Children's ratings of the intensity and unpleasantness of post‐operative pain using facial expression scales

Abstract

This study explored whether global unidimensional self-report pain scales based on facial expression help children separately estimate the sensory and affective magnitude of post-operative pain. Ninety paediatric elective surgery patients (in two age groups: 5-9 and 10-15 years) used each of four scales to estimate pain intensity and pain affect during the first 2 days after surgery. The four scales were: Faces Pain Scale (FPS), Facial Affective Scale (FAS), and the Coloured Analogue Scale (CAS) (one for intensity and one for unpleasantness). As hypothesised, ratings on the FPS correlated more highly with analogue scale ratings for intensity than for unpleasantness, whereas ratings on the FAS correlated more highly with those on the analogue scale for unpleasantness than for intensity. Factor analysis indicated that although all measures loaded on a single dimension of distress, there was an additional weaker factor corresponding to a unique contribution of the FAS. No systematic age effects were observed. It was concluded that the FPS and the FAS may partly measure different aspects of the postoperative pain experience in children, although shared instrument variance may obscure true estimates of covariation in ratings of intensity and affective magnitude. The clinical relevance of the present results remains to be determined.

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

“…8,9 In the remainder of the studies, the majority of the instruments whose psychometric qualities were being assessed used ordinal scales, i.e., they categorize attributes and establish a sequential order based on the characteristics of the attribute measured. 6 It should be pointed out that, although ordinal scales are less precise than interval scales, they are generally used with children to obtain self-reported pain assessments since they are easier for children to understand, as is the case of the Oucher Faces Scale, 10 the Faces Pain Scale (FPS) 11,12 and the Facial Affective Scale (FAS). 11 Nevertheless, in the course of this literature review it was found that ordinal scales are also used by trained observers or by the medical and nursing teams to assess child pain.…”

“…6 It should be pointed out that, although ordinal scales are less precise than interval scales, they are generally used with children to obtain self-reported pain assessments since they are easier for children to understand, as is the case of the Oucher Faces Scale, 10 the Faces Pain Scale (FPS) 11,12 and the Facial Affective Scale (FAS). 11 Nevertheless, in the course of this literature review it was found that ordinal scales are also used by trained observers or by the medical and nursing teams to assess child pain. In these cases the following instruments were used: the Objective Pain Scale (OPS), 8 the Faces, Leg, Activity, Cry and Consolability scale (FLACC), 8,[13][14][15] the Children's Hospital of Eastern Ontario Pain Scale (CHEOPS), 8 the Pediatric Pain Profile (PPP), 16 the Alder Hey Triage Pain Score (AHTPS), 17 the Child Facial Coding System (CFCS) 18 and the Non-Communicating Children's Pain Checklist-Revised (NCCPC-R).…”

“…The FPS, for example, has been validated to be administered in the clinical hospital context of surgical procedures 11 and invasive blood collection procedure, 21 during immunization, 18 ear piercing 22 and for the assessment of remembered painful situations. 19 …”

“…19 Specifically with relation to the studies related to surgical procedures, eight defined their objectives as assessing pain during the postoperative period; not including a baseline pain assessment. 7,9,11,[13][14][15]20,21 These studies performed either two or three postoperative pain assessments, and there was a great deal of variation in terms of the time when assessments were carried out. The multiple-assessment approach is highly to be recommended in postoperative pain assessment, since it offers better monitoring of the clinical progress of the patient's pain during this period, in contrast with acute pain, which is focused.…”

“…The CAAS, 7 Just one study combined assessment of the pain dimension intensity with the dimension affective quality, by using two different instruments, respectively the FPS and the FAS. 11 The FAS only assessed the affective magnitude of pain using nine faces that range in expression from happiness to sadness. The authors state that the reason for using the FAS is to differentiate the affective dimension of pain from its sensory dimension.…”