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FACES Pain Scale - Revised (FPS-R)  

Pain intensity rating scale useful for all older adults, including those with mild to moderate cognitive impairment. Some older adults will find this tool easy to use, and may prefer it over the Numerical Rating Scale. This scale requires either verbal ability or the ability to point to the image on the scale that most closely represents their pain.

Purpose:   To assess pain intensity in persons who are able to self report1 but are unable to use a numeric rating scale (NRS). Some studies show African Americans and Asians prefer the Faces Pain Scale.
When to Use:

Use the FACES Pain Scale

  1. At admission
  2. At each quarterly nursing review
  3. Each shift in an individual with pain
  4. Each time a change in individual's pain status is reported
  5. Following a pain intervention to evaluate treatment effectiveness
How to Use:

Instruct the individual that “The faces show how much pain or discomfort one is feeling. The face on the left shows no pain. Each face shows more and more pain up to the last face that shows the worst pain possible. Point to the face that shows how bad your pain is right NOW.” 

Then score the chosen face 0, 2, 4, 6, 8, or 10, counting left to right, so '0' = 'no pain' and '10' = 'very much pain.'

NOTE: This tool is not to be used by the health care provider to look at the resident's facial expression and pick a face.

Documentation: Document/record all scores in a location that is readily accessible by other health care providers.

To use as a pocket guide, print the FPS-R and directions document front to back on card stock paper to create two tools. Cut to size and laminate for increased durability.

Additional information about the FPS-R, including instructions in 33 translations, can be found at

References: Hicks, C, L., von Baeyer, C.L., Spafford, P.A., van KorlaarI., & Goodenough, B., (2001). The Faces Pain Scale–revised toward a common metric in pediatric pain measurement, Pain 93 (2001); 173–183. 


1 Self-report of pain is defined as the ability to indicate presence and/or severity of pain verbally, in writing, or by other means such as finger span, pointing, head movement, or blinking eyes to answer yes or no questions.

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