Infant Clinical Pain Assessment: Core Behavioral Cues

DiLorenzo, Miranda G.; Riddell, Rebecca Pillai; Flora, David B.; Craig, Kenneth D.

doi:10.1016/j.jpain.2018.03.016

Cited by 9 publications

(13 citation statements)

References 34 publications

(47 reference statements)

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“…The five items of the FASS are also found in the Child Facial Coding System (CFCS) scale created by Gilbert in 1999 and which is validated postoperatively in preschool children (Gilbert et al, 1999). Most pain scales based on facial expression have been studied for brief pain such as vaccination or blood sampling (DiLorenzo et al, 2018;Kappesser et al, 2019). The CFCS based on 13 action units was the first facial scale that accurately describes children's postoperative pain.…”

Section: Content Validitymentioning

confidence: 99%

Facial expressions of pain in daily clinical practice to assess postoperative pain in children: Reliability and validity of the facial action summary score

Bringuier

Macioce

Boulhais

et al. 2021

European Journal of Pain

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Background: Behavioural pain scales are recommended to assess postoperative pain for children who are too young to use self-report tools. Their main limitation is underestimation of pain in the days following an intervention. Although relevant, facial expression is not used in daily clinical practice. This prospective study aimed to assess the validity and reliability of the Facial Action Summary Score (FASS), a fiveitem scale, to assess postoperative pain until hospital discharge in children <7 years. Methods: Assessments of pain and anxiety of 123 children using FASS and validated scales were used to study the psychometric validity of the FASS in clinical practice. Results: The content validity was previously investigated in a development study. The internal validity of the FASS was high with excellent reliability (intraclass coefficient = 0.94) and a high Cronbach α (0.89). Convergent validity with pain scales (FLACC [Face, Legs, Activity, Cry, Consoling] and FPS-R [Faces Pain Scale -Revised]) was high (r > 0.8). Sensitivity to change was verified by a significant decrease in the score after rescue analgesia. For a threshold of 2/5, the FASS shows excellent specificity (97%) and sensitivity (82%). The low number of false negatives is the main strength of this tool. Conclusions: This work highlights the interest in using facial expression in daily clinical practice to manage postoperative pain. The FASS is easy to use with excellent psychometric properties and is particularly sensitive to measure pain in the days following surgery. Significance: The aim of this study was to prove that facial expression of pain can be used in clinical practice to measure postoperative pain in children. The reduced number of false negatives is the main strength of this tool.

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Section: Content Validitymentioning

confidence: 99%

Facial expressions of pain in daily clinical practice to assess postoperative pain in children: Reliability and validity of the facial action summary score

Bringuier

Macioce

Boulhais

et al. 2021

European Journal of Pain

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“…When the term-aged neonate undergoes a painful medical procedure, such as a blood test, cannulation, or injection, distinct noxious-evoked activity can be observed across multiple levels of the nervous system. For example, a noxious procedure can evoke autonomic responses, including increased heart rate ( Waxman et al 2016 ) and skin conductance ( Eriksson et al 2008 ), spinally mediated limb withdrawal activity ( Cornelissen et al 2013 ; Hartley et al 2015 ), and behavioral facial grimacing responses ( Grunau et al 1990 ; DiLorenzo et al 2018 ). In addition, patterns of noxious-evoked brain activity that are distinct from that evoked by nonnoxious sensory stimulation have been well characterized ( Slater et al 2010 ; Hartley et al 2017 ).…”

Section: Introductionmentioning

confidence: 99%

Premature infants display discriminable behavioral, physiological, and brain responses to noxious and nonnoxious stimuli

et al. 2021

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Pain assessment in preterm infants is challenging as behavioral, autonomic, and neurophysiological measures of pain are reported to be less sensitive and specific than in term infants. Understanding the pattern of preterm infants’ noxious-evoked responses is vital to improve pain assessment in this group. This study investigated the discriminability and development of multimodal noxious-evoked responses in infants aged 28–40 weeks postmenstrual age. A classifier was trained to discriminate responses to a noxious heel lance from a nonnoxious control in 47 infants, using measures of facial expression, brain activity, heart rate, and limb withdrawal, and tested in two independent cohorts with a total of 98 infants. The model discriminates responses to the noxious from the nonnoxious procedure from 28 weeks onward with an overall accuracy of 0.77–0.83 and an accuracy of 0.78–0.79 in the 28–31-week group. Noxious-evoked responses have distinct developmental patterns. Heart rate responses increase in magnitude with age, while noxious-evoked brain activity undergoes three distinct developmental stages, including a previously unreported transitory stage consisting of a negative event-related potential between 30 and 33 weeks postmenstrual age. These findings demonstrate that while noxious-evoked responses change across early development, infant responses to noxious and nonnoxious stimuli are discriminable in prematurity.

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“…Facial expression has come to be used extensively in clinical and basic research examining biological, behavioral, and social features of pain. The NFCS infant scale continues to be subject to study and refinement, 65,66 and it has provided a basis for study of contextual 67 and modulating factors that determine pain expression and developing capacities for self‐regulation of pain and stress 68,69 . It also has proven to be a valid and useful outcome measure for investigating analgesic interventions 70–72 .…”

Section: Assessment and Measurementmentioning

confidence: 99%

A child in pain: A psychologist’s perspective on changing priorities in scientific understanding and clinical care

Craig

2020

Paediatric and Neonatal Pain

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My research and clinical career followed a trajectory of increasing appreciation for the importance of social factors as determinants of pain experience and expression.The social contexts of children's lives determine whether infants and children are exposed to pain, how socialization in family and ethnocultural contexts lead to pain as a social experience, comprised of thoughts and feelings as well as sensory input, how others shape pain experience and expression, less so for automatic/reflexive features than purposeful representations, and how other's appraisals of children's pain reflect the observer's unique background and capacities for intervening in the child's interests. A greater understanding of the social dimensions of pain, as reflected in the social communication model of pain, would support innovation of psychological and social interventions.

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Infant Clinical Pain Assessment: Core Behavioral Cues

Cited by 9 publications

References 34 publications

Facial expressions of pain in daily clinical practice to assess postoperative pain in children: Reliability and validity of the facial action summary score

Facial expressions of pain in daily clinical practice to assess postoperative pain in children: Reliability and validity of the facial action summary score

Premature infants display discriminable behavioral, physiological, and brain responses to noxious and nonnoxious stimuli

A child in pain: A psychologist’s perspective on changing priorities in scientific understanding and clinical care

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