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What is a pain scale and how to use it

Pain scales are widely used in healthcare settings for patients to indicate their pain levels. There are various types of pain scales, but today we’re mainly focusing on the categorical scale that uses smiley faces or emojis. In addition to being extremely useful in the healthcare field for evaluating pain in children, emojis are also used in a variety of surveys. Let’s look at the different types of rating scales and how they can benefit you both in and outside of healthcare.

What is a pain scale?

In 1983, Donna Wong and Connie Baker invented the Wong-Baker FACES® Pain Rating Scale to help children communicate about their pain with healthcare professionals. This was the first picture-based pain scale, using six simply drawn faces to represent varying pain levels. This was found to be extremely helpful in interpreting pain levels in children who do not have the verbal skills to explain how they feel. 

Today, numerous variations of this scale are used in medical assessments as well as in situations beyond the healthcare setting to determine levels of satisfaction or service.

Face emoji scales

Across the globe, people of all ages tend to interpret facial expressions in similar ways. Using smiley faces takes a large amount of information and condenses it into a single emoji. It’s often easier to choose a facial expression that represents your feelings about something than to rate it on a numerical scale or choose between multiple options. For example, it’s easier to choose a face that represents your feelings about something than it is to figure out whether to rate something a five or six on a scale of seven.

Colors are another factor in some emoji surveys. While black and white imagery may be adequate for expressing opinions, color makes the choices more dynamic. Choosing colors should be well thought out. Many colors have different meanings in different cultures and locations. 

The one group of colors that most people are familiar with is the red, yellow, and green of traffic lights. Red would represent the most negative answer, yellow the middle, and green the most positive option.

In addition to adding color, you may also factor in the intensity of each color in relation to the intensity of the feeling or emotion.

There are innumerable variations that are similar to the Wong-Baker FACES® scale. Some use very simple emojis with only eyes, eyebrows, and mouths. Some add more facial features and tears. And more still, combine the faces with colors. 

While the typical pain scale is used in healthcare, it can be adapted for use to assess satisfaction, service, and other conditions outside of the pain realm.

Advantages of visual scales

An emoji survey, pain scale, or smiley face rating system are all based on the same premise—to use visual imagery to represent a feeling. 

There are several advantages to using this type of scale:

  • Using a visual scale instead of asking for a short answer allows you to collect more accurate, standardized data.
  • As a general system, a visual scale can be used for many types of assessments.
  • Visual scales can break up a text-heavy survey to prevent survey fatigue.
  • Smiley survey questions make options fast and easy to understand.
  • It’s easy to answer by clicking an emoji than typing a sentence or more to make a point.
  • Emoji surveys are faster to complete than traditional, text-based surveys.

In the event that you are using a visual scale in a healthcare setting, you can feel confident knowing that SurveyMonkey offers HIPAA-compliant features to safeguard protected health information collected online. Visit our healthcare survey center for information on using surveys to assess patient satisfaction, patient safety culture, regular dental care, women’s and men’s healthcare issues, and more. Elevate your patients’ experiences with our healthcare survey solutions.

Types of pain scales

There are two categories and several types of pain scales. We’ll look at them in more detail so that you have a better understanding of each one.

Unidimensional pain scales 

This type of pain scale provides a simple way for individuals to rate the intensity of their pain. The scales use text, images, or descriptors to measure pain or pain relief.

Numeric rating scales (NRS)

The most commonly used way to measure pain is the 0-10 numeric rating scale. The patient is asked to rate their pain with zero meaning no pain, and 10 as the worst pain they could experience. You may have used this type of interval scale to evaluate customer satisfaction or in another context.

Visual analog scale (VAS)

Rather than using numbers, a VAS uses a 10 cm line. The beginning of the line is no pain, and the end is the worst possible pain. If the survey is given on paper, patients are asked to mark the spot indicating the intensity of their pain. If the scale is presented online, it would be a slider question, where you could move the slider to the desired place on the scale line.

