Quick answer: A pain scale is a way to describe how much something hurts, usually from 0 (no pain) to 10 (the worst pain you can imagine). Rate your pain the same way each time, for example your average over the day, and add how it affects sleep, work and daily tasks. There is no right or wrong number.
"On a scale of 0 to 10, how bad is your pain?" It is one of the most common questions in healthcare, and one of the hardest to answer. Is a 6 a lot? Will saying 8 sound like an exaggeration? Should you score the worst moment, or today in general? This guide explains what pain scales are for, how to use them consistently with arthritis, and how to go beyond the number so your GP, physiotherapist or rheumatology team really understands what you are living with.
Why clinicians use pain scales
Pain cannot be seen on an X-ray or measured in a blood test. Only you know how much it hurts. A pain scale turns that personal experience into something that can be compared over time. It helps:
- Track change. Is your pain better, worse or the same as last month?
- Judge whether treatment is working. If a new exercise programme, medicine or injection is helping, your scores should come down.
- Spot flares. A jump above your usual level can signal a flare.
- Start a conversation. The number opens the discussion; it does not close it.
A pain score is not a test you can pass or fail. There is no correct number for a particular condition, and your score does not decide whether you deserve treatment. NICE's chronic pain guideline (NG193) emphasises a person-centred assessment that looks at how pain affects your life, not just its intensity.
The 0 to 10 scale explained
The most common scale in the NHS is the numeric rating scale, from 0 to 10. Descriptions vary between services. The table below is a common, practical guide, not an official definition.
| Score | What it often means | Typical effect on daily life |
|---|---|---|
| 0 | No pain | None |
| 1–3 | Mild pain: noticeable but you can ignore it much of the time | You can do most things; pain is in the background |
| 4–6 | Moderate pain: hard to ignore, interrupts concentration | You can do daily tasks but with difficulty or changes; may affect sleep |
| 7–9 | Severe pain: dominates your attention | Hard to do normal activities, sleep or concentrate; may need to stop and rest |
| 10 | The worst pain you can imagine | Unable to do anything else |
Many people with long-term arthritis live with pain in the 2 to 5 range on ordinary days, with higher scores during flares, but everyone is different. Your scores are about you, not about anyone else.
How to score your pain consistently
The number is most useful when you use it the same way every time. Decide on your approach and stick to it:
- Choose what you are scoring. Common choices are your average pain over the last 24 hours, your pain right now, or your worst pain today. Average pain is often the most useful for tracking.
- Score at a similar time each day. For example, each evening for the day just gone.
- Score the main painful area, or score key joints separately if they behave differently, such as knee 5, hands 3.
- Anchor your top end. Think of 10 as the worst pain imaginable, not the worst pain you have had. This leaves room above, and stops you running out of scale during a bad flare.
- Do not compare with others. Your 6 does not have to match someone else's 6.
- Be honest, not strategic. Scoring higher to be taken seriously, or lower to seem brave, makes the number less useful. Describe the impact instead (see below).
Why your score can change from day to day
It is normal for pain scores to vary, even when nothing obvious has changed. Pain is shaped not only by what is happening in your joints but also by sleep, stress, mood, tiredness, activity levels and what else is going on in your life. A poor night or a worrying week can push scores up; a good night's sleep or an enjoyable day can bring them down. This is not "all in your head". It reflects how the nervous system processes pain, which our guide to understanding pain explains. It is also why looking at the pattern over a week or a month is more useful than any single day's number.
Other scales you may come across
Verbal rating scale
Instead of numbers, you choose a word: none, mild, moderate or severe. It is simple and useful if numbers feel unnatural.
Visual analogue scale
A 10 cm line with "no pain" at one end and "worst pain imaginable" at the other. You mark where your pain sits, and the distance is measured. It is often used in research.
Faces scales
A row of faces from happy to very distressed. Originally designed for children, they can help adults who find numbers difficult.
Observational tools
For people who cannot easily communicate their pain, for example some people with advanced dementia, staff may use tools such as the Abbey Pain Scale or PAINAD, which look at facial expression, breathing, body language and behaviour. Carers' observations are very valuable here.
Arthritis-specific questionnaires
Your clinicians may use questionnaires that combine pain with function. Examples include the Oxford Knee Score and Oxford Hip Score, often used before and after joint replacement, and questionnaires that ask about daily activities, such as the Health Assessment Questionnaire (HAQ) in rheumatoid arthritis. In rheumatoid arthritis, clinicians also use a measure of disease activity called DAS28, which combines a count of swollen and tender joints, a blood test and your overall rating of how you are.
Going beyond the number
A number alone misses a lot. Two people who both score 6 may have very different experiences. To give the full picture, describe:
Where
Which joints or areas, one side or both, and whether pain spreads. Our pain map by joint can help you describe this.
