Systematic review of observational (behavioral) measures of pain for children and adolescents aged 3 to 18 years

Abstract

Observational (behavioral) scales of pain for children aged 3 to 18 years were systematically reviewed to identify those recommended as outcome measures in clinical trials. This review was commissioned by the Pediatric Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials (www.immpact.org). In an extensive literature search, 20 observational pain scales were identified for review including behavior checklists, behavior rating scales, and global rating scales. These scales varied in their reliance on time sampling and inclusion of physiological items, facial and postural items, as well as their inclusion of multiple dimensions of assessment (e.g., pain and distress). Each measure was evaluated based on its reported psychometric properties and clinical utility. Scales were judged to be indicated for use in specific acute pain contexts rather than for general use. Two scales were recommended for assessing pain intensity associated with medical procedures and other brief painful events. Two scales were recommended for post-operative pain assessment, one for use in hospital and the other at home. Another scale was recommended for use in critical care. Finally, two scales were recommended for assessing pain-related distress or fear. No observational measures were recommended for assessing chronic or recurrent pain because the overt behavioral signs of chronic pain tend to habituate or dissipate as time passes, making them difficult to observe reliably. In conclusion, no single observational measure is broadly recommended for pain assessment across all contexts. Directions for further research and scale development are offered.

Pain as a quality of care measure in juvenile idiopathic arthritis: One step forward, but is it the best foot? Comment on the article by Lovell et al

“…Most children as young as 5 years of age are capable of validly self-reporting at least current pain if presented with an age-appropriate pain scale (3). With children younger than 5 years, and those who have cognitive or verbal communication deficits, pain assessment is more challenging and requires selecting an observational measure of pain (4). The same pain scale should be used with the child each time to allow for longitudinal comparison.…”

Avaliação do comportamento de crianças em situações de dor: revisão da literatura

“…Other studies have also indicated that facial expressions have an important function in pain assessment since they are one of the most reliable behavioral indicators of pain. 3,40 Future studies of pain assessment during painful proce- In this review it was found that this scale meets the validity parameter, but this does not mean that, in prior studies, the scale has not met other psychometric parameters, such as reliability, sensitivity, specificity or applicability. This study has been used in studies of concurrent validity of new scales, which definitely suggests it has good psychometric qualities.…”

“…13,14 One review study of behavioral measures of pain assessment submitted certain scales to a rigorous review procedure and found their levels of clinical evidence. 40 The FLACC was recommended for postoperative pain assessment, the CHEOPS for preoperative and postoperative pain assessment, and the PPPM for postoperative pain assessment on hospital discharge: three scales widely used for pain assessment, according to the levels of clinical evidence given. 40 In contrast, the AHTPS and the TPPPS were scales whose levels of evidence compromise their clinical use.…”

“…40 The FLACC was recommended for postoperative pain assessment, the CHEOPS for preoperative and postoperative pain assessment, and the PPPM for postoperative pain assessment on hospital discharge: three scales widely used for pain assessment, according to the levels of clinical evidence given. 40 In contrast, the AHTPS and the TPPPS were scales whose levels of evidence compromise their clinical use. One should therefore be cautious with relation to their clinical applicability.…”

Chronic Pain Assessment Tools for Cerebral Palsy: A Systematic Review

“…[26][27][28][29][30] However, the heterogeneity of physical and cognitive impairments associated with CP makes it difficult to assess chronic pain using a single standardized tool. [26][27][28][29][30][31][32] Further, barriers to assessment stem from a lack of awareness among health professionals of psychometrically sound tools and/or a lack of standardization within organizations for routine chronic pain assessment. [32][33][34] Although previous reviews have identified measures to inform clinical practice, the application to children with disabilities is lacking.…”