Pain Assessment Scales in Children: A Comparative Narrative Review of Existing Tools

Document Type : Systematic Review

Author
S. Behkam
Physical Medicine and Rehabilitation Department, School of Medicine, Tehran University of Medical Science, Tehran, Iran.
10.22034/IJMPP.9.1.975
Abstract
Aims: This study aimed to examine six different assessment tools for pain in children. The study sought to determine whether there were differences in clinical usage among the various scales. Additionally, the study aimed to identify if any of the scales demonstrated superior sensitivity compared to the others.

Method and Materials: A narrative review of currently published studies was performed following standard guidelines. Online databases PUBMED and Google Scholar were searched for systematic reviews published before January 2024. The search terms initially included pain rating scales, pain measurement, and pain intensity. Papers were examined for abstract relativity before being included. Ultimately, a total of 6 articles were selected for the final analysis.

Findings: The Wong-Baker FACES Pain Scale and Faces Pain Scale (FPS) were found to be the most frequently mentioned as sensitive, valid, and reliable tools in various clinical scenarios. In terms of clinical application, the Oucher Scale and Poker Chip Pain Scale have not been utilized for chronic pain assessment, whereas the other four measures have been employed in different contexts, including acute, chronic, and postoperative pain.

Conclusion: All six assessed instruments yielded noteworthy, favorable outcomes when assessing acute pain in children aged three and above. However, their sensitivity, validity, and reliability varied.

