Scale of Pain Intensity Screen (SPIN)
The SPIN & NGRS tool is a six-point visual scale and consists of a sequence of red circles increasing in size to denote “no pain” to “pain as bad as it can be”. The patient can indicate the circle which best indicates the severity of their pain by either using a pen or pointing to the circle. The score range is 0-5 but for comparison with the Numbered graphic rating scale (NGRS) a multiplier of 2 can be used.
The SPIN has three main uses:
- To screen and document any pain symptoms for all in-patients following an acquired brain injury (including patients with either cognitive or communicative limitations)
- To identify pain severity
- To use serially to record pain symptoms
The Numbered Graphic Rating Scale (NGRS)
The NGRS is a 10cm vertical line with numbered increments at 1cm intervals. The score range is 0-10, where 0 = “No pain” and 10 = “pain as bad as it can be”
The patient can indicate the severity of their pain by either pointing on the line, circling the number of verbally reporting the number.
The SPIN screen was developed to provide a method of assessing pain, particularly in the cognitively impaired population, that avoided the use of numbers or faces.
The six-point circles were designed in red to promote visual impact and presented in a vertical line to make it user-friendly. The red circles increase in size to represent the scale of “no pain” to “pain as bad as it can be.”
Once developed the tool was validated in both a general population and a cognitively impaired population
Source references
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Jackson D, Horn S, Kersten P, Turner-Stokes L. Development of a pictorial scale of pain intensity for patients with communication impairments: initial validation in a general population. Clinical Medicine 2006; 6:580585
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Turner-Stokes L, Disler R, Shaw A, Williams H. Screening for pain in patients with cognitive and communication difficulties: evaluation of the SPIN-screen. Clinical Medicine 2008; 8: 393-398
Administering the tool
Please find out more about the explanation of the SPIN screening tool and NGRS.
- This is a tool to measure your pain. The red circles show how intense the pain is.
- The bottom circle (point to the circle) shows “no pain” and the top circle (point to the top circle) shows “worse pain ever or pain as bad as it could be”.
- Explain that the level of redness in the circle increases going up the vertical scale indicating worsening pain.
- Which of these circles best shows how bad your pain is at when moving, during the night and when staying still (resting).
Guidelines
There are no additional guidelines for completing the SPIN screen tool.
However, if used in conjunction with the Shoulder ICP it may be useful to use it in booklet format to present the scale alongside pictures indicating shoulder pain at rest, night and on movement.
If teams would like further clarification, please email LNWH-tr.ukroc@nhs.net
The SPIN screen is routinely used for all in-patients on a specialist level 1a neurorehabilitation unit, but is useful for patients with cognitive/communicative disorders that are unable to use other pain screen tools.