Patients were asked on a scale of 1 to 10 to grade their pain.

Other things were graded as well, their sleep, function, quality of life, et cetera. You can apply this to a lot of things. 

The most important thing about this scale is it is subjective. It is not objective. What we mean by that is subjective is what matters to you.

We are all individuals, we all have our unique experiences, feelings, interpretations of life, judgments of life, and just being us.

Objectively is a completely different world. It is more scientific when we have information or data supporting our conclusions, either based on scientific fact or assumption by hypothesis, but the reality is objective pain is not real.


Hardly Perceptible Pain

Number one, a VAS scale of one, is hardly perceptible pain. Everybody at any given moment, at any age in any walk of life has some type of pain. It might be psychological, anxiety, it might be something more relative such as I got a boo boo, or I stubbed my toe. That type of pain does not necessarily interfere with pain, quality of life, or function, it’s a start. It’s a start of understanding.


Mild Pain

Number two. Two is an advancement of one. You might actually have some measurement of the pain by visual association. There may be a bruise, cut, scrape. Certainly not going to be a problem, you’ll likely recover. Very unlikely it’ll turn into chronic pain.



Three is advancing one through two, it literally means one plus two equals three. This is the definition of the world according to me. A three pain is you may see something like a scrape, bruise, something along those lines. You may see something like a grimace. You may see something like an occasional tear that takes you to four. 


Moderate Pain

Four. You’re starting to understand pain is something real. Here’s where chronic pain, and seeing your healthcare provider really makes a difference. Keeping journaling makes a difference. Understanding what kind of pain you have makes a difference. Along the Mankoski Pain Scale, we’re going to push it and get a better sight on the limits. Number four is akin to five and six. Really important here as you can’t be coming back and forth to your healthcare provider with pain level at 5, 6, 7 every single time or even eight. That just means that your therapy, your treatments are not effective. This is a poor communication with the visual analog scale and defeats its purpose. Think about it. What are you doing as function?





Six, progressive pain. This is the type of pain we’re going to see with a significant back strain or injury without neurological changes, but you can’t sit, you have trouble moving, you have trouble with range of motion, you’re just having trouble getting comfortable. You’re beyond anti-inflammatories at this time. Tylenol (which most people will understand is an anti-inflammatory, in the central nervous system) are making very little difference. Sleep is starting to get interrupted, endurance is impaired. It may be a little, but you’re keeping track of that.


Unmanageable Pain

This takes us to seven. Endurance, quality of life, restorative sleep capacity are all significantly impaired. This is a broken bone for example. It may be wrist, it might be forearm, could be ankle. The ankle strain or sprain is closer to a four. This one is real, this one actually takes you to want advancing healthcare in a healthcare provider.


Intense Pain

Eight is significant pain and usually the farthest you will get without being of either severe traumatic injury, or significant progressive pain as we see in cancer. Eight is about as far as chronic pain is going to go. Not always, but probably so.


Severe Pain

Nine is obtainable, but it might be near exhaustion. It might be near the worst pain you’ve ever had, which is 10.


Unable to Move

Ten is the worst pain you’ll ever have. It will knock you out. It’ll make you unconscious. It will cause significant impairment in all activities, you are crying, you have complete lack of self-awareness or desires to do anything, you will not eat. You must go to the hospital or the hospital comes to you. It’s this type of pain that is most troubling and must be addressed as an emergency.

If 8 through 10 are significant pain, I will call them emergencies. 7 is borderline. 6 is sitting there where most people consider the worst, and I’ve seen in reality very few people go beyond 7 and 8.

There is no such thing as 11, 12, 13, 14 and above.

They don’t exist, the scale is 1 to 10. Above 10, that completely invalidates the whole situation.

This scale has its definitions, and there is no 11, 12, 13, et cetera. This is problematic in conversations, and may need us to look a little further in different directions.