Keywords

Subjects

1. Akhriansyah M, Surahmat R. The effect of characteristics and cool pack on reducing intensity of infustion pain in children in hospital. International Journal Of Community Medicine And Public Health. 2022
2. Brudvik C, Moutte SD, Baste V, Morken T. A comparison of pain assessment by physicians, parents and children in an outpatient setting. Emerg Med J. 2017 Mar;34(3):138-144. doi: 10.1136/emermed-2016-205825. Epub 2016 Oct 25. PMID: 27797872; PMCID: PMC5502236.
3. Fullwood D, Means S, Merriwether EN, Chimenti RL, Ahluwalia S, Booker SQ. Toward Understanding Movement-evoked Pain (MEP) and its Measurement: A Scoping Review. Clin J Pain. 2021 Jan;37(1):61-78. doi: 10.1097/AJP.0000000000000891. PMID: 33093342; PMCID: PMC7708514.
4. von Baeyer CL, Spagrud LJ. Systematic review of observational (behavioral) measures of pain for children and adolescents aged 3 to 18 years. Pain. 2007 Jan;127(1-2):140-50. doi: 10.1016/j.pain.2006.08.014. Epub 2006 Sep 25. PMID: 16996689.
5. Chambers CT, Giesbrecht K, Craig KD, Bennett SM, Huntsman E. A comparison of faces scales for the measurement of pediatric pain: children's and parents' ratings. Pain. 1999 Oct;83(1):25-35. doi: 10.1016/s0304-3959(99)00086-x. PMID: 10506669.
6. Chambers CT, Reid GJ, Craig KD, McGrath PJ, Finley GA. Agreement between child and parent reports of pain. Clin J Pain. 1998 Dec;14(4):336-42. doi: 10.1097/00002508-199812000-00011. PMID: 9874013.
7. Birnie KA, Hundert AS, Lalloo C, Nguyen C, Stinson JN. Recommendations for selection of self-report pain intensity measures in children and adolescents: a systematic review and quality assessment of measurement properties. Pain. 2019 Jan;160(1):5-18. doi: 10.1097/j.pain.0000000000001377. PMID: 30180088.
8. Karcioglu O, Topacoglu H, Dikme O, Dikme O. A systematic review of the pain scales in adults: Which to use? Am J Emerg Med. 2018 Apr;36(4):707-714. doi: 10.1016/j.ajem.2018.01.008. Epub 2018 Jan 6. PMID: 29321111.
9. Karelov AE, Ryazankina AA, Semkichev VA, Karelov DA, Zabolotskii DV, Kulyova SA. Аssessment of pain intensity: tools and their clinical using. Meditsinskiy sovet = Medical Council. 2023.
10. Tomlinson D, von Baeyer CL, Stinson JN, Sung L. A systematic review of faces scales for the self-report of pain intensity in children. Pediatrics. 2010 Nov;126(5):e1168-98. doi: 10.1542/peds.2010-1609. Epub 2010 Oct 4. PMID: 20921070.
11. Stein PR. Indices of pain intensity: construct validity among preschoolers. Pediatr Nurs. 1995 Mar-Apr;21(2):119-23. PMID: 7746676.
12. Garra G, Singer AJ, Domingo A, Thode HC Jr. The Wong-Baker pain FACES scale measures pain, not fear. Pediatr Emerg Care. 2013 Jan;29(1):17-20. doi: 10.1097/PEC.0b013e31827b2299. PMID: 23283256.
13. West N, Oakes L, Hinds PS, Sanders L, Holden R, Williams S, Fairclough D, Bozeman P. Measuring pain in pediatric oncology ICU patients. J Pediatr Oncol Nurs. 1994 Apr;11(2):64-8; discussion 69-70. doi: 10.1177/104345429401100205. PMID: 8003263.
14. Miró J, Castarlenas E, de la Vega R, Solé E, Tomé-Pires C, Jensen MP, Engel JM, Racine M. Validity of three rating scales for measuring pain intensity in youths with physical disabilities. Eur J Pain. 2016 Jan;20(1):130-7. doi: 10.1002/ejp.704. Epub 2015 Mar 31. PMID: 25833415; PMCID: PMC4591090.
15. von Baeyer C, Hicks C. Support for a common metric for pediatric pain intensity scales. Pain Res Manag. 2000;5(2): 157–160
16. Hicks CL, von Baeyer CL, Spafford PA, van Korlaar I, Goodenough B. The Faces Pain Scale-Revised: toward a common metric in pediatricpain measurement. PAIN 2001;93:183.
17. Newman CJ, Lolekha R, Limkittikul K, Luangxay K, Chotpitayasunondh T, Chanthavanich P. A comparison of pain scales in Thai children. Arch Dis Child. 2005 Mar;90(3):269-70. doi: 10.1136/adc.2003.044404. PMID: 15723913; PMCID: PMC1720298.