What it feels like
Words help clinicians understand the type of pain:
- Aching, stiff, grinding are common in osteoarthritis
- Throbbing, hot, swollen can suggest inflammation
- Burning, shooting, tingling, electric can suggest nerve involvement
- Sharp, catching may come with particular movements
When
Morning stiffness and how long it lasts, pain with activity or rest, night pain, and whether it is constant or comes and goes.
What makes it better or worse
Activity, rest, warmth, cold, medicines, weather, stress or sleep.
How it affects your life
This is often the most important part. Examples: "I can only walk for 10 minutes", "I wake three times a night", "I can no longer open jars", "I have had to cut my hours at work", "I have stopped seeing friends". NICE's chronic pain guideline highlights the impact of pain on daily life, sleep, mood and relationships as central to assessment.
Example: two ways to describe the same pain
Number only: "My knee is a 7."
Full picture: "My right knee averages about 5 out of 10 on a normal day, but it has been 7 most days this month. It aches and feels stiff for about 20 minutes in the morning, and it is worst on stairs and after walking more than 10 minutes. It wakes me most nights. I have stopped walking the dog, and I am struggling with my job, which involves standing."
The second gives your clinician much more to work with, and makes it far more likely that the conversation leads to useful next steps.
Using pain scores at appointments
- Track your scores for two to four weeks beforehand. Our pain tracking journal makes this easy.
- Bring your usual score, your worst recent score, and how often you have flares.
- Add two or three examples of how pain affects your daily life.
- Say what matters most to you, such as sleeping through the night or getting back to work.
- Our clinic appointment pack helps you prepare.
What a "good" result looks like
For many long-term conditions, being completely pain-free is not a realistic goal. A meaningful improvement might be a drop of a couple of points, fewer flares, better sleep or being able to do something important again. When you start a new treatment, agree with your clinician what improvement you are hoping for and how you will judge it. The NHS page on ways to manage chronic pain also emphasises self-help approaches such as staying active, pacing and relaxation alongside treatment.
Pain scores and carers
If you care for someone who finds it hard to rate their pain, ask them simple questions ("Is it a little or a lot?"), use a faces or verbal scale, or note what you observe, such as wincing, guarding a joint, being restless, sleeping poorly or eating less. Write down who recorded each score. These observations are useful for GPs, nurses and care home staff.
When to get medical help
A pain score is for tracking, not for deciding whether to seek urgent help. The type and pattern of symptoms matter more than the number:
- Call NHS 111 or go to A&E for a suddenly hot, red, swollen, very painful joint, especially with fever or feeling unwell, even if you score it lower than you expect.
- Call 999 for chest pain, severe breathlessness, signs of a stroke, or sudden severe pain with collapse.
- Go to A&E or call 999 for back pain with numbness around the bottom or genitals, bladder or bowel problems, or weakness in both legs.
- See your GP if your usual scores are rising, pain is waking you most nights, or it is stopping you doing things that matter to you.
- See your GP if pain is affecting your mood. If you have thoughts of harming yourself, call NHS 111 or Samaritans free on 116 123.
What does a 7 out of 10 pain score mean?
A 7 usually means severe pain that dominates your attention and makes normal activities, sleep or concentration hard. Descriptions vary, and the number is personal. Explaining how the pain affects your day gives your clinician the most useful information.
Should I score my worst pain or my average pain?
Choose one and stay consistent. Average pain over the last 24 hours is often the most useful for tracking change over weeks. If you have occasional severe spikes, note your worst score as well.
What if I find it hard to give my pain a number?
That is common. Try a word scale (none, mild, moderate, severe), a faces scale, or describe what you can and cannot do. Clinicians are used to working with different ways of describing pain.
Will my GP think I am exaggerating if I say a high number?
Your pain score is your own report, and there is no right or wrong number. Describing the impact on your daily life, sleep and work alongside the number helps your clinician understand your score and plan next steps.
What pain scale do NHS physiotherapists use?
Many use the 0 to 10 numeric rating scale, often alongside questionnaires about function, such as the Oxford Knee or Hip Score. They will also ask what makes pain better or worse and what activities you find difficult.
How much should my pain score drop for a treatment to be working?
There is no single figure for everyone. A drop of a couple of points, fewer flares, better sleep or being able to do an important activity again can all be meaningful. Agree with your clinician what you are aiming for.
Sources and further reading
- NICE NG193: Chronic pain (primary and secondary) in over 16s
- NICE NG226: Osteoarthritis in over 16s
- NHS: Ways to manage chronic pain
- NHS: Osteoarthritis
- NHS: Septic arthritis
Educational information for people in the United Kingdom — not a diagnosis or personal medical advice. Charity no. 1218461. Pending clinical review. Everyone's situation is different, so always follow the advice of your own GP, pharmacist or rheumatology team. If you feel very unwell, call 999 or go to A&E. For urgent advice, contact NHS 111.
Continue with related help
- Pain tracking journal — record your scores
- Pain map by joint — where it hurts
- Clinic appointment pack — prepare for appointments
- Is it a true flare? — using scores to spot flares
- Understanding pain — how pain works
- Pain relief — options to discuss