Background: Using subjective tools for pain assessment is essential, but may confuse healthcare professionals in some clinical situations. It is also useful to assess pain severity objectively. Several observational pain scales have been developed, but they are mostly for intensive care units and not for the emergency department (ED). Objectives: The purpose of the present study was to compare the verbal rating scale (VRS) and Nonverbal Rating Scale (NVRS) in the determination of pain severity in patients with limb trauma, in the ED of a general hospital in Kashan, Iran, in 2014. Methods: This observational, prospective study was conducted on 450 traumatic patients admitted to the trauma ED of Shahid Beheshti Hospital in 2014. The tool used in this study consisted of three parts: demographic data, VRS, and NVRS scores at 7 time points, from arrival until 4 hours. The statistical analysis was conducted using the two-tailed Student’s t-test, Mann-Whitney U test, Pearson correlations, and repeated measures. The data analysis was conducted using SPSS software, version 16. Results: The average age of the participants was 35.2 years, and the extremities were the most common painful area (66.2%). The mean VRS and NVRS pain intensity ratings upon arrival were 6.16 (± 2.63) and 3.06 (± 2.17), respectively. The estimation of pain was lower in the NVRS when compared to the VRS, and the scores in these two tools showed a significant correlation. One-hundred and seventy-two of the patients received interventions for pain relief; 60 patients received analgesics and 112 patients (24.8%) received non-pharmacological interventions, such as stabilization of the injured extremity. Conclusions: This study indicated that the modified version of the adult NVPS in step with the VRS is a useful tool for pain intensity assessment in the ED.