Pain Intensity Instruments
Visual Analogue Scales:
Description: Self-report measures using line bisection, numerical, or pictorial representations indicating a continuum of pain intensity. Numerical and pictorial pain rating measures are generally preferred to line bisection measures as they provide a discrete number that is more easily interpreted.
Populations of use: These measures are useful with most populations. Numerical rating scales are most often used in adult populations. Pictorial rating measures are often used with children and cognitively impaired individuals. For the visually impaired, a Verbal Rating Scale (VRS) may be preferred. These involve verbally reporting intensity of pain. May be reported on a scale from 0-10 with 10 being the highest intensity or a scale of 0-3 (no pain, minimal pain, moderate pain, severe pain).
Line bisection tasks:
Visual Analogue Scale (VAS) via Partners Against Pain
Stratton Hill, C. (1997).Guidelines for the treatment of caner pain: the revised pocket edition of the final report of the Texas Cancer Council’s workgroup on pain control in cancer patients, 2nd edition; pages 61-63. Texas Cancer.
Numerical rating measures:
Numerical Rating Scale (NRS) via NIH
McCaffery, M., & Beebe, A. (1993). Pain: Clinical Manual for Nursing Practice. Baltimore: V.V.Mosby Company.
Instrument provided via NIH. Click the NRS link to view a copy of the questionnaire.
Multilingual NRS via Partners Against Pain
McCaffery M, Pasero C (1999). Pain: Clinical manual, pp. 68-73, Mosby, Inc.
May be duplicated for use in clinical practice.
Quadruple Visual Analogue Scale (QVAS) via Chiro Org
Von Korff M, Deyo RA, Cherkin D, Barlow SF (1993) Back pain in primary care: Outcomes at 1 year. Spine, 18, 855-862.
Permission to duplicate may be obtained through Elsevier Science.
Pictorial Rating Meausres:
Wong-Baker FACES of Pain via Elsevier Science
Wong-Baker FACES of Pain Spanish Version via NIH
Wong-Baker FACES of Pain Multilingual Version via UCLA
Wong, D. and Baker, C. (1988). Pain in children: comparison of assessment scales, Pediatric Nursing 14(1),9-17.
Permission to reproduce is required only if it is to be included in copyrighted material, such as an article or a book, or an agency's forms. Click the Wong-Baker FACES link for permissions and downloads.
Nonverbal Pain Intensity Measures
Checklist of Non-Verbal Indicators (CNVI) via NIH
Description: 6-item observational measure of pain indicators; scored as either present of absent (0 or 1) yielding a total score between 0-6. May be used in the general population or for individuals who are unable to report pain intensity.
Feldt, KS. (2000). The checklist of nonverbal pain indicators (CNPI). Pain Management in Nursing,1(1), 13-21.
Instrument provided via NIH. Click the CNVI link to view a copy of the questionnaire.
Pain Assessment in Advanced Dementia Scale (PAINAD) via University of Iowa
Description: 5-item observational measure of pain indicators used in cognitively impaired populations. Scored on a scale of 0-2, with a total possible score of 10.
Warden V, Hurley AC, Volicer L. (2003). Development and psychometric evaluation of the Pain Assessment in Advanced Dementia (PAINAD) scale. Journal of the American Medical Director’s Association, 4(1),9-15.
Instrument provided via UI website. Click the PAINAD link to view a copy of the measure.
FLACC Scale via NIH
Description: 5-item observational measure of pain indicators in infants and small children (2months-7years). Scored on a scale of 0-2, with a total possible score of 10.
Merkel, S.I., Voepel-Lewis, T., Shayevitz, J.R. & Malvlya, S. (1997). The FLACC: a behavioral scale for scoring postoperative pain in young children. Pediatric Nursing, 23 (3), 293-297.
Instrument provided via NIH. Click the FLACC link to view a copy of the questionnaire.
McGill Pain Questionnaire (MPQ) &
McGill Pain Questionnaire-Short-form (MPQ-SF) via MAPI Research Trust
Description: MPQ (20-item) and MPQ-SF (15-item) are self report measure of multiple aspects of pain quality (sensory, affective, evaluative, and misc). Recommended for use with adult populations.
Melzack R. (1975).The McGill Pain Questionnaire: major properties and scoring methods. Pain, 1, 277-99
Melzack R. (1987).The short-form McGill Pain Questionnaire. Pain 30(2), 191-7
Must register and complete a user agreement. Measures may be duplicated for use in clinical practice and non-funded academic research free of charge. Royalty fee is required if intended for use in funded or commercial research. Click the MPQ-SF or the MPQ link to complete the user agreement and a review copy of the questionnaire.
Pain Quality Assessment Scale (PQAS) via MAPI Research Trust
Description: 20-item measure of multiple aspects of pain quality. Items measured on a 0-10 scale.
Jensen, M.P. (in press). Pain assessment in clinical trials. In D. Carr & H. Wittink (Eds.), Evidence, outcomes, and quality of life in pain treatment. Amsterdam: Elsevier.
