Assessing My Pain, From Zero to 10

Ed Tobias avatar

by Ed Tobias |

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Lately, I’ve been thinking about pain — specifically, how to count my pain.

When I was lying on a treatment table while my physical therapist Richard manipulated my shoulder, he asked me to rate my pain, on a scale from one to 10. I’m sure many of you have been asked something similar by a healthcare provider, as it’s a standard way of assessing pain. But it doesn’t make a lot of sense to me.

A scale that doesn’t add up

Let’s assume that for me, zero equals no pain at all, and level one equals a slight feeling of discomfort that’s nearly always present. Where do we go from there?

As Richard continued to tug, twist, and palpate my left rotator cuff, my pain increased. Level two, in my mind, was uncomfortable. Level three was painful enough to make me wince, but I could handle it. (No pain, no gain, right?) At the next pain stage, level four, I told Richard to stop. If we had reached level five, I would have let out a banshee scream.

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So, what’s the point of level six through 10 for me? I guess I could have skipped levels and rated my pain as two (I’m uncomfortable), five (I’m wincing), eight (stop now), and 10 (screaming), but that didn’t seem to provide a better assessment.

“Who thought up this numbering system?” I asked Richard. He didn’t know. My thought: Use words rather than numbers: “I hardly feel it,” “That’s uncomfortable,” “It hurts but I can handle it,” “Stop, now.”

Guess what? There’s actually a scale that does that.

Other pain scales

In researching this column, I discovered three pain scales used in healthcare.

The Numerical Rating Scale (NRS) is the one my physical therapist uses. It rates zero as no pain, one to three as mild, four to six as moderate pain, and seven to 10 as severe.

The Visual Analogue Scale is a visual NRS. A patient is asked to mark their pain intensity on a line that’s usually 100 mm long. Generally, it’s divided as: no pain (0–4 mm), mild pain (5–44 mm), moderate pain (45–74 mm), and severe pain (75–100 mm).

The Verbal Rating Scale (VRS), sometimes called the Verbal Pain Intensity Scale, uses five adjectives to describe pain intensity: none, mild, moderate, severe, and very severe.

The VRS is exactly what I was thinking of. It’s simple, clear, and in my opinion, precisely describes what a patient actually feels. Why mess around with anything more complicated? Why ask me to choose from a group of numbers and hope that the healthcare provider will understand what each number means to me? Don’t words do this much better?

I think my physical therapist and others in healthcare should use this more practical pain scale. I’ll tell him I rate it a 10. (Or should that be a zero?)

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Michelle avatar


There is another pain scale, the Wong-Baker FACES Pain Rating Scale, that is often used with children. Or so I was taught in nursing school in the late 1900s. You can see it at
I am a retired (because of disability secondary to SPMS) emergency/trauma registered nurse. Thought of the Wong-Baker FACES scale when I read your article and did not see it included in your list of pain scales.

Ed Tobias avatar

Ed Tobias

Hi Michelle,

Thanks for the info about the FACES scale. Honestly, I saw it but forgot to include it.

Also, I'm sorry for the late response. I can't respond to a comment until an editor approves and posts it and that editor doesn't work weekends.


Penny-Marie Wright avatar

Penny-Marie Wright

I saw my chiropractor on Sep. 14 & he doesn't need me to tell him what number my pain level is at. I just tell him for part of it when I'm on my stomach he's lucky because I can't kick him. I'm very vocal when he's manipulating? me. He is a great doctor who I've seen for years. I usually leave his office feeling better even after the torture. Also with the MS at the app. before when I sat up to leave I had a major vertigo spell. Ended up sitting for quite a while before I could move & then sat in his waiting room for a few hours until it settled down & I could drive. Felt like I was going to throw up. I occasionally get spells like this. First one was right after I was diagnosed with MS I think. It was major also.

Ed Tobias avatar

Ed Tobias

Hi Penny-Marie,

Thanks for that interesting info. Obviously, you have your own, personal, pain scale. Whatever works for you.
Hope you're vertigo is better.


Max Gutbrod avatar

Max Gutbrod

In my mind, grading is not helpful. I feel generally bad, sort of or very much, and when it gets better I understand how bad it was and what hurt. I feel something in my back, neck or stomach is stiff and when I succeed in loosening it I feel relief. I dislike movements, in particular those my physiotherapist asks me to make, and the way I am touched, and we then try to find out why that is and whether I can do something about it or whether the muscle is overloaded and better relax.

Ed Tobias avatar

Ed Tobias

Hi Max,

Thanks for sharing that info. It sounds as if you and your PT communicate well. That's the best pain scale there can be.


Lois avatar


I agree with you. I also like the emojii scale at my pulmonary rehab office. ????

Ed Tobias avatar

Ed Tobias

Hi Lois,

Yes, that's similar to the FACES scale, which another reader commented about. My faces wouldn't be quite as peaceful looking.


June Patricia Turnbull avatar

June Patricia Turnbull

I couldn't agree more I sometimes think that NO ONE could possibly be in as much pain as me so that's a 10 then or is at a 100....I often tell my nurse that it's a screaming pain and that's without any manipulation. I've just about lost count of all the pills I'm on morphine/steroids/or anything else even paracetamol nothing seems to work for me. In a very strange way it is good to know that I'm not the only one! I write children's books but sometimes even my fingers hurt too much to type! Don't get me on to the pins and needles they are just about the limit!!!! June P Turnbull xxx

Ed Tobias avatar

Ed Tobias

Hi June,

I'm sorry you've been in so much pain. I sure hope it isn't affecting what you write about. I have 5 and 7 year old grandchildren who might be readers! BTW, have you considered substituting voice recognition for your fingers when you write?


Catherine Helm avatar

Catherine Helm

Hi Ed.
I like to use color or noise examples whenever I get asked this silly question.
Colors: I especially like the example of color sample strips from paint companies. And noise: I use the volume dial for radio or tv.
In fact, I will be using my very own "scales" quite often in the next 8 days - lots of medical appointments.
Enjoy the last bits of summer! Thanks for keeping it real.

Ed Tobias avatar

Ed Tobias

Hi Cathy,

Thanks for those unique suggestions and good luck with your upcoming appointments. I hope you won't be seeing any red.



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