18. Miró J, Huguet A. Evaluation of reliability, validity, and preference for a pediatric pain intensity scale: the Catalan version of the faces pain scale--revised. Pain. 2004 Sep;111(1-2):59-64. doi: 10.1016/j.pain.2004.05.023. PMID: 15327809.
19. Stanford EA, Chambers CT, Craig KD. The role of developmental factors in predicting young children's use of a self-report scale for pain. Pain. 2006 Jan;120(1-2):16-23. doi: 10.1016/j.pain.2005.10.004. Epub 2005 Dec 13. PMID: 16359800.
20. Wood C, von Baeyer CL, Falinower S, Moyse D, Annequin D, Legout V. Electronic and paper versions of a faces pain intensity scale: concordance and preference in hospitalized children. BMC Pediatr 2011;11:87
21. von Baeyer CL, Uman LS, Chambers CT, Gouthro A. Can we screen young children for their ability to provide accurate self-reports of pain? Pain. 2011 Jun;152(6):1327-1333. doi: 10.1016/j.pain.2011.02.013. Epub 2011 Mar 10. PMID: 21392889.
22. Gupta N, Naegeli AN, Turner-Bowker DM, Flood EM, Heath LE, Mays SM, Dampier C. Cognitive Testing of an Electronic Version of the Faces Pain Scale-Revised with Pediatric and Adolescent Sickle Cell Patients. Patient. 2016 Oct;9(5):433-43. doi: 10.1007/s40271-016-0166-z. PMID: 27026180; PMCID: PMC5021749.
23. Castarlenas E, Jensen MP, von Baeyer CL, Miró J. Psychometric Properties of the Numerical Rating Scale to Assess Self-Reported Pain Intensity in Children and Adolescents: A Systematic Review. Clin J Pain. 2017 Apr;33(4):376-383. doi: 10.1097/AJP.0000000000000406. PMID: 27518484.
24. Ruan X, Padnos IW, Kaye AD. Validation of a New "Objective Pain Score" vs. "Numeric Rating Scale" For the Evaluation of Acute Pain: A Comparative Study. Anesth Pain Med. 2016 Jun 6;6(4):e38886. doi: 10.5812/aapm.38886. PMID: 27843783; PMCID: PMC5098393.
25. Castarlenas E, Miró J, Sánchez-Rodríguez E. Is the verbal numerical rating scale a valid tool for assessing pain intensity in children below 8 years of age? J Pain. 2013 Mar;14(3):297-304. doi: 10.1016/j.jpain.2012.12.004. Epub 2013 Feb 4. PMID: 23380267.
26. Hirschfeld G, Wager J, Schmidt P, Zernikow B. Minimally clinically significant differences for adolescents with chronic pain-variability of ROC-based cut points. J Pain. 2014 Jan;15(1):32-9. doi: 10.1016/j.jpain.2013.09.006. Epub 2013 Sep 28. PMID: 24268356.
27. Brahmbhatt A, Adeloye T, Ercole A, Bishop SM, Smith HL, Wheeler DW. Assessment of post-operative pain in children: who knows best? Pediatr Rep. 2012 Jan 2;4(1):e10. doi: 10.4081/pr.2012.e10. Epub 2012 Mar 1. PMID: 22690302; PMCID: PMC3357609.
28. Myles PS, Myles DB, Galagher W, Boyd D, Chew C, MacDonald N, Dennis A. Measuring acute postoperative pain using the visual analog scale: the minimal clinically important difference and patient acceptable symptom state. Br J Anaesth. 2017 Mar 1;118(3):424-429. doi: 10.1093/bja/aew466. PMID: 28186223.
29. Beck E, Nwachukwu B, Mehta N, Jan K, Okoroha K, Drager J, Nho S, Rasio J. Defining Meaningful Functional Improvement on the Visual Analog Scale for Satisfaction at 2-years After Hip Arthroscopy for Femoroacetabular Impingement Syndrome. Orthop J Sports Med. 2020 Jul 31;8(7 suppl6):2325967120S00439. doi: 10.1177/2325967120S00439. PMCID: PMC7401077.
30. Le May S, Ballard A, Khadra C, Gouin S, Plint AC, Villeneuve E, Mâsse B, Tsze DS, Neto G, Drendel AL, Auclair MC, McGrath PJ, Ali S. Comparison of the psychometric properties of 3 pain scales used in the pediatric emergency department: Visual Analogue Scale, Faces Pain Scale-Revised, and Colour Analogue Scale. Pain. 2018 Aug;159(8):1508-1517. doi: 10.1097/j.pain.0000000000001236. PMID: 29608509.
