Pain scale
The 0–10 numeric rating scale is the most used measurement in musculoskeletal care and the most casually collected. Three readings — now, best, worst — turn a mood into data.
Three readings, not one. A single “now” score tells you almost nothing about a week.
Three-point average
4.3
Current reading sits at moderate — Distracting. You can still work through it.
A 5-point spread across the week is a variability problem as much as a pain problem: look at what the good days have in common.
- 0None. No pain at all.
- 2Mild. Noticed, but it does not interrupt anything.
- 4Moderate. Distracting. You can still work through it.
- 6Distressing. It interferes with concentration and with most tasks.
- 8Severe. It dominates. Conversation is difficult.
- 10Worst imaginable. The worst pain you can conceive of.
Ask the same question the same way
The number is only comparable if the question is identical every time. “How is the pain today?” and “Rate your pain right now, zero to ten, where ten is the worst you can imagine” produce different scales in the same patient. Write the question down and use it verbatim.
Two points is the threshold
A one-point move is inside the noise of the instrument. Around two points — or roughly a third of the starting score — is where patients start describing the change as worth having. Set goals accordingly.
The spread is the interesting number
A week that runs 2 to 7 is a different clinical problem from one that sits flat at 5, even though the averages match. A wide spread points at load, sleep or position — things you can change. A flat middling score more often points at central sensitisation or at a plan that is not doing anything.
Pain is not the only outcome
Pair the rating with something functional. For an upper limb that is usually the DASH; for exertion tolerance it is the Borg RPE scale. Pain that improves while function does not is a finding, not a success.
Red flag — refer out
Pain that climbs steadily against treatment, wakes the patient every night, or arrives with unexplained weight loss or fever is not a scale problem. Refer.
Sources
Keep reading
Home Exercise Program Builder
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Range of Motion Chart
Normal ROM by joint and plane, with the measured value scored against it.
Borg RPE Scale
The 6-20 and 0-10 Borg scales side by side, with a target zone readout.
DASH Score Calculator
Score the 30-item DASH disability questionnaire and read the result.