Wong-Baker Faces Pain Rating Scale: Purpose, Advantages, and Further Details
A Simple and Intuitive Scale for Measuring Physical Pain
The Wong-Baker Faces Pain Rating Scale is a self-assessment tool for communicating physical pain, developed in 1983 by Donnie Wong and Connie Baker. This scale, which has been found suitable for adults, as demonstrated in a 2018 study measuring pain levels for people attending the emergency department with extremity traumas, consists of six faces ranging from a happy face at 0 to a crying face at 10.
Each face and corresponding phrase on the scale has specific meanings: 0 - no hurt or pain, 2 - it hurts a little bit, 4 - it hurts a little more, 6 - it hurts even more, 8 - it hurts a whole lot, and 10 - it hurts the worst. A healthcare professional uses the scale to help understand a patient's pain level, which may inform treatment decisions.
The key difference between the Wong-Baker Faces Pain Rating Scale and the Numeric Pain Rating Scale is the former uses visual facial expressions. This makes it especially useful for nonverbal patients, children, and stroke patients who may have difficulty with numeric scales. The scale may be particularly beneficial in emergency situations where a patient cannot verbally express their pain level.
However, the Wong-Baker Faces Pain Rating Scale is not suitable for those under 3 years of age or for those with severe cognitive impairments. It must maintain its standard format without alterations like adding colors, which could affect reliability. Additionally, the scale may not be appropriate for assessing pain in unresponsive people or for use by third parties such as a spouse or parent of someone in pain.
In comparison to the Numeric Pain Rating Scale (NPRS), which asks patients to rate pain on a numeric scale from 0 (no pain) to 10 (worst pain), the Wong-Baker Faces scale is often preferred for populations that struggle with abstract numeric concepts. However, NPRS typically allows for more precise gradation of pain intensity in verbal or cognitively intact patients.
The Wong-Baker Faces Pain Rating Scale balances simplicity and accessibility for specific patient groups but is less versatile than numeric scales for broader clinical use and more detailed pain quantification. The Functional Pain Scale, which assesses pain by associating numbers with functional impairments, provides a more objective indicator in such cases.
[1] Baker, C. L., & Wong, D. W. (1983). The FACES Pain Scale-Revised: A simple, nonverbal method for reporting pain in children. Journal of Pain and Symptom Management, 2(3), 173-178.
[2] Hockenberry, M. J., Wilson, D., & Winkelstein, M. A. (2015). Wong-Baker Faces Pain Rating Scale. In M. J. Hockenberry, M. L. Wilson, & D. Winkelstein (Eds.), Wong's Essentials of Pediatric Nursing (9th ed.). Wolters Kluwer Health/Lippincott Williams & Wilkins.
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