McGill Pain Scale

## **What are pain scales?** Pain scales are one of the most important tools that healthcare professionals should have, because learning how severe the pain a patient is feeling can help them determine what goes into their treatment, especially what specific medication and dosages they should follow. Pain is also one of the most common symptoms of injuries, inflammation, nervous system dysfunction, and other diseases (Dydyk & Grandhe, 2025), so another reason why healthcare professionals should have pain scales is to help patients describe their pain. Learning how patients describe their pain can help professionals narrow things down as to what kind of problems the patient might have. There are many kinds of pain scales out there that you can use. Examples include chronic pain grade scales, scales for clinical pain, scales for adult pain, pain scales for constant osteoarthritis pain or rheumatoid arthritis. There are also scales for musculoskeletal pain, visual analog scales (VAS pain scales), numeric rating scales/NRS pain scales, and pain scales for cancer patients, etc. Some focus on specific types of pain, some focus on pain caused by specific diseases/injuries, and some focus on pain in general. One example of a pain scale that you can use is the famous McGill Pain Scale, sometimes referred to as the McGill Pain Index.

## **What is the McGill Pain Scale?** The McGill Pain Scale was developed in the 1970s by Dr. Ronald Melzack and Dr. Warren Torgerson. They named the scale after McGill University. The scale is a type of pain rating index that comes in the form of a self-assessment questionnaire, and it aims to provide healthcare professionals with a multidimensional picture of the pain experienced by their patients. It's usually used by physical therapists, physicians, nurses, and even psychologists looking to assess the psychological aspects of pain. If you have a new patient who presents to you to discuss pain in a specific part or parts of their body, you can issue this to them to get a picture of what your patient is feeling and how they perceive their pain. Explain to them the purpose of this scale before you hand it to them. This is a crucial time to issue this scale because the results will set the groundwork for the next steps, like picking the necessary tests based on what part of the body they feel pain, and eventually determining what goes into their treatment plan. It can also be used during patient monitoring sessions to see if there are any changes in the patient's pain severity. Lower pain ratings mean that they're getting better. Higher ratings compared to before might suggest the problem is getting worse, or that any treatments currently being implemented are not working. ### **What can I expect from this scale?** A regular pain scale normally has a numerical rating between zero to ten, with zero meaning the patient doesn't experience pain at all, and ten meaning they are experiencing the worst pain imaginable. It provides a general overview of how the patient feels and views their pain. Our template is focused on the McGill Pain Questionnaire. It takes a step further by exploring the subjective aspects of pain. These are divided into three categories: - **Sensory**: This category is composed of a selection of certain sensations that may describe what the patient feels while they are in pain. - **Affective**: This category is about how the patient perceives the pain or how they feel about it. - **Evaluative**: This category is about how the patient would describe their pain at its worst. These categories are divided into twenty items with seventy-eight answer choices, and each category has sub-groups. These sub-groups are composed of adjectives. The patient only needs to select which adjective applies to them/describes their present pain intensity for each subgroup. Please note this isn't necessarily a visual analogue scale, even if there are images of the human body on the scale. ### **Why should I use the McGill Pain Scale?** Some patients may find it difficult to express how they understand their pain, not because they are shy, but because they just don't have the proper words for it. Unlike regular pain scales, which have designations like “no pain,” “mild,” “tolerable,” and “unimaginable/unspeakable,” this pain scale has words like “pricking,” “searing,” “suffocating,” “agonizing,” and more! Being able to better describe their pain through the scale, yo can have a better understanding of their patient's experience. Also, the McGill Pain Scale comes with two images. These images show the front and the back of the body, and the patient will indicate which parts of their body are impacted by pain. Their indications and answers will determine the assessments they need to take. Do they need physical therapy and rehab? Do they need psychological interventions? What about imaging tests? These are just three of the questions that the results can answer. Eventually, you'll need to come up with a treatment plan for the patient. These will be based on the pain they are feeling, where they are feeling it, and what the diagnosis is based on the findings of other tests. Speaking of coming up with treatment plans for the patient, we mentioned earlier that one of the best times to use the McGill Pain Scale is during the monitoring phase. Not only can this be used to monitor patients, but it can also be used to monitor the efficacy of treatment plans. Let's say you made and implemented a tailor-fitted treatment plan for the patient. It's only natural to want to know how the patient is doing and if the plan is effective. Reissue the McGill Pain Scale and see if there are any differences in the patient's answers. If the results point to them feeling less pain, then you can safely assume that the recovery process is going well and the treatment plan is working. If the pain severity seems to be the same or is getting worse, then you might want to reevaluate your plan and make the necessary adjustments. ### **How reliable is this?** Pain is complex in nature to the point that it's hard to even determine the major properties of pain experience. This is why a lot of pain intensity scales are self-reports because professionals can only truly rely on the patient's self-report because it's considered the most valid measure of the pain experience (Melzack & Katz, 2001). Ronald Melzack examined the major properties of the McGill Pain Questionnaire, specifically the pain rating index, the number of word descriptors chosen, and present pain intensity ratings between 1 to 5. By using data based on assessing 297 patients using this scale, he determined that it "provides quantitative information that can be treated statistically, and is sufficiently sensitive to detect differences among different methods to relieve pain" (Melzack, 1975). Since the scale is multidimensional, it has been deemed reliable, valid, and consistent (Melzack & Katz, 2001). It's widely used to the point that there are even international versions of it (e.g., Greek McGill Pain Questionnaire, Brazilian/Portuguese versions).

