Pain Scoring Systems

Pain Scoring Systems


Pain scoring systems are scientifically developed and tested procedures for assessment of pain and severity of illnesses.

Several types of pain scoring systems have been developed to grade the severity of illnesses in critically ill patients. These systems are often moderately accurate in predicting the scope of individual survival.

However, these systems have proven to be more valuable for monitoring quality of care by enabling the comparison of outcomes amongst groups of critically ill patients with similar illness severity.

Scoring Systems

A number of scoring systems have been developed in the recent years for facilitating effective diagnostic measures. Here we discuss some of the most common amongst them.

Acute Physiologic Assessment and Chronic Health Evaluation (APACHE II)

The Acute Physiologic Assessment and Chronic Health Evaluation (APACHE II) – 2nd version is one of the most popular and commonly used pain scoring system. Originally developed in 1985, the APACHE II system generates a point score ranging from 0 to 71, based on 12 physiologic variables, age and underlying health. According to the published reports about the APACHE II scoring system, an increasing score is associated with an increasing risk of a hospital death.

Meanwhile, the APACHE III system was developed in 1991. This system is more complex than its previous version. Having a set of 17 physiologic variables, the APACHE III system is comparatively less common than its original version.


The IInd Simplified Acute Physiology Score (SAPS II) is a severity of disease classification system, designed to measure the severity of disease for patients admitted to Intensive care units aged 15 or more.

The SAPS II system is most commonly used for:

Describing the morbidity of a patient when comparing the outcome with other patients Describing the morbidity of a group of patients when comparing the outcome with another group of patients

Pediatric Pain Scoring Systems

There are a vast number of pain scoring systems available for pediatric patients. The age of the child is the main criteria that influences the choice of the scoring system that is selected. Here we briefly discuss the pain scoring systems used for different age groups.


There are a variety of assessment tools that are used for neonates. These include observation of facial expression, body position and movement, crying, arterial pressure, heart rate, skin color, ventilatory frequency and sleeplessness.

Infants and children up to 3 years

Pain assessment in this age group is also based on behavioral and physiological response to comfort and analgesic therapy. The most common systems used to asses the intensity of pain in this age group include the objective pain scale (OPS) and toddler-preschooler postoperative pain scale (TPPPS).

3 to 7 years

Since these patients can differentiate between the presence and absence along with estimating the location of pain, they are able to express the intensity of pain in the form of nil, mild, moderate and severe. Commonly used systems include face scale and Oucher scale.

Selecting Scoring Systems

There are a vast series of factors the influence the choice of a pain scoring system. Here we list the main amongst them.

Proposed Use

The type of scoring system to be used depends on the planned usage of the mechanism. The target group of patients along with the nature of illnesses and disorders are taken into consideration while deciding on a specific pain scoring system.

Validity and reliability of score

The accuracy of the score is the second most important criteria. The score expected from the process should be nearest to the highest possible accurate level. The significance of this criteria further increases with the severity of the medical condition in question.

Discrimination and Calibration of scoring system

The scores achieved from the system in question should be capable of calibration .i.e. should have the clarity to be compared with set standards.

Similarly, the achieved score should be capable of discrimination for the scoring system to be efficient and result-oriented.


Pain scoring systems are one of the most successful components of the modern medicine industry. Though at times, the conclusions are based on subjective assessments, yet pain-scoring systems are generally found to be consistent and useful for making valuable assessments.