How To

2 HOURS

try this Continuing Education

By Ellen Flaherty, PhD, GNP-BC

Using Pain-Rating
Scales with
Older Adults
The numeric rating scale, verbal descriptor scale,
and Faces Pain Scale–Revised.
Ed Eckstein

40 AJN ▼ June 2008 ▼ Vol. 108, No. 6 http://www.nursingcenter.com


Overview: Pain is often undertreated and under-
diagnosed in older adults. Regular use of short, sim-
ple, reliable pain-rating scales provides nurses and
physicians with measurable information to establish
and modify a pain management plan. This article
describes the use of three widely used pain-rating
scales: the numeric rating scale, the verbal descrip-
tor scale, and the Faces Pain Scale–Revised. For a
free online video demonstrating the use of these
scales in older adults, go to http://links.lww.com/
A251.
A
nne Madrid, age 80, visits the emer-
gency department complaining of a dry
cough and flu-like symptoms. (This case
is a composite based on my experience.)
Three weeks ago she fell in her home
and fractured her pelvis; she was prescribed oxy-
codone plus acetaminophen (Percocet and others)
orally every four hours as needed for pain and placed
on bed rest at home for a week. Upon examination,
she is found to have pneumonia and admitted to the
medical–surgical unit. Her admitting orders include
acetaminophen 650 mg every four hours as needed
for pain.
Ms. Madrid lives with her 82-year-old husband,
who tells Lily Sanders, the floor nurse, that his wife
has had a great deal of pain since her fall, spending
more time in bed than usual and avoiding movement
around the house. Ms. Sanders asks Ms. Madrid to
rate her pain: “On a scale of 0 to 10, with 0 being no
pain and 10 being the worst pain imaginable, what
is your pain like now?”
Ms. Madrid says that her current pain level is
between 2 and 3 while she is in bed, but increases
to between 7 and 8 when she tries to move from the
bed to walk to the toilet or sit up in a chair. After
her pelvic fracture, says Ms. Madrid, she took oxy-
codone plus acetaminophen every four hours as
needed; however, after a few days she tapered her-
self off the opioid because she didn’t want to
become addicted. Since stopping the drug, she has
ajn@wolterskluwer.com
read it watch it try it
Web Video
Watch a video demonstrating the use and inter-
pretation of the numeric rating scale, the verbal
descriptor scale, and the Faces Pain Scale–
Revised at http://links.lww.com/A251.
A Closer Look
Get more information on why it’s important for
nurses to assess older patients for the intensity
of their pain.
Try This: Pain Assessment for
Older Adults
This is the tool in its original form. See page 45.
been taking acetaminophen 650 mg as needed, usu-
ally three times per day.
PAIN ASSESSMENT IN OLDER ADULTS
The evaluation of pain intensity using a pain-rating
scale provides crucial information to guide treatment
plans. This screening will inform the development
of an interdisciplinary pain management plan. Be-
cause there are no objective measures of pain such
as laboratory values or blood pressure, the most
reliable measure of pain is the patient’s self-report. A
quantified pain measurement can be quickly and
regularly obtained and used on an ongoing basis to
determine the effectiveness of interventions.
The following three simple pain-intensity scales,
as shown in Pain Assessment for Older Adults, page
46, are widely used with older adults in acute, long-
term, and home care settings: the numeric rating scale
(NRS), the verbal descriptor scale, and the Faces Pain
Scale–Revised (FPS–R).
The NRS asks a patient to rate her or his pain by
assigning it a numeric value, with 0 indicating no
pain and 10 representing the worst pain imaginable.
The verbal descriptor scale asks the patient to
describe her or his pain using the following descrip-
tors: “no pain,” “mild pain,” “moderate pain,” “se-
vere pain,” or “pain as bad as it could be.”
The FPS–R is a visual scale on which patients
choose the depiction of a facial expression that best
corresponds with their pain. The six distinct images
AJN ▼ June 2008 ▼ Vol. 108, No. 6 41
How To
try this
Why Assess Older Adults’ Pain?
he philosopher Jean-Jacques Rousseau wrote,
T “Except pain of body and remorse of conscience,
all our evils are imaginary.” In 2000 the Joint
Commission called pain a “fifth vital sign” and man-
dated its regular assessment.1 Even so, undertreatment
of older adults’ pain is common. In 2006, the Centers
for Disease Control and Prevention made the following