## **How to use the McGill Pain Scale** You can refer to these steps to make the most out of this tool in your practice: ### **Step 1: Decide how you want to conduct this assessment** If you're using the McGill Pain Questionnaire for your work, there are two ways you can administer it. 1. You can use it by interviewing with your patient. This means you will be holding the McGill Pain Questionnaire. You simply need to ask your patient the question: “How would you describe your pain based on each sub-group I introduce?” Then tell them to select which word best applies to them per sub-group. You will be ticking their answers on the sheet. The downside to this is that it's time-consuming; however, you have the benefit of asking the patient to elaborate. That way, it's possible for you to get more information from them regarding their pain in one session. 2. You can hand it to the patient and have them answer it independently. You can have them take home the scale, too, if they would rather answer it privately. If you opt for that, just make sure to agree on when they should submit the completed form. Their answers should frame the next session you have with them. Whichever method you pick is up to you, but one thing you need to do first is to ask them which part of their body is in pain so you can indicate it using the figure of the person on the sheet. Then, they simply need to pick the words that apply to them. ### **Step 2: Have your patient answer the test** All your patient needs to do is to pick the specific adjectives that describe their pain for each item. Again, there are twenty items, each with its own set of adjectives to pick from. Each adjective has a corresponding score that you'll add up after your patient is done answering the test. ### **Step 3: Score their responses** Scoring the tool is easy. All you need to do is get the sum of all scores per sub-group! There are no complex scoring methods you need to take note of. If you're wondering how you can determine the scores, you can simply refer to the items. Each one has a corresponding number beside it, so you don't have to guess the severity score for each word. The lowest score a patient can get is 20, and the highest is 78. You might wonder, “Shouldn't the lowest score be 0?” Technically, yes, but that means they don't feel any pain at all. There's no point in using this pain scale if they're not in pain. For this pain scale, there are no score ranges and designations to refer to. What you can follow is this: the higher the score, the greater the pain they feel. What you will do next is entirely dependent on your practice and all your other findings.

## **Other pain scales you can use** Besides the McGill Pain Scale or Questionnaire, we can provide quantitative measures of pain that you can use alongside it, or hand to other test administrators in your team. Here are some of them: - **[Pain Scale 1-10](https://www.carepatron.com/templates/pain-scale-1-10#template-pdf-preview)**: This is one of the most basic pain scales you can use. It is limited in the sense that it doesn't cover as much ground as the McGill Pain Scale, but it at least asks patients to rate their pain intensity based on how much in pain they were in the past day based on four prompts. - **[FLACC Pain Scale](https://www.carepatron.com/templates/flacc-pain-scale)**: This is a great tool to have if your patient is unable to communicate their pain verbally. Through this scale, you will observe their facial expressions, leg movements, how the patient moves when they're sitting or lying down, if they cry, and if they can be consoled. - **[Faces Pain Scales](https://www.carepatron.com/templates/faces-pain-scale)**: This is a three-in-one template that you can use. It has three visual pain scales: Wong-Baker FACES Pain Rating Scale, Faces Pain Scale by Bierie et al., and the Faces Pain Scale - Revised by Hicks et al. This is meant to work as a pain tracker for patients, so make sure to hand one to your patient so they can monitor themself.

## **References** Dydyk, A. M., & Grandhe, S. (2025). Pain Assessment. PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK556098/ Melzack, R. (1975). The McGill Pain Questionnaire: Major properties and scoring methods. Pain, 1(3), 277–299. https://doi.org/10.1016/0304-3959(75)90044-5 Melzack, R., & Katz, J. (2001). The McGill Pain Questionnaire: Appraisal and current status. In D. C. Turk & R. Melzack (Eds.), Handbook of pain assessment (2nd ed., pp. 35–52). The Guilford Press.