Richard Rathe, MD

Associate Professor of Family Medicine (ret.) and Medical Informatician

An Alternative Symptom Score to Replace the Overused 10 Point Pain Scale

By •• Posted in HPI, Medicine

I was taught in medical school that pain scores were only useful for tracking progression/remission for individual patients. In my opinion it was a fundamental mistake to apply this tool as an objective “vital sign” across all patients. It simply doesn’t work that way. Scores remove context!

During my training we used an implicit 3 point scale: mild, moderate, severe. In later years I pondered why I still preferred this over the newer 10pt version. I decided it was because a 3pt scale is easy to tie to function: mild=annoying, mod=disruptive, severe=disabling.

I think the average patient views their condition in similar terms, rather than “my pain a 6 or a 7 out of 10.”

If you take the 3pt functional symptom scale and couple it with a 3pt frequency scale: intermittent, frequent, constant—then you have a 3×3 grid that might be more meaningful than a one dimensional 10pt scale.


It may be appropriate to record more than one score, for example: the patient has constant mild dizziness (3/1) with occasional disabling episodes (1/3).

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