observations, based on data from the 1999–2002
National Health and Nutrition Examination Survey
and the 2003 National Health Interview Survey2:
• One-fifth of adults age 65 years and older said
they had experienced pain persisting for more
than 24 hours in the past month. (Of all adults,
older adults were, interestingly, the least likely to
report pain.)
• Almost three-fifths of adults age 65 and older with
pain said it had lasted for one year or more.
• More than one-fourth of adults said they had expe-
rienced low back pain in the past three months.
• One-half of adults age 65 and older said they’d
experienced “joint pain, aching, or stiffness (exclud-
ing the back or neck)” in the previous 30 days.
• Reports of severe joint pain were higher among
older adults, and women reported severely painful
joints more often than men did (10% versus 7%,
respectively).
Reasons for the undertreatment of pain in older
adults that are frequently mentioned in the literature or
have been observed by the author include3
• the belief that pain is a normal part of aging that
should be lived with and not complained about.
• nurses’ and physicians’ fear that providing ade-
quate pain relief may lead to respiratory depres-
sion or addiction.
• older adults’ fear that they will become addicted
to opioid analgesics or that complaints of pain
may lead to additional testing.
• inadequate staffing.
range from a smiling face (intensity = 0) to a harsh
grimace (intensity = 10).
ADMINISTERING THE SCALES
Choosing a scale. The NRS and the verbal descrip-
tor scale are widely known and frequently used: one
or the other may be preferred by specific institutions
or nurses. It is important for clinicians to be able
to choose from several pain scales. While most clini-
cians choose the NRS, it may not be the best scale for
all patients. For example, a nurse might use the
42 AJN ▼ June 2008 ▼ Vol. 108, No. 6
• communication breakdown caused by cognitive
and sensory impairment in many older adults.
• insufficient education for nurses on pain assess-
ment; and other causes.
Too often, pain assessment in older adults is neither
undertaken nor documented. Using patient interviews
and chart review, Sengstaken and King identified
chronic pain in 66% of a group of 76 nursing home
residents who were communicative; however, physi-
cians had detected pain in only 17 of the 43 patients
who reported chronic pain when interviewed.4 Using
explicit processes to assess, measure, and document
pain is an important step in improving the quality of
life in older adults in both acute and long-term care as
well as community settings.
Accurate measurement of pain is essential for
developing an effective management plan. In addi-
tion, the regular measurement of pain intensity helps
nurses evaluate the effectiveness of interventions. Pain
management is a process, and it is important to
measure the success of this process with precision. To
watch the portion of the online video discussing the
need for ongoing assessment of pain in older adults,
go to http://links.lww.com/A254.
REFERENCES
1. Joint Commission on Accreditation of Healthcare Organizations.
Pain assessment and management: an organizational approach.
Oakbrook Terrace, IL: Joint Commission Resources; 2000.
2. National Center for Health Statistics. Health, United States,
2006. With chartbook on trends in the health of Americans.
Special feature: Pain. Hyattsville, MD: Centers for Disease
Control and Prevention; 2006. http://www.cdc.gov/nchs/data/
hus/hus06.pdf#chartbookontrends.
3. Martin R, et al. A qualitative investigation of seniors’ and care-
givers’ views on pain assessment and management. Can J Nurs
Res 2005;37(2):142-64.
4. Sengstaken EA, King SA. The problems of pain and its detec-
tion among geriatric nursing home residents. J Am Geriatr Soc
1993;41(5):541-4.
FPS–R with a patient who is hearing impaired so that
the patient can visualize the levels of pain. Regardless
of the scale used, one of the most important consider-
ations is the consistent use of the same scale with each
patient. (To watch the portion of the video discussing
use of the scales, go to http://links.lww.com/A252. )
Before administering any of the three pain scales,
the nurse should tell the patient that she or he is con-
cerned about whether the patient is in any pain. The
nurse could begin by saying, “I am curious whether
you are bothered by pain right now.”
http://www.nursingcenter.com

