Validation of Self-Report Pain Scales in Children

Tsze, Daniel S; Baeyer, Carl L. von; Bulloch, Blake; Dayan, Peter

doi:10.1542/peds.2013-1509

Cited by 134 publications

(132 citation statements)

References 31 publications

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“…This investigation was part of a larger pain scale validation study that included children with both painful and nonpainful conditions; the present study analyzed only the children with painful conditions. 15 The population in this study was a convenience sample of patients based on availability of the investigators and research coordinators. We enrolled English- and Spanish-speaking children between 4 and 17 years of age, inclusive.…”

Section: Methodsmentioning

confidence: 99%

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

Tsze

Hirschfeld

Baeyer

et al. 2015

Academic Emergency Medicine

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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.

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Section: Methodsmentioning

confidence: 99%

“…1,12–15 The FPS-R, in particular, is one of the self-report measures recommended for clinical trials in children. 1 However, the clinically significant differences in pain severity have not been previously determined for the FPS-R and have only been determined in a limited population for the CAS.…”

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confidence: 99%

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

Tsze

Hirschfeld

Baeyer

et al. 2015

Academic Emergency Medicine

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“…Indeed, after the first acute phase of pain that is accompanied by a reaction which may last for a few minutes and is characterized by a wide range of behaviors, including flailing and crying [13], a second phase can be described consisting mainly of a shutdown of activity. In long-term acute and chronic pain, an absence of visible signs of pain is common, except during exacerbations that occur when the patient moves or perceives a social cue, e.g., someone asking about his/her pain [4].…”

Section: Discussionmentioning

confidence: 99%

“…Tools for pain assessment in children should provide reliable and reproducible results. Children over 6 years of age having no communication impairment can provide reliable self-report of pain using visual analog scales, verbal rating scales, or numeral rating scales [2][3][4]. In children under 6 years of age, self-assessment is not always feasible and observational rating scales are needed.…”

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confidence: 99%

HEDEN Pain Scale: A Shortened Behavioral Scale for Assessment of Prolonged Cancer or Postsurgical Pain in Children Aged 2 to 6 Years

Marec‐Bérard

Gómez

Combet

et al. 2015

Pediatric Hematology and Oncology

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Few observational scales are available for assessing chronic or recurrent pain in children with cancer because overt behavioral signs of chronic pain dissipate as time passes, making them difficult to detect reliably. The Douleur Enfant Gustave Roussy (DEGR) scale developed by Gauvain-Piquard to monitor prolonged pain in children with cancer aged 2-6 years is currently the only validated tool available for this purpose, but is time consuming and difficult to use in daily clinical practice. To shorten composite measurement scales, we developed the Hétero Evaluation Douleur Enfant (HEDEN) scale from the DEGR scale. We present here the process and validation of this scale. Expert consensus was used for the elaboration of HEDEN: 5/10 DEGR items were chosen with three rating levels. Concurrent validity was tested in a first cohort with correlation analysis between HEDEN and DEGR. The HEDEN scale was then validated in a second cohort. In the first step, the study (59 children) showed acceptable correlation between DEGR and HEDEN (r = 0.5), with good reliability (α = 0.61), and interrater agreement (r = 0.62). Subsequent validation in 48 children showed a significant correlation between DEGR and HEDEN (r = 0.6). Reliability was good (α = 0.75), with excellent interrater agreement [r = 0.67 (95% CI: 0.48-0.79)]. On average, the evaluation took 23 minutes (SD = 10.4) for DEGR versus 4.42 minutes (SD = 5.9) for HEDEN. This study shows a good correlation between HEDEN and DEGR scales. HEDEN allows accurate assessment of prolonged pain in young children with cancer.

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“…Pain assessment is the foundation of pain management, with self-report often considered the primary source of assessment in capable children and adults [40]. In preverbal infants, clinicians and researchers are wholly dependent on proxy judgments by benevolent adult caregivers, posing challenges with notable drawbacks [25,29].…”

Section: Introductionmentioning

confidence: 99%

Infant Clinical Pain Assessment: Core Behavioral Cues

DiLorenzo

Riddell

Flora

et al. 2018

The Journal of Pain

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2 Highlights NFCS and MBPS coding systems were examined using Confirmatory Factor Analysis.  A revised 3-item NFCS maintained good psychometric properties of 7-item version.  Redefinition of MBPS with cry as a sole indicator was suggested.  The revised scales increase efficiency of coding based on improved psychometrics. AbstractDiverse behavioural cues have been proposed to be useful cues in infant pain assessment, but there is a paucity of evidence based on formal psychometric evaluation to establish their validity for this purpose. We aimed to examine two widely-used coding systems, the Neonatal Facial Coding System (NFCS) and the Modified Behaviour Pain Scale (MBPS), by examining their factor structures with confirmatory factor analysis using a large archival dataset. The results indicated that an item-reduced NFCS scale with three items produced a one-factor pain model that maintained the good psychometric properties of the 7-item scale. In addition, it was found that MBPS also has challenging internal consistency, with items that are both weakly correlated and highly redundant. One-item of the MBPS may be able to capture the construct of pain equally well or potentially improve its psychometric properties. Redefinition of MBPS with cry as a sole indicator was suggested. This analysis provides two new iterations of the NFCS and MBPS that improve construct validity and internal consistency. These shorter versions also improve the feasibility of both measures and increase their potential for clinical use as less time is required for their administration.Perspective: This article presents new iterations of the NFCS and MBPS scales. These revised measures improve the internal consistency of the measures, feasibility of use of the tools in research settings and the efficiency of the coding process. The revised tools could also improve the feasibility of coding within clinical settings.

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Validation of Self-Report Pain Scales in Children

Cited by 134 publications

References 31 publications

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

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

HEDEN Pain Scale: A Shortened Behavioral Scale for Assessment of Prolonged Cancer or Postsurgical Pain in Children Aged 2 to 6 Years

Infant Clinical Pain Assessment: Core Behavioral Cues

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