked this question (On a scale from 1-10 with 10 being the worst you’ve ever felt) – all I can think is.. Umm – two years ago this would have been a 9, but now it’s “just” a 6… Same pain – the scale has just shiften due to chronic pain. I get used to it – ugh. Surgery on 4/22 – then the scale may shift again…

  4. I typically spend more time with a migraine than without one. Many are 6 or 7 on this scale, but usually 4-5. I also have a 25 year old back injury that consistently ranges from a 3 – 6 on this scale, worked for 10 years like this. I’m finally out on disability, but I did go the 16 years of school and work with levels that spelled out on this scale that would make me unable to work during that time. It resulted in disability eventually, but the fact remains that I did function for that 16 years, negating to doctors the validity of any pain scale that says you can’t work. I’m having difficulty with this in applying for disability retirement, it is so hard to convey and quantify and make it tangible and valid to others.

  5. I am not sure if this scale is all that helpful. The pain associated with my average headaches is quite mild (probably only a 3) but the nausea associated with a headache is worse and makes it almost impossible for me to work or have a “normal” day. Just a thought…

  6. This is why I detest 10 point pain scales–they are essentially meaningless for me to interpret on the physician side. What is your “6”? It could be someone else’s “3” or “8”. Or your “9” from last year before you realized how bad pain could get.

    It is also why most migraine research uses more simplified pain scales: none, mild, moderate, and severe is standard. The gradations are understandable and more easily quantifiable.

    At most, a 5-point scale is all that I find sensible.

    Just a pet peeve of mine. Carry on. 🙂

    Thanks for giving the research scale — it makes a lot of sense.


  7. I think the scale is directed for the “average” person. “Average” meaning a person who doesn’t suffer from chronic migraine pain (or chronic pain period). Looking at this scale, it’s sad and unreal to think I operate at a 6/7 on any given day. Really hits home, doesn’t it?

    I’d love to show this to my boss and co-workers who constantly tell me how I’m grumpy and mean all the time. Then I’d ask them how they’d function at a pain level of 6/7 most days! 🙂

    Looking at my daily levels on this schedule definitely scared me. I can’t believe the levels of pain we all function with.


  8. Thank you for this scale – I’m going to make use of it – I’ve always found that my own ratings seem to go up and down.
    Just a note regarding pain scales and disability claims: I am, very regrettably, living on disability. During my 3rd year of disability, as part of an update, I was asked to fill out a pain scale for a two-week period, choosing one number from 1 to 10 for each day. The paperwork had always been overwhelming, but this was a new twist. At first I agonized over the task, trying to average out a number, over the various pain levels of each day, to neatly write into the tiny box provided. Then I just wrote: “see back”. On the back of the form, for each day, I gave all of the pain levels in whatever increments they actually occurred. For instance:
    Thursday, March 2nd:
    5:30-7:30am: 7
    7:30-Noon: 3
    Noon-2pm: 1
    2pm-8pm: 7
    8pm-11pm: 8
    I have not been sent a two-week pain scale to fill out since.

    Great idea. I’ve tried to record in that detail, but it is so discouraging. But it’s worth it if the disability folks are also discouraged.


  9. That’s interesting. I don’t think I would ever rate my pain a 10 – I would consider that a theoretical impossibility. But 9? Been there.

    One thing I notice about this scale is that it seems to focus on pain over a longer period of time (talks about being able to live alone, holding a job, etc). With migraine it’s a little different because the pain is so up and down. I can’t imagine what it would be like to have a 7-9 (or even 6) migraine attack all the time.

    Though I do have some pain most of the time, my deepest respect to those who have a high level of pain for months.

    Great point. Because my pain level ia fairly strong, it’s easy for me to imagine how all the categories would fit my life. Maybe someone with less pain could make up a useful scale for themselves by looking at this list and trying to correlate the items with things in their lives.

    There are tons of pain scales available. I’m sure some are better for acute pain than others.


  10. I agree with you, the scale is subjective. For instance, my headaches are far worse than the natural birth I had with my son. And the idea of a shot makes me want to throw up and pass out LOL.

    I’m sure there are docs that would use that above scale and tell me my headaches “aren’t that bad”, but I’m the one living with them.

    But it’s very helpful, thank you 🙂

    I recently read that women become less susceptible to pain in the two weeks before labor. And that they’re “programmed” to forget the severity of the pain if childbirth. Not to discount your experience, I just thought it was interesting.

    And, unfortunately, there’s no scale that will convince all doctors of the severity of our pain. Maybe a personal scale is best for that. Then you can describe directly how much your pain affects you.


  11. Thank you so much for posting this. I often struggle with words to try to measure my pain. I tried the 0-3 scale, using any incriment I wanted (ie, 2.6 was an aceptible number), but no one other then my husband and I knew what that scale was. So I switched to the 1-10 scale, but this is so great, really puts the right words together. If you don’t mind, I might post this on my blog. And I”m going to print it, and take it with me to describe the pain to my doctor the next time I go.
    Thanks again,

    I’m so glad it’s helpful for you. You’re more than welcome to post it on your blog. It’s all about helping as many people as possible.


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