Date Last Reviewed: April 27, 2018

Image of pain scale using faces and numbers
Pain scale. Photo by Tom Woodward (cc license).

This information below is taken from Phyllis R. Coolen’s article Cultural Relevance in End-of-Life Care. See the article for more information on the topic of culture and pain.

There are a number of scales available for assessing pain among culturally diverse populations, such as the Wong-Baker FACES™ Pain Rating Scale, the 0-10 Numeric Rating Scale, the Visual Analogue Scale (VAS), and the Memorial Pain Assessment Card (MPS), which have been validated for appropriate use with ethnically diverse populations, including African-Americans, Hispanics, Asian Americans, and Native Alaskans (Badr (Zahr), Puzantian, Abboud, Abdallah, & Shahine, 2006; Hunter & Cassey, 2000; Kim & Buschmann, 2006; Luffy & S., 2003; Newman et al., 2005; Ramer et al., 1999; Shavers, et al., 2010; Shin, Kim, Kim, Chee, & Im, 2008; Tomlinson, von Baeyer, Stinson, & Sung, 2010).  Patients usually indicate on the various scales by pointing to the area that best depicts their level of pain.

The Wong-Baker FACES™ Pain Rating Scale

The Wong-Baker FACES™ Pain Rating Scale has a series of 6 gender-neutral face circles that range from depicting a neutral facial expression of “no pain/no hurt’ to the “worst possible pain/hurt worst” depicting a crying face.  The Wong-Baker FACES™ Pain Rating Scales is available in 13 different languages, including Spanish, French, Vietnamese, Chinese and Romanian (see Figure 1).  Free access to download the scale can be obtained at FACES Download - Wong-Baker FACES Foundation.  The Wong-Baker FACES ™ scale has been validated with African American, Thai, Asian, Hispanic, and older Korean American populations.  A modified Wong-Baker FACES™ scale used on fabric dolls with Lebanese children also validated the effectiveness of the scale. Curtin and Goldstein (Curtin & Goldstein, 2010), who work with the Native Alaskan Yup’ik culture, effectively utilized the modified Wong-Baker FACES™ scale, known as the Northern Pain Scale, which depict Native Alaskan faces to improve  communication about pain with patients (Curtin & Goldstein, 2010; Ellis et al., 2011). 

pain rating scale
Copyright 1983, Wong-Baker FACES™ Foundation, Used with permission. Originally published in Whaley & Wong’s Nursing Care of Infants and Children. ©Elsevier Inc.

The 0-10 Numeric Pain Rating Scale

The 0-10 Numeric Pain Rating Scale consists of a vertical line that has been evenly marked with numbers from 0-10, with 0 being “no pain” to 10 being the “worst possible pain.”  This scale was considered reliable and validated for measuring pain in older African-Americans and older Koreans (Kim & Buschmann, 2006; Shavers, et al., 2010). 

The Visual Analog Scale (VAS)

The Visual Analog Scale (VAS) consists of a 10-centimeter horizontal line with “no pain” anchored on the left side and “worse possible pain” anchoring the right side.  The patient marks the area on the line that indicates the intensity of his/her pain and the mark is then measured from the left side of the anchor (Kim & Buschmann, 2006).  A VAS color-coded slide ruler can also be used, which the patient moves to indicate the intensity of his/her pain.  The far left side of the ruler is color coded blue, indicating “no pain,” and the far right side is color coded red, indicating “pain as bad as it could possibly be.”  The back of the ruler has a 100 millimeter scale that quantifies the pain intensity (Ramer, et al., 1999).  The VAS scale was considered reliable and validated for measuring pain in older African-Americans, older Koreans, non-Hispanic whites, and Asians with cancer pain (Kim & Buschmann, 2006; Shavers, et al., 2010).