Categorical scales

Similar to the NRS, this scale uses a line with delineations indicating pain intensity with verbal or visual pain descriptors, such as mild pain or very severe pain—they may also use a star rating to rate their pain. For children, images of smiley faces with various facial expressions are used to indicate pain levels.

Multidimensional tools

These tools are not used as frequently for pain assessment. Some experts say that they are valuable and underused.

Initial pain assessment tool

This tool collects information about pain when a patient presents with it for the first time. It gives a more thorough picture of the characteristics of the pain. It is usually accompanied by a diagram of the body for patients to indicate the location of their pain. Questions about pain onset, duration, effects on lifestyle, and more are included.

Brief pain inventory (BPI)

The BPI is similar to the initial pain assessment tool, but it is used to assess and address pain felt over the previous 24 hours.

McGill pain questionnaire (MPQ)

The MPQ is very commonly used in pain assessment. It is used to evaluate pain based on how the patient describes it—for example, throbbing, flickering, shooting, etc.

Use cases for pain and emoji scales

There are several instances in which you might use a pain scale or an emoji rating scale for assessment. 

Here are some examples of using these valuable tools:

Healthcare patient assessment

Throughout our discussion of pain, emoji, and other types of rating scales, we’ve talked about their use in healthcare—particularly in evaluating and moderating pain in patients. Pain scales help medical providers understand a patient's pain levels, qualities, and effects. They also help doctors make diagnoses, formulate treatment plans, and measure the effectiveness of a particular treatment.

In healthcare, they may use any of the pain scales we discussed—including the emoji pain scale, to assess pain in children. The initial pain assessment, BPI, and MPQ are explicitly used for measuring pain. 

Our healthcare solutions can help elevate patient experiences, strengthen your facility’s reputation, and promote employee well-being. 

Customer satisfaction surveys

It may seem odd to consider a pain scale being used to evaluate customer satisfaction, but the smiley face pain scale is for more than patients. Send your customers a survey using this unique scale. Instead of each face indicating a level of pain, they each indicate the level of satisfaction they have with their experiences with your company. 

In addition to an emoji categorical scale, you could use any of the other unidimensional pain scales. A numerical rating scale can measure levels of satisfaction with numerical values. And a visual analog scale with a slider can also indicate how your customers feel.

Your customers will appreciate how quickly they can respond to these surveys, so they’ll be more likely to take it. And you’ll end up with quantifiable results to help turn feedback into loyalty. 

Employee satisfaction surveys

Similar to customer satisfaction surveys, employee satisfaction surveys can measure how your employees feel about your business. Use any of the unidimensional scales to obtain quantitative data related to employee morale, satisfaction, engagement, benefits, etc.

Measuring customer service

Customer service surveys are critical to assessing how your team interacts with customers. A report from Microsoft indicates that 90% of Americans use customer service to decide whether or not to do business with a company. And 58% of American consumers will switch companies because of poor customer service. 

Make sure your customer service is excellent by sending an emoji survey to your customers. The emojis make the survey fun and easy while providing you with actionable insights. The results will help you identify areas for improvement, subjects for training, and individuals who need mentoring.

Tips for using a pain scale

So, you’re ready to send out a survey using a pain scale. Use these tips to ensure your respondents provide you with clear, actionable data.

  • Keep it simple: use emojis instead of text. There’s no real need to explain what each one means—they are used universally. Your respondents will appreciate the brevity and will be more likely to answer your questions.
  • Avoid leading questions: don’t use language that may bias your results. For example, don’t ask if they enjoyed your “award-winning” wine with dinner.
  • Avoid double-barrelled questions: ensure that each question only asks ONE question. For example, don’t ask how a customer would rate their wait time and service. They may have had a long and unacceptable wait time, but they experienced fantastic service. Ask respondents to rate one item per question.

How will you use a pain scale survey?

From evaluating patients to employees to customers, pain scale surveys are a valuable addition to your toolkit. Get started with your first survey with SurveyMonkey now!

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