How to assess childrens pain experiences

How to assess childrens pain experiences?

Self-report is the gold standard for assessing children’s pain. By 3 to 4 years of age, children can differentiate pain intensity with pictorial adaptations of the numeric rating scale (NRS) and visual analogue scale. Most children over 7 to 8 years of age can understand rank order and rank pain severity on a scale of 0 to 10 or 0 to 5, with the 0 anchor representing “no pain” and 5 or 10 representing the “worst possible pain.” Therefore, like adults, most school-age children can use the NRS and VAS to report and quantify their pain intensity. Children 6 to 16 years of age, however, report a preference for using the faces scale to the NRS. No single pain intensity scale is valid, reliable, and appropriate for all pediatric age groups or types of pain.

Valid and Reliable Pictorial Adaptations of the Numeric Rating Scale and Visual Analogue Scale for Assessing Children’s Pain

TOOL (ACRONYM) AND REFERENCE (YEAR)	AGE RANGE	TYPE OF PAIN	COMMENTS
Faces Pain Scale—Revised (FPS-R) Bieri et al. (1990); Hicks et al. (2001)	4–12 years	Acute, disease-related, postop, procedural	Highly feasible. Neutral anchors. Recommended by PediIMMPACT.
Oucher Beyer and Aradine (1986)	3+	Acute, disease-related, postop, procedural	Available with photographs of different races/ethnicities to facilitate cultural competency.
Wong–Baker FACES Pain Scale (WBPRS) Wong and Baker (1988)	3+	Acute, disease-related, postop, procedural	Validated with 0 to 5 and 0 to 10 anchors. Anchor faces are smiling and crying, which may confuse measurement of intensity and affect.

Pain intensity is the most common component of pain assessed with children and adults, but a more comprehensive pain assessment is often necessary. Pediatric self-report tools of pain quality, pattern, triggers, aggravating, and alleviating factors, and how pain interferes with everyday life has been developed and validated for children and adolescents with acute and chronic pain. Few self-report multidimensional pain assessment tools have been developed and validated for assessing children with chronic pain. The Patient-Reported Outcomes Measurement Information System (PROMIS) comprises valid, person-centered measures for (1) assessing symptoms and functions across chronic health conditions, (2) enhancing communication between health care providers and patients, and (3) evaluating and monitoring physical, social, and emotional health. PROMIS self-report measures are available for children 8 to 17 years of age, and parent-proxy measures are available for children 5 to 17 years of age. Pain interference, emotional distress, fatigue, physical activity, physical function, strength impact, physical stress experiences, psychological stress experiences, family relationships, peer relationships, global health, and life satisfaction are all PROMIS measures appropriate for obtaining a more comprehensive assessment of children with chronic pain.

Valid and Reliable Multidimensional Pediatric Self-Report Pain Assessment Tools for Chronic Pain

TOOL (ACRONYM) AND REFERENCE (YEAR)	AGE RANGE	TYPE OF PAIN	COMMENTS
Adolescent Pediatric Pain Tool (APPT) Jacob et al. (2014); Savedra et al. (1989)	8+	Acute, chronic, disease-related, postop, procedural	Validated to assess pain intensity, pattern or timing, location, and quality. Available in English and Spanish.
Bath Adolescent Pain Questionnaire (BAPQ) Eccleston et al. (2005)	11–18	Chronic	Validated to assess the impact of chronic pain.
Pediatric Pain Assessment Tool (PPAT) Abu-Saad et al. (1990)	5+	Acute, chronic, disease-related, postop	Validated to assess pain intensity and quality of pain by circling words in the sensory, affective, evaluative, and temporal domains of pain.
Pediatric Pain Questionnaire (PPQ) Varni and Thompson (1985)	5+	Chronic, disease-related	Validated to assess pain intensity, location, sensory, evaluative, and affective qualities of pain. Available in seven languages.