Hyperbole and a Half pain scale: Every level + free template

The Hyperbole and a Half pain scale is Allie Brosh’s humorous pain chart, with a relatable description for each pain level (0-10). It starts at Level 0, “I don’t know why I’m even here.” Then it runs past 10 to an 11 and a “Too Serious For Numbers” tier.

Patients pick the description that sounds like them, and you translate it into a 0-10 score for the chart. It isn’t formally validated, so it works best as an icebreaker at intake, backed by a validated scale. This guide maps every level to a chartable score and includes a printable template.

Key takeaways

Allie Brosh’s Hyperbole and a Half pain scale runs from Level 0 to 10, then adds an 11 and a “Too Serious For Numbers” tier.

Each level pairs an intensity with an exaggerated reaction. Level 2 is “I probably just need a Band Aid,” and Level 10 is being mauled by a bear.

Levels 0 to 10 share their numbers with the 0-10 numeric rating scale, so you can chart a patient’s choice as an NRS score.

The scale isn’t formally validated, so use it to open the pain conversation and record the formal score on a validated tool.

Pabau, the practice software we build, can send the scale before the visit and save each answer to the patient record.

What is the Hyperbole and a Half pain scale?

The scale comes from Allie Brosh’s 2010 blog post “Boyfriend Doesn’t Have Ebola. Probably.” She redrew the hospital pain chart, which she felt didn’t have all the numbers. Her target was the clinical Numeric Rating Scale (NRS), which runs from 0 (no pain) to 10 (worst pain imaginable).

Instead of a bare number, each level gets a scenario a patient can recognize. Level 1 reads: “I am completely unsure whether I am experiencing pain or itching or maybe I just have a bad taste in my mouth.” Level 7 is “I see Jesus coming for me and I’m scared.”

What started as a comic has found an informal place in practice. Nurses, therapists and pain specialists reference it because the humor eases the tension patients feel when reporting pain. The descriptors also capture how the patient is coping, alongside how much it hurts.

What each level means and how to chart it

Brosh’s chart has 13 tiers. The first 11 share their numbers with the NRS, which clinical teams commonly band as mild (1-3), moderate (4-6) and severe (7-10). The table pairs each descriptor with the score you would document.

The tiers past 10 are where the joke lands hardest, and they need a rule before anyone charts them. The NRS stops at 10, so a patient pointing at 11 goes in the record as 10, with a note of the tier they chose. The chart below shows how all 13 tiers fold into the NRS bands.

The humor serves a clinical purpose too. Each descriptor names a reaction, such as confusion, worry, fear or desperation, alongside the intensity. That tells you how the pain is affecting the patient, which a bare number leaves out.

Why practices use this pain scale

Practitioners reach for it over a purely numeric tool for three reasons:

• Patient engagement: The humor makes pain reporting feel less formal and intimidating. Patients who laugh while answering tend to relax, and they are less likely to downplay pain to seem “brave.”
• Clarity of subjective experience: A numeric scale asks patients to put a number on a feeling. This one asks them to recognize themselves in a scenario. A patient who can’t say “my pain is a 6” can often point at the Level 6 description instead.
• Accessibility: Patients with cognitive delays or low health literacy often understand a story better than an abstract number. The scale works across education levels and backgrounds.

How it compares with validated pain scales

Brosh’s chart is the friendliest of the three tools below, and the only one without formal validation. That makes it a fit for intake rather than for the record.

Use the Hyperbole and a Half scale for intake, triage and rapport. Use the NRS or the Mankoski scale for clinical documentation, audit and research. Together they give you a patient who opens up and a score that holds up in the notes.

Our guide to pain assessment scales covers the other validated options and when each one fits.

How to use it in your practice

Fold the scale into your workflow in five steps:

1. Print or display it at intake: Hand the scale out as a printout at the first consultation, or show it on a tablet during triage. Patients read it before they’re asked, which takes some of the anxiety out of reporting pain.
2. Ask patients to pick their level: Skip “Rate your pain from 0 to 10.” Ask “Which of these descriptions sounds most like you right now?” Patients circle or tap a level, and you record it in the clinical notes.
3. Use it to open the conversation: If a patient picks Level 6, ask what makes it feel that way. That leads to location, duration, triggers and emotional impact. A PQRST pain assessment gives that follow-up a structure.
4. Track changes over time: Use Pabau’s digital forms to send the scale at each visit. Comparing answers across sessions shows treatment progress from the patient’s point of view.
5. Back it up with a formal score: Once the pain has been discussed, record it on the numeric pain rating scale or the Mankoski scale. Brosh’s chart opens the conversation, and the validated tool gives you the audit trail.

Many practitioners keep the scale visible during the appointment. Patients often refer back to it (“I was a Level 5 last month, and I’m at a 3 now”), which makes progress concrete and motivating.

You can customize the template for your practice. Adjust the font size, add your logo, or drop the “Jesus” reference where it may not suit your patients. The scale keeps working after edits like these, as long as each level still describes a scenario patients recognize.

How Pabau gets the scale to patients before the visit

On paper, the scale gets handed over at check-in, and someone copies the patient’s answer into the notes by hand. That eats into appointment time and invites transcription errors.

Pabau’s automated workflows send the scale by SMS or email before the appointment instead. Patients arrive having already thought about their pain, so you can open with the discussion rather than the explanation.

Each answer is saved to the patient record next to your notes, so progress across visits sits in one timeline. For physical therapy teams, the same forms live inside a physical therapy EMR that also runs booking and treatment plans.

Send pain scales before every appointment

Pabau sends the pain scale to patients by SMS or email before the visit and saves each answer to the patient record. You can start each appointment by discussing the result.

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Conclusion

Use the Hyperbole and a Half pain scale for what it does best: getting patients to talk about pain they might otherwise play down. Pair it with a validated score every time, and agree in advance how your team charts an 11.

Settle that rule once, and the humor at intake never costs you accuracy in the notes. Book a demo to see how Pabau sends pain scales before the visit and files every answer in the patient record.

Continue your research

Prefer a line over a number? Visual analogue scale (VAS) lets patients mark their pain on a line instead of picking a score.

Need the whole intake in one form? Pain assessment intake form template collects pain history, location and intensity before the first visit.

Want to know where it hurts? Body pain chart lets patients mark the location of their pain on a body outline.

Assessing a patient who can’t self-report? FLACC pain scale scores pain from behavior in young children and nonverbal patients.

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