To administer the NRS, which asks patients to rate
pain on a numeric scale, the nurse should then con-
tinue, “On a scale of 0 to 10, with 0 representing no
pain and 10 representing the worst pain you have ever
experienced in your life, what is your pain now?”
When using the verbal descriptor scale, which
uses words instead of numbers, the nurse could say,
“Would you please describe your pain for me, from
‘no pain’ to ‘mild,’ ‘moderate,’ ‘severe,’ or ‘pain as
bad as it could be’?”
When using the FPS–R, which depicts a range of
faces, the nurse could ask: “Would you please look at
this card and point to the face that best represents the
level of pain you are experiencing right now?” This
tool might be used in patients with some challenges
with verbal communication, such as patients who pri-
marily speak another language or those with demen-
tia, as well as those with a hearing impairment.
CHALLENGES
Many other factors besides those mentioned above
could influence a nurse’s choice of a pain scale. For
example, patients with a visual deficit won’t be able
to use the FPS–R, while language barriers might inter-
fere with a patient’s comprehension of questions.
Cognitive impairment. Some evidence suggests
that the three scales discussed in this article are inef-
fective with a significant proportion of cognitively
impaired older adults. Ferrell and colleagues studied
pain assessment in a skilled nursing home with a “very
high prevalence of cognitive impairment.”1 (The mean
Folstein Mini-Mental State Examination [MMSE]
score was 12 ± 7.9 out of 30; scores of 23 or less indi-
cate cognitive impairment.) They found that 83% of
residents could complete at least one of the five pain-
rating scales used during the study. Most residents
(65%) could complete the Present Pain Intensity Scale
of the McGill Pain Questionnaire (choosing words to
describe the pain), which is similar to the verbal
descriptor scale. Residents were least likely to com-
plete the NRS (called the “verbal scale” in the study)
or a “visual analog scale” that required patients to
mark their pain level along a line using a pencil.
Wynne and colleagues studied the effectiveness of
the NRS (referred to in the study as the “verbal rating
scale”), a “visual analog scale,” an earlier version of
the FPS–R (“Wong-Baker Pain Scale”), and the
“McGill Word Scale” in 37 nursing home residents,
64% of whom were cognitively impaired.2 Making
monthly pain assessments for a year, the authors
found that participants couldn’t complete the NRS
49% of the time, the visual analog scale 43% of the
time, the Wong-Baker scale 39% of the time, and
the McGill Word Scale 27% of the time. In addition,
“residents with an MMSE [score] of less than 15
ajn@wolterskluwer.com
Watch It!
o to http://links.lww.com/A251 to watch a nurse use
G pain-intensity scales to assess pain in a patient and
discuss how to administer them and interpret results. Then
watch the health care team plan intervention strategies.
View this video in its entirety and then apply for CE credit
at www.nursingcenter.com/AJNolderadults; click on the
How to Try This series link. All videos are free and in a
downloadable format (not streaming video) that requires
Windows Media Player.
demonstrated significantly lower response rates to
all the severity instruments than residents with higher
MMSE scores,” with the NRS, visual analog scale,
and faces scale eliciting the lowest response rates in
this population. The authors stress that more research
is needed. They suggest that no single method of pain
assessment has been established for use with this pop-
ulation and that the choice of a scale must reflect the
needs of individual patients. (To view the segment of
the online video discussing the assessment of pain in
patients with dementia, go to http://links.lww.com/
A253. Also, AJN will feature an article on this
topic next month.)
Ethnic and racial minorities. A descriptive study
by Ware and colleagues—in which participants were
74% black, 16% Hispanic, and 10% Asian—found
that all three of these scales were easily used by over
90% of the study participants.3 However, more
research is needed into the disparities of pain man-
agement across racial and ethnic populations, and it
is important to consider the possible influence of
culture on the expression of pain.
INTERPRETING AND USING THE RESULTS
Scoring the NRS. The numerical scores of the NRS
are interpreted as follows: 1 to 3 represents mild pain;
4 to 6, moderate pain; and 7 to 10, severe pain. When
any confusion exists about the intensity of the pa-
tient’s pain (such as when the nurse suspects that the
patient has underestimated her or his pain), the nurse
can confirm the results of the NRS by using verbal
descriptors, as in the following exchange between
Ms. Sanders and Ms. Madrid:
“Ms. Madrid,” says Ms. Sanders, “would I be
correct in describing your pain as mild when you
are resting and severe when you try to move?”
“Yes,” says Ms. Madrid. “I think this is why I
have spent so much time in bed. My pain is just so
severe when I move around.”
Scoring the verbal descriptor scale. Interpreting
the results of the verbal descriptor scale should focus
on the words used to describe the pain. The nurse
should record the words used by the patient and