Must register and complete a user agreement. Measure may be duplicated for use in clinical practice and non-funded academic research free of charge. Royalty fee is required if intended for use in funded or commercial research. Click the PQAS link to complete the user agreement and a review copy of the questionnaire.
Physical Functioning Measures
Pain Disability Index (PDI) via University of Michigan
Description: 7-item measure of disability related to pain. Items are scored on a 0-10 scale and summed.
Pollard CA. (1984). Preliminary validity study of the pain disability index. Perceptual and Motor Skills, 59, 974.
Oswestry Disability Index (ODI) via MAPI Research Trust
Description: 10-items measure examining extent of functional impairment due to back pain. Items are scored on a scale of 0-5, with a maximum score of 50. Values indicate level of disability (≤ 4 (no disability), 5-14 (mild), 15-24 (moderate), 25-34 (severe), and ≥ 35 (complete).
Fairbank J., Pynsent P.B. (2000). The Oswestry Disability Index. Spine, 25(22), 2940-2953
Fairbank J.C.T., Couper J., Davies J.B., O’Brien J.P. (1980). The Oswestry Low Back Pain Disability Questionnaire. Physiotherapy., 66, 271-273
Measure may be duplicated for use in clinical practice and non-funded academic research free of charge. Royalty fee is required if intended for use in funded or commercial research. Click the ODI link to complete the user agreement and a review copy of the questionnaire.
Roland Morris Disability Questionnaire (RMDQ) via rmdq.org
Description: 24-item measure of disability related to back pain. Items are either endorsed or denied (0-1 scoring), with a maximum score of 24 possible. Item values are summed; no specific cut-off values have been defined.
Roland M, Morris R. (1983) A study of the natural history of back pain: part I: development of a reliable and sensitive measure of disability in low-back pain. Spine; 8,141-144.
Instrument is public domain with many translations. Click the RMDQ link to obtain a copy of the questionnaire.
Emotional Functioning Measures
Patient Health Questionnaire-9 (PHQ-9) via Pfizer PHQ Screeners
Description: A 9-item depression screener derived from the Primary Care Evaluation of Mental Disorders (PRIME-MD). Other versions of the PHQ are available, including a 2-item depression screener. Additional assessments derived from the PRIME-MD assess mood, anxiety and somatic symptom severity and can be found on the Pfizer PHQ Screeners website.
Kroenke K., Spitzer R.L., Williams J.B.W. (2001). The PHQ-9: Validity of a brief depression severity measure. Journal of General Internal Medicine, 16, 606-613.
Profile of Mood States (POMS) via MHS
Description: 65-item inventory examining 6 clinically outlined mood states in clinical and nonclinical populations. Items are measured on a 0-5 scale.
McNair, D.M., Lorr, M., & Droppleman, L.F. (1971). Profile of mood states. San Diego: Educational and Industrial Testing Service.
Scale may be purchased via the MHS website. For more information please click the POMS link. Example protocols are not available for this questionnaire.
Beck Depression Inventory–II (BDI–II) via Pearson Assessment
Description: 21-item inventory examining clinical criteria of depression. Items are measured on a 0-4 scale.
Beck, A. T., Brown, G. K., and Steer, R. A. (1996). Beck Depression Inventory-II (BDI-II). San Antonio, TX: The Psychological Corporation.
Beck, A. T. (2000). Beck InterpreTrak. San Antonio, TX: The Psychological Corporation.
Scale may be purchased via the Pearson Assessment website. For more information please click the BDI-II link. Example protocols are not available for this questionnaire.
Patient Global Impression of Change (PGIC) via ChiroCode
Description: 1-item measure of change in pain from a circumscribed time-point. Scale range is 0-10
Hurst, H., & Bolton, J. (2004). Assessing the clinical significance of change scores recorded on subjective outcome measures. Journal of Manipulative and Physiological Therapeutics, 27(1), 26-35.
An example protocol may be obtained by clicking on the PGIC link above.
Multidimensional Pain Inventory (MPI) via University of Pittsburgh
Description: 48-item inventory yielding 12 subscales dealing with pain impact on the individual, perceived responses of others to individual’s pain, and functional status.
Kerns, R.D., Turk, D.C., & Rudy, T.E. (1985). The West Haven-Yale Multidimensional Pain Inventory (WHYMPI). Pain, 23, 345-56.
Computer administered and scored version of MPI can be purchased through the UPMC Pain Medicine Program. Click the MPI link to view a copy of the questionnaire. The UPMC Pain Medicine Program site also has information on scoring and norms for the MPI.
Brief Pain Inventory Long Form (BPI) &
Brief Pain Inventory Short Form (BPI) via MD Anderson Cancer Center
Description: 32-item (Long Form) and 9-item (Short Form) self-report questionnaires examining pain severity and interference by pain on emotional and physical domains. Items are scored on a 0-10 scale. The authors recommend use of the short form as numerous validity studies have been conducted with this version, however they note that the long form offers descriptive pain items that may provide additional clinical information. For the short form, mean of 4 pain severity items (items 3-6) yields a general pain severity score; while mean of 7 interference values (items 9a-g) are averaged to yield a general interference score. Other items provide information about location of pain and use of pain relief methods.
