Clinically Significant Differences in Acute Pain Measured on Self‐report Pain Scales in Children

Abstract

Objectives The objective was to determine the minimum and ideal clinically significant differences (MCSD, ICSD) of the Faces Pain Scale–Revised (FPS-R) and the Color Analog Scale (CAS) in children and to identify any differences in these estimates based on patient characteristics. Methods This was a prospective study of children aged 4 to 17 years with acute pain presenting to two urban pediatric emergency departments. Participants self-reported their pain severity using the FPS-R and CAS and qualitatively described their changes in pain. Changes in pain score reported using the FPS-R and CAS that were associated with “a little less” and “much less” pain (MCSD and ICSD, respectively) were identified using a receiver operating characteristic–based method and expressed as raw change score and percent reductions. Estimates of MCSD and ICSD were determined for each category of initial pain severity (mild, moderate, and severe) and patient characteristics (age, sex, and ethnicity). Post hoc exploratory analyses evaluated categories of race, primary language, and etiology of pain. Results A total of 314 children with acute pain were enrolled; mean (±SD) age was 9.8 (±3.8) years. The FPS-R raw change score and percent reduction MCSD estimates were 2/10 and 25%, with ICSD estimates of 3/10 and 60%. For the CAS, raw change score and percent reduction MCSD estimates were 1/10 and 15%, with ICSD estimates of 2.75/10 and 52%. For both scales, raw change score and percent reduction estimates of the MCSD remained unchanged in children with either moderate or severe pain. For both scales, estimates of ICSD were not stable across categories of initial pain severity. There was no difference in MCSD or ICSD based on age, sex, ethnicity, race, primary language, or etiology of pain. Conclusions The MCSD estimates can be expressed as raw change score and percent reductions for the FPS-R and CAS. These estimates appear stable for children with moderate to severe pain, irrespective of age, sex, and ethnicity. Estimates of ICSD were not stable across different categories of initial pain severity, therefore limiting their potential generalizability.

A smartphone version of the Faces Pain Scale‐Revised and the Color Analog Scale for postoperative pain assessment in children

“…Results: Sixty-two participants, median (range) age 7.5 (4)(5)(6)(7)(8)(9)(10)(11)(12) years, participated in the FPS-R trial; Panda scores correlated strongly with the original scores at both time points (Pearson's r > 0.93) with limits of agreement within clinical significance (80% CI). Sixty-six participants, age 13 (5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18) years, participated in the CAS trial. Panda scores correlated strongly with the original scores at both time points (Pearson's r > 0.87); mean pain scores were higher (up to +0.47 out of 10) with Panda than with the original tool, representing a small systematic bias, but limits of agreement were within clinical significance.…”

“…Correlations between the pain scores obtained from the original FPS-R and CAS tools and those obtained from the Panda versions were assessed using Pearson's correlation coefficient, r. In order to determine if the agreement between the two methods (original vs Panda) is adequate, the difference in the pain scores should be within a clinically significant change in perception of pain. The Minimum Clinically Significant Difference (MCSD) was set as 2/10 for both the FPS-R and CAS, based on the findings of Tsze et al (18) and McConahay et al (19), respectively. Limits of agreement were calculated at the two different assessment times (t 0 and t 30 ) using the at rest pain scores using the Bland-Altman method (20) set at 80% confidence interval.…”

Dry Needling Versus Cortisone Injection in the Treatment of Greater Trochanteric Pain Syndrome: A Noninferiority Randomized Clinical Trial

“…Our data suggest that DN is a noninferior treatment alternative to cortisone injections in this patient population. 7,10,16,[23][24][25]28,30,45 Evidence suggests that analgesic injection is not superior to DN in other regions of the body. 17,21,46 Therefore, it is possible that cortisone injection for GTPS is not superior to DN.…”

“…A 2-sample t test for noninferiority was used, with a noninferiority margin of 1.5, a standard deviation of 2, and a true difference of zero. 1,14,26,27,45 For the PSFS, it was assumed that a difference of 3 units was of clinical significance. …”

Quantitative Sensory Testing in Pain Management

“…• neuropathy • pain medicine • quantitative sensory testing • small peripheral nerve fibers Pain scales, despite their well-known limitations are still broadly used in research and in clinical practice [1][2][3]. The assessment of pan intensity by the self-report method has always been considered a limiting tool in the practice of pain medicine.…”