compare them with words she or he used previously.
This can be complicated if patients choose to use dif-
ferent descriptors than those specified by the scale.
AJN ▼ June 2008 ▼ Vol. 108, No. 6 43
How To
try this
Online Resources
For more information on this and other geriatric assessment
tools and best practices go to www.ConsultGeriRN.org—the
clinical Web site of the Hartford Institute for Geriatric Nursing,
New York University College of Nursing, and the Nurses
Improving Care for Healthsystem Elders (NICHE) program.
The site presents authoritative clinical products, resources, and
continuing education opportunities that support individual
nurses and practice settings.
Visit the Hartford Institute site, www.hartfordign.org, and
the NICHE site, www.nicheprogram.org, for additional
products and resources.
Visit www.nursingcenter.com/AJNolderadults and click on
the How to Try This link to access all articles and videos in
this series.
For example, if the patient describes her or his pain
as “excruciating,” the nurse would need to clarify
the patient’s meaning by asking whether the best
descriptor would be “severe” or “pain as bad as it
could be.”
Scoring the FPS–R. This scale is interpreted by
applying a numeric scale with values assigned to
each of the six facial expressions. The face that
depicts a slight smile would be scored 0 points. The
remaining faces are scored from 2 to 10 points
depending upon the severity of the pain depicted by
the face. The numeric notation for the faces on the
scale is not displayed to the patient.
Using the results. The following dialogue
describes how Ms. Sanders uses the results of the
NRS to help Ms. Madrid think more objectively
about her own pain and whether her treatment
should be modified. The results of the verbal descrip-
tor scale and the FPS–R could be used in similar ways.
Ms. Sanders tells Ms. Madrid, “I am concerned
that your level of pain is as high as 7 or 8 when you
start moving around. Reducing your pain level will
certainly help you to feel better but will also allow
you to move around more and speed your recovery
from pneumonia. I think it would be helpful if I call
Dr. Stevens to discuss how we can work to increase
your comfort. At what level would you like your
pain to be when you’re moving around?” Ms.
Madrid: “I would feel much better if my pain was
less than 5 when I’m moving around.” (The pain
rating that allows the patient to perform a range of
activities with relative ease is sometimes called the
comfort–function goal. For more, see “Comfort–
Function Goals,” Pain Control, September 2004.)
Dr. Stevens agrees that Ms. Madrid’s pain should
44 AJN ▼ June 2008 ▼ Vol. 108, No. 6
be better controlled. He changes her acetaminophen
prescription to 650 mg orally three times per day
(rather than “as needed”) and recommends that Ms.
Madrid take one tablet of oxycodone plus acetamin-
ophen orally every morning one hour before she
engages in activity such as rehabilitation. Ms.
Sanders also implements a fall-risk care plan for her
because of the increased risk of falls when a patient
is taking opioid analgesics.
COMMUNICATING THE RESULTS
Managing pain in older adults with multiple med-
ical problems is best accomplished by an interdisci-
plinary team. Communication around the issue of
pain should include team members, the patient,
caregivers, and others. (For more information about
the prevalence and perceptions of pain in older
adults, see “Why Assess Older Adults’ Pain?” on
page 42.)
A sense of control. Teaching patients to use
quantitative or descriptive reports of pain will help
them to communicate their concerns about pain to
nurses, physicians, and physical therapists and can
also increase their sense of control. Ms. Sanders
teaches Ms. Madrid how to keep a pain diary in
which she can document her pain and her responses
to analgesics and other interventions. This simple
tool can help patients determine the effectiveness of
their pain management plans and share their find-
ings with the team members. (For more on pain
diaries, see “Pain Diaries,” Pain Control, page 36.)
Patient education. Nurses need to provide
patients with information on the importance of pain
management to maintain mobility and safety. They
should also address patients’ fears of addiction, let-
ting them know that fear of addiction is common but
that the percentage of patients who become addicted
to pain medications has been shown to be quite low.4
Patient education that focuses on the benefits of effec-
tive pain management is important.
CONSIDER THIS
What evidence supports the use of the scales? A
literature review found that all three scales pre-
sented in this article (and variations of these scales)
have demonstrated solid psychometric properties
across health care settings.5 A study measuring
“experimentally induced thermal stimuli” conducted
by Herr and colleagues found strong reliability and
validity for all three scales when they are used in adults
of all ages, including older adults with mild cognitive
impairment. Overall, the study found the verbal
descriptor scale to have the “strongest psychometric
support,” followed by the FPS–R and the NRS or its
equivalent.6 And the participants in the study said
http://www.nursingcenter.com
 from

