Discordance between self-report and behavioral pain measures in children aged 3–7 years after surgery

Abstract

This study examined concurrent self-reports of pain intensity and behavioral responses in 25 children aged 3-7 yr. Behavioral (Children's Hospital of Eastern Ontario Pain Scale, CHEOPS) and self-report (the Oucher and Analogue Chromatic Continuous Scale) measures of pain were obtained following major surgery. The two self-report measures were strongly and significantly correlated, and the pattern of scores over the 36-hr observation period was as expected. There was little relationship between the scores for the self-report and the behavioral measures. Many children who reported severe pain manifested few of the behavioral indicators of distress used in the CHEOPS. This behavioral response pattern may occur commonly in children experiencing pain after surgery and may limit the applicability of current behavioral scales as sole measures of pain intensity in younger children.

Effects of Continuous Rate Intravenous Infusion of Butorphanol on Physiologic and Outcome Variables in Horses after Celiotomy

“…5,12,[14][15][16][17] These studies have been complicated by difficulties in accurately assessing and quantifying pain in a nonverbal species. [2][3][4][5][6]16,[18][19][20] Horses undergoing exploratory celiotomy for acute abdominal pain usually receive flunixin meglumine, a nonsteroidal anti-inflammatory drug (NSAID), although doses and dose intervals have varied. In human beings, NSAID medications are considered insufficient for management of pain related to abdominal surgery and a combination of opiates and nonsteroidal analgesic agents is preferred as a multimodal plan for pain management.…”

In Children with Limb Injury Pain, Shall We Use Intranasal Fentanyl or Ketamine?

“…In this study, the assessment of pain severity was undertaken via different modalities of pain rating scales using a child's self-reporting of pain, which was shown to be superior to observational assessments in estimating pain severity in young children (8). However, the self-reporting of pain depends on the cognitive ability of children and their understanding that their pain severity can be objectively measured on a scale (9).…”

Summary Proceedings From the Neonatal Pain-Control Group

“…A preferred approach is to have the bedside nurse give the NCA bolus based on a pain-score criterion, 90,91 but an overriding concern is whether NCA based on an observational pain-score criterion has validity. 76,83,92,93 Important issues about the study of perioperative pain include whether surrogate measures of efficacy (eg, "opioid sparing" or reducing the need for opioid analgesics) are sufficient, whether one can control for the interactions of the supplemental opioid with the other agent under study, and how to study the efficacy and time course of each incremental dose. Furthermore, standardization of intraoperative management, including (1) intraoperative analgesics, anesthetics, and muscle relaxants, (2) fluid management, (3) glucose infusion rate, (4) body temperature, (5) and the degree of surgical stress 94 would be critical to the proposed study design.…”

“…Determining appropriate efficacy or benefit measures is a common problem for the design of all studies on the control of perioperative pain. 12,76,[83][84][85] Classic paradigms and study designs for perioperative pain evaluation in adults (pain from third-molar extraction 86,87 ) and older children (using a patient-controlled analgesia device with cumulative morphine use and the opioid-sparing effects as outcomes 88,89 ) are not applicable for the neonatal age group. Creative study designs and novel outcomes, therefore, may need to be considered for studies that investigate neonatal anesthesia or analgesia.…”