Numeric Rating Scale (NRS) Pain Assessment and Management
Numerical Rating Scale (0-10) for pain assessment. Guides analgesic ladder escalation in ED and inpatient settings per WHO/BPS guidelines.
Score interpretation
→ Step 1 — adults: paracetamol 1g QDS; ibuprofen 400mg TDS (if no contraindication); reassess in 30-60 min; non-pharmacological: ice, elevation, distraction. Children: use a children's formulary.
→ Step 2 — adults: add codeine 30-60mg QDS or tramadol 50-100mg QDS; or dihydrocodeine 30mg QDS; regular paracetamol; NSAID if appropriate; neuropathic component: add amitriptyline 10mg nocte or gabapentin; reassess in 30 min. Children: use a children's formulary.
→ Step 3 — adults: IV/IM morphine 0.1mg/kg (titrate 2-4mg q5-15min); intranasal fentanyl 1-2mcg/kg if no IV access; ketamine sub-dissociative 0.3mg/kg IV for pain crises; for neuropathic severe pain: pregabalin 75-150mg BD; pain team review if refractory. Children: use a children's formulary.
Interpretation bands for the NRS Pain Score. Apply clinical judgement and local guidance.
References
Related
Curated clinical cross-links plus same-class fallbacks.
- Morphine (Oral) · Strong Opioid Analgesic — Step 3 WHO Ladder
- Morphine Slow-Release (Elderly Chronic Pain) · Opioid Analgesic — Modified-Release Oral
- Morphine (Orthopaedic Acute Pain) · Opioid Analgesic — Strong
- Morphine (Paediatric) · Opioid Analgesic — Moderate to Severe Pain in Children
- Morphine PCA (Burns Pain) · Opioid Analgesic (Patient-Controlled Analgesia)
- Morphine (PCA — Post-Operative Pain) · Opioid Analgesic — Patient-Controlled Analgesia
Decision support only — verify against a current formulary, NICE, or your local guideline before clinical use.