Issue Number 7, Revised 2007 Series Editor: Marie Boltz, PhD, APRN, BC, GNP
Managing Editor: Sherry A. Greenberg, MSN, APRN, BC, GNP
New York University College of Nursing

Pain Assessment for Older Adults

By: Ellen Flaherty, PhD, APRN, BC, Village Care of New York

WHY: Studies on pain in older adults (persons 65 years of age and older) have demonstrated that 25%-50% of community
dwelling older people have persistent pain. Additionally, 45-80% of nursing home residents report pain that is often left
untreated. Pain is strongly associated with depression and can result in decreased socialization, impaired ambulation and
increased healthcare utilization and costs. Older adults tend to minimize or not report their pain or are unable to due to
sensory and or cognitive impairments. A significant barrier in treating pain in older adults is inadequate pain assessment.
Therefore, a proactive, consistent approach must be taken to screen and assess older adults for persistent pain.

BEST TOOL: Patients’ self report is the most reliable measure of pain intensity as there are no biological markers
of pain. Simply worded questions and tools, which can be easily understood, are the most effective, as older adults
frequently encounter numerous factors, including sensory deficits and cognitive impairments. The most widely used
pain intensity scales used with older adults are the Numeric Rating Scale (NRS), the Verbal Descriptor Scale (VDS) and
the Faces Pain Scale-Revised (FPS-R). The most popular tool, the NRS, asks a patient to rate their pain by assigning a
numerical value with zero indicating no pain and 10 representing the worst pain imaginable. The VDS asks the patient
to describe their pain from “no pain” to “pain as bad as it could be.” The FPS-R asks patients to describe their pain
according to a facial expression that corresponds with their pain.
TARGET POPULATION: All three scales are used with both community and older adults in acute and long term care
settings. While there are specific tools designed to capture pain in non-verbal cognitively impaired older adults, studies
have shown that the Faces, Numeric Rating and Verbal Descriptor scales may be used effectively with cognitively
impaired older adults. The choice of a scale may depend on the presence of a particular language or sensory impairment.
The same scale should be used consistently with each individual patient.
VALIDITY AND RELIABILITY: Among these three scales, several studies have demonstrated concurrent validity
between 0.56 and 0.90 with the lowest correlations found between the FPS-R and the other scales, suggesting that
the FPS-R may be measuring a broader construct incorporating pain. Test-retest reliability was demonstrated with
coefficients ranging from 0.75-0.89.

STRENGTHS AND LIMITATIONS: Overall, the NRS was the preferred scale with cognitively intact older adults and the
FPS-R was the preferred scale with cognitively impaired patients. In addition, African-Americans and Hispanics preferred
the FPS-R. The FPS-R was also the scale that was preferred with mildly, moderately and severely impaired older adults.
These brief assessment tools should not replace performing a comprehensive health history and physical exam, which
may lead to the determination of etiologies of pain.

MORE ON THE TOPIC:

Best practice information on care of older adults: www.ConsultGeriRN.org.
American Geriatrics Society Panel on Persistent Pain in Older Persons. (2002). Clinical practice guidelines:
The management of persistent pain in older persons. JAGS, 50, S205-S224. Available at
http://www.americangeriatrics.org/products/positionpapers/persistent_pain_guide.shtml, from the American Geriatrics Society Web site,
www.americangeriatrics.org.
Herr, K., Bjoro, K., & Decker, S. (2006). Tools for assessment of pain in nonverbal older adults with dementia:
A state-of-the-science review. Journal of Pain and Symptom Management, 31(2), 170-192.
Herr, K., Spratt, K., Mobily, P., & Richardson, G. (2004). Pain intensity assessment in older adults: Use of Experimental Pain to Compare Psychometric
Properties and Usability of Selected Scales in Adult and Older Populations. Clinical Journal of Pain, 20(4), 207-219.
Taylor, L., & Herr, K. (2003). Pain intensity assessment: A comparison of selected pain intensity scales for use in cognitively intact and cognitively impaired
African American older adults. Pain Management Nursing, 4(2), 87-95.
Taylor, L.J., Harris, J., Epps, C., & Herr, K. (2005). Psychometric evaluation of selected pain intensity scales for use
in cognitively impaired and cognitively intact older adults. Rehabilitation Nursing, 30(2), 55-61.
Ware, J. Epps, C., Herr, K., & Packard, A. (2006). Evaluation of the revised faces pain scale, verbal descriptor
scale, numeric rating scale, and Iowa pain thermometer in older minority adults. Pain Management Nursing, 7(3), 117-125.

