This study was designed to test a new rating observational scale for the diagnosis and grading of pain evoked by cancer in children aged 2-6 years. We began by collecting retrospective clinical findings consisting of descriptions of children in pain. From these descriptions, an item scale was built up comprising overall patterns of behavior specific to pain. Because depression and anxiety-like items occurred very frequently in the descriptions, they were included in the rating scale. The present preliminary report gives the results of the scale, which was tested in 80 children, chosen because they were liable to be in pain. Each child was evaluated by 2 nurses and 2 auxiliaries. Sensitivity and reproducibility were satisfactory. Factorial correspondence analysis showed that both depression and pain items contributed to the first axis, which accounted for 51% of the variance. A second axis was found, which contrasted anxiety and pain items, but it only accounted for 13% of the variance. These results suggest that in young children, pain evoked by severe disease leads to a depression-like reaction that correlates with that pain's intensity. They indicate that in children of pre-school age, pain can be assessed by observing its overall specific patterns.

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