31. Lootens CC, Rapoff MA. Measures of pediatric pain: 21-numbered circle Visual Analog Scale (VAS), E-Ouch Electronic Pain Diary, Oucher, Pain Behavior Observation Method, Pediatric Pain Assessment Tool (PPAT), and Pediatric Pain Questionnaire (PPQ). Arthritis Care Res (Hoboken). 2011 Nov;63 Suppl 11:S253-62. doi: 10.1002/acr.20634. PMID: 22588749.
32. Bailey B, Bergeron S, Gravel J, Daoust R. Comparison of four pain scales in children with acute abdominal pain in a pediatric emergency department. Ann Emerg Med. 2007 Oct;50(4):379-83, 383.e1-2. doi: 10.1016/j.annemergmed.2007.04.021. Epub 2007 Jun 22. PMID: 17588706.
33. Abu-Saad H, Holzemer WL. Measuring children's self-assessment of pain. Issues Compr Pediatr Nurs. 1981 Sep-Dec;5(5-6):337-49. doi: 10.3109/01460868109106349. PMID: 6922127.
34. Berntson L, Svensson E. Pain assessment in children with juvenile chronic arthritis: a matter of scaling and rater. Acta Paediatr. 2001 Oct;90(10):1131-6. doi: 10.1080/080352501317061521. PMID: 11697423.
35. Bai J, Jiang N. Where Are We: A Systematic Evaluation of the Psychometric Properties of Pain Assessment Scales for Use in Chinese Children. Pain Manag Nurs. 2015 Aug;16(4):617-31. doi: 10.1016/j.pmn.2014.11.003. PMID: 26256224.
36. Yeh CH. Development and validation of the Asian version of the oucher: a pain intensity scale for children. J Pain. 2005 Aug;6(8):526-34. doi: 10.1016/j.jpain.2005.03.002. PMID: 16084467.
37. Beyer JE, Turner SB, Jones L, Young L, Onikul R, Bohaty B. The alternate forms reliability of the Oucher pain scale. Pain Manag Nurs. 2005 Mar;6(1):10-7. doi: 10.1016/j.pmn.2004.11.001. PMID: 15917740.
38. Villarruel AM, Denyes MJ. Pain assessment in children: theoretical and empirical validity. ANS Adv Nurs Sci. 1991 Dec;14(2):32-41. doi: 10.1097/00012272-199112000-00005. PMID: 1759808.
39. Yeh CH. Development and validation of the Asian version of the oucher: a pain intensity scale for children. J Pain. 2005 Aug;6(8):526-34. doi: 10.1016/j.jpain.2005.03.002. PMID: 16084467.
40. Aradine CR, Beyer JE, Tompkins JM. Children's pain perception before and after analgesia: a study of instrument construct validity and related issues. J Pediatr Nurs. 1988 Feb;3(1):11-23. PMID: 3339533.
41. von Baeyer CL. Children's self-reports of pain intensity: scale selection, limitations and interpretation. Pain Res Manag. 2006 Autumn;11(3):157-62. doi: 10.1155/2006/197616. PMID: 16960632; PMCID: PMC2539005.
42. Suraseranivongse S, Montapaneewat T, Manon J, Chainchop P, Petcharatana S, Kraiprasit K. Cross-validation of a self-report scale for postoperative pain in school-aged children. J Med Assoc Thai. 2005 Mar;88(3):412-8. PMID: 15962653.
43. Chan AY, Ge M, Harrop E, Johnson M, Oulton K, Skene SS, Wong IC, Jamieson L, Howard RF, Liossi C. Pain assessment tools in paediatric palliative care: A systematic review of psychometric properties and recommendations for clinical practice. Palliat Med. 2022 Jan;36(1):30-43. doi: 10.1177/02692163211049309. Epub 2021 Dec 29. PMID: 34965753; PMCID: PMC8796159.
44. Nagarwal, P., Rana, V., Srivastava, N., & Kaushik, N. (2022). Levels of pain assessment tools for pediatric dental patients: a narrative review. International Journal Of Community Medicine And Public Health, 9(7), 3034–3039. https://doi.org/10.18203/2394-6040.ijcmph20221778
45. McConahay T, Bryson M, Bulloch B. Clinically significant changes in acute pain in a pediatric ED using the Color Analog Scale. Am J Emerg Med. 2007 Sep;25(7):739-42. doi: 10.1016/j.ajem.2006.12.010. PMID: 17870473.
46. Bijur PE, Silver W, Gallagher EJ. Reliability of the visual analog scale for measurement of acute pain. Acad Emerg Med. 2001 Dec;8(12):1153-7. doi: 10.1111/j.1553-2712.2001.tb01132.x. PMID: 11733293.
International Journal of Musculoskeletal Pain Prevention
Volume 9, Issue 1
March 2024
Pages 975-982