Permission is hereby granted to reproduce, post, download, and/or distribute, this material in its entirety only for not-for-profit educational purposes only, provided that
The Hartford Institute for Geriatric Nursing, College of Nursing, New York University is cited as the source. This material may be downloaded and/or distributed in electronic
format, including PDA format. Available on the internet at www.hartfordign.org and/or www.ConsultGeriRN.org. E-mail notification of usage to: hartford.ign@nyu.edu.

ajn@wolterskluwer.com AJN ▼ June 2008 ▼ Vol. 108, No. 6 45

✁
 FACES PAIN SCALE – REVISED

Numbers are
not shown to
the patient

0 2 4 6 8 10

From PAIN, 2001, 93, 173-183 “The Faces Pain Scale – Revised. Toward a Common Metric in Pediatric Pain
Measurement,” by C.L. Hicks, C.L. von Baeyer, P.A. Spafford, I. van Korlaar, & B. Goodenough,. Reprinted with
permission of the International Association for the Study of Pain®.

Note: This is a smaller sample of the actual scale. For further instructions on the correct use of the scale in order to
get valid responses, please go to www.painsourcebook.ca

NUMERIC RATING SCALE

Please rate your pain from 0 to 10 with 0 indicating no pain and 10 representing the worst
possible pain. ___________________
Adapted from Jacox, A., Carr, D.B., Payne, R., et al. (March 1994). Management of Cancer Pain. Clinical Practice
Guideline No. 9. AHCPR Publication No. 94-0592. Rockville, MD: Agency for Health Care Policy and Research,
U.S. Department of Health and Human Services.

VERBAL DESCRIPTOR SCALE

Please describe your pain from “no pain” to “mild”, “moderate”, “severe”, or “pain as bad as it
could be.”

Adapted from Jacox, A., Carr, D.B., Payne, R., et al. (March 1994). Management of Cancer Pain. Clinical Practice
Guideline No. 9. AHCPR Publication No. 94-0592. Rockville, MD: Agency for Health Care Policy and Research,
U.S. Department of Health and Human Services.

A SERIES PROVIDED BY
The Hartford Institute for Geriatric Nursing
EMAIL : hartford.ign@nyu.edu
HARTFORD INSTITUTE WEBSITE : www.hartfordign.org
CONSULTGERIRN WEBSITE : www.ConsultGeriRN.org
✃