Cleeland C.S (1989). Measurement of pain by subjective report. In: Chapman C.R., Loeser J.D., & editors. Advances in Pain Research and Therapy, Volume 12: Issues in Pain Measurement. New York: Raven Press, 391-403.
Cleeland C.S., Ryan K.M. (1994). Pain assessment: global use of the Brief Pain Inventory. Annuls of the Academy of Medicine Singapore, 23(2), 129-138.
Permission must be obtained to use the BPI in publications or clinical/research trial. Fees may apply for funded or commercial research. Visit the MD Anderson Cancer Center website for information on pricing and permission. Click the BPI links to view sample questionnaires. The BPI User Manual is available on the MD Anderson site.
SF-36 Health Survey via Quality Metric
Description: 36-item self-report or computer administered measure assessing physical and emotional functioning, pain interference, and overall health. Other shortened versions are available.
Stewart A.L., Hays R.D., Ware J.E. Jr. (1988). The MOS short-form general health survey. Reliability and validity in a patient population. Medical Care, 26(7),724-35.
McHorney C.A., Ware J.E. Jr, Rogers W., Raczek A.E., Lu J.F. (1992). The validity and relative precision of MOS short- and long-form health status scales and Dartmouth COOP charts. Results from the Medical Outcomes Study. Medical Care, 30(5 Suppl),MS253-65.
Permission must be obtained to use the SF-36 in publications or clinical/research trial. Fees may apply for funded or commercial research. Visit the SF Health Survey website for information on licensing and user registration. Click the SF-36 link to view a demo questionnaire.
Neuropathic Pain Measures
NPS (Neuropathic Pain Scale)
Description: 10-item measure assessing distinct pain qualities associated with neuropathic pain. Items are scored on a 0-10 scale.
Galer B.S., Jensen M.P. (1997). Development and preliminary validation of a pain measure specific to neuropathic pain: the Neuropathic Pain Scale. Neurology, 48(2), 332-338.
Must register and complete a user agreement. Measure may be duplicated for use in clinical practice and non-funded academic research free of charge. Royalty fee is required if intended for use in funded or commercial research. Click the NPS link to complete the user agreement and a review copy of the questionnaire.
NPSI (Neuropathic Pain Symptom Inventory)
Description: 12-item measure assessing intensity of neuropathic pain symptoms. Items are scored on a 0-10 scale.
Bouhassira D., Attal N., Fermanian J., Alchaar H., Gautron M., Masquelier E., Rostaing S., Lanteri-Minet M., Collin E., Grisart J., Boureau F. (2004). Development and validation of the Neuropathic Pain Symptom Inventory. Pain, 108(3), 248-257.
Must register and complete a user agreement. Measure may be duplicated for use in clinical practice and non-funded academic research free of charge. Royalty fee is required if intended for use in funded or commercial research. Click the NPSI linkto complete the user agreement and a review copy of the questionnaire.
Douleur Neuropathique 4 (DN-4) via Pfizer DN-4
Description: 10-item questionnaire differentiating neuropathic pain from nonneuropathic pain. Items related to symptoms and clinical examination. Items are scored yes or no (1 or 0) and summed. Maximum score is 10 with a cutoff score of 4 for neuropathic pain.
Bouhassira D., Attal N., Alchaar H., Boureau F., Bruxelle J., Cunin G.,et al. (2005). Comparison of pain syndromes associated with nervous orsomatic lesions and development of a new neuropathic pain diagnostic questionnaire (DN4). Pain, 114, 29–36.
Instrument may be obtained from the Pfizer DN-4 website. Click the DN-4 link to obtain a copy of the questionnaire.
Leeds Assessment of Neuropathic Symptoms and Signs (LANSS) via PainXChange
Description: 7-item pain scale that consists of sensory description and sensory examination. Items are scored yes or no with corresponding scale scores for each answer (1-5). Maximum score is 24, with a cutoff score of 12 for neuropathic pain.
Bennett MI (2001) The LANSS Pain Scale: The Leeds Assessment of Neuropathic Symptoms and Signs. Pain, 92, 147–157.
Instrument is in the public domain and may be obtained from by accessing the source article or following the provided LANSS link.
PainDETECT Questionnaire (PD-Q) via Virtual Medical Center
Description: 9-item measure assessing neuropathic pain in individuals with back pain. Items are scored 0-5, with an additional dimension for measuring temporal and spatial qualities. Maximum score is 38, with scores less than 12 indicating unlikely neuropathic pain and greater than 19 indicated probable neuropathic pain.
Freynhagen R., Baron R., Gockel U., Tolle T. (2006) painDETECT: A new screening questionnaire to detect neuropathic components in patients with back pain. Current Medical Research & Opinion, 22, 1911–1920.
Instrument may be viewed by accessing the source article or following the provided PD-Q link.