46 AJN ▼ June 2008 ▼ Vol. 108, No. 6 http://www.nursingcenter.com

they most preferred a version of the NRS with 21
gradations (from 0 to 20), then the verbal descriptor
scale, the 11-point NRS (from 0 to 10), and the
FPS–R.
• Reliability. All of the scales have demonstrated
good internal consistency, with Cronbach’s α
coefficients of 0.86 to 0.88 for the NRS, 0.85 to
0.86 for the verbal descriptor scale, and 0.88 to
0.89 for the FPS–R.5, 6 Test–retest reliability for
each ranged from 0.57 to 0.83 for the NRS, from
0.52 to 0.83 for the verbal descriptor scale, and
from 0.44 to 0.94 for the FPS–R.5, 6
• Validity. Herr and colleagues also reported that a
factor analysis showed that all three scales were
valid, although the FPS-R was the weakest.6
❍ Sensitivity. Herr and colleagues found that all
three scales were sensitive to the discomfort
reported by older adults with exposure to vari-
ous temperatures. ▼
Ellen Flaherty is vice president for quality improvement at
Village Care of New York in New York City. The author of this
article has disclosed no significant ties, financial or otherwise, to
any company that might have an interest in the publication of
this educational activity. Contact author: ellenf@vcny.org.
How to Try This is a three-year project funded by a grant
from the John A. Hartford Foundation to the Hartford Institute
for Geriatric Nursing at New York University’s College of
Nursing in collaboration with AJN. This initiative promotes the
Hartford Institute’s geriatric assessment tools, Try This: Best
Practices in Nursing Care to Older Adults: www.hartfordign.
org/trythis. The series will include articles and corresponding
videos, all of which will be available for free online at www.
nursingcenter.com/AJNolderadults. Nancy A. Stotts, EdD, RN,
FAAN (nancy.stotts@nursing.ucsf.edu), and Sherry A. Greenberg,
MSN, GNP-BC (sherry@familygreenberg.com), are coeditors of
the print series. The articles and videos are to be used for educa-
tional purposes only. The scales discussed in this article are
reprinted with the permission of the International Association
for the Study of Pain.
Routine use of Try This tools or approaches may require
formal review and approval by your employer.
REFERENCES
1. Ferrell BA, et al. Pain in cognitively impaired nursing home
patients. J Pain Symptom Manage 1995;10(8):591-8.
2. Wynne CF, et al. Comparison of pain assessment instruments
in cognitively intact and cognitively impaired nursing home
residents. Geriatr Nurs 2000;21(1):20-3.
3. Ware LJ, et al. Evaluation of the Revised Faces Pain Scale,
Verbal Descriptor Scale, Numeric Rating Scale, and Iowa
Pain Thermometer in older minority adults. Pain Manag
Nurs 2006;7(3):117-25.
4. Portenoy RK, et al. Long-term use of controlled-release oxy-
codone for noncancer pain: results of a 3-year registry study.
Clin J Pain 2007;23(4):287-99.
5. Hadjistavropoulos T, et al. An interdisciplinary expert con-
sensus statement on assessment of pain in older persons.
Clin J Pain 2007;23(1 Suppl):S1-S43.
6. Herr KA, et al. Pain intensity assessment in older adults: use
of experimental pain to compare psychometric properties
and usability of selected pain scales with younger adults.
Clin J Pain 2004;20(4):207-19.
ajn@wolterskluwer.com
2 HOURS
Continuing Education
EARN CE CREDIT ONLINE
Go to www.nursingcenter.com/CE/ajn and receive a certificate within minutes.
GENERAL PURPOSE: To describe for registered professional
nurses the use of three widely used pain-rating scales with
older adults.
LEARNING OBJECTIVES: After reading this article and taking
the test on the next page, you will be able to
• discuss the background information helpful for under-
standing the need for pain-rating scales for use with
older adults.
• compare and contrast the three scales described in this
article.
• outline the use of these scales with older adults.
TEST INSTRUCTIONS
To take the test online, go to our secure Web site at www.
nursingcenter.com/CE/ajn.
To use the form provided in this issue,
• record your answers in the test answer section of the CE
enrollment form between pages 48 and 49. Each ques-
tion has only one correct answer. You may make copies
of the form.
• complete the registration information and course evalua-
tion. Mail the completed enrollment form and registration
fee of $21.95 to Lippincott Williams and Wilkins CE
Group, 2710 Yorktowne Blvd., Brick, NJ 08723, by
June 30, 2010. You will receive your certificate in four to six
weeks. For faster service, include a fax number and we will
fax your certificate within two business days of receiving
your enrollment form. You will receive your CE certificate of
earned contact hours and an answer key to review your
results. There is no minimum passing grade.
DISCOUNTS and CUSTOMER SERVICE
• Send two or more tests in any nursing journal published by
Lippincott Williams and Wilkins (LWW) together, and
deduct $0.95 from the price of each test.
• We also offer CE accounts for hospitals and other health
care facilities online at www.nursingcenter.com. Call
(800) 787-8985 for details.
PROVIDER ACCREDITATION
LWW, publisher of AJN, will award 2 contact hours for
this continuing nursing education activity.
LWW is accredited as a provider of continuing nursing
education by the American Nurses Credentialing Center’s
Commission on Accreditation.
LWW is also an approved provider of continuing nurs-
ing education by the American Association of Critical-
Care Nurses #00012278 (CERP category A), District of
Columbia, Florida #FBN2454, and Iowa #75. LWW
home study activities are classified for Texas nursing
continuing education requirements as Type 1. This activity
is also provider approved by the California Board of
Registered Nursing, provider number CEP 11749, for
2 contact hours.
Your certificate is valid in all states.
TEST CODE: AJNTT17
AJN ▼ June 2008 ▼ Vol. 108, No. 6 47