Discordance between self-report and behavioral pain measures in children aged 3-7 years after surgery. Validity of Simplified Versus Standard Self-Report Measures of Pain Intensity in Preschool-Aged Children Undergoing Venipuncture. Pain in 4- to 6-year-old children receiving intramuscular injections: a comparison of the Faces Pain Scale with other self-report and behavioral measures. Developmental data supporting simplification of self-report pain scales for preschool-age children. A new analogue scale for assessing children's pain: an initial validation study Postoperative self-report of pain in children: interscale agreement, response to analgesic, and preference for a faces scale and a visual analogue scale. Validation of Self-Report Pain Scales in Children Do 0–10 Numeric Rating Scores Translate into Clinically Meaningful Pain Measures for Children? [Initial results of the reliability and validity of a German-language scale for the quantitative measurement of postoperative pain in young children]. Criterion and Convergent Validity for 4 Measures of Pain in a Pediatric Sickle Cell Disease Population Cross-validation of a self-report scale for postoperative pain in school-aged children. Pain-QuILT: Assessing Clinical Feasibility of a Web-based Tool for the Visual Self-Report of Pain in an Interdisciplinary Pediatric Chronic Pain Clinic Clinically significant differences in acute pain measured on self-report pain scales in children. The faces pain scale for the self-assessment of the severity of pain experienced by children: Development, initial validation, and preliminary investigation for ratio scale properties Parents and practitioners are poor judges of young children's pain severity. Assessment of clinically significant changes in acute pain in children. Validation of 2 pain scales for use in the pediatric emergency department.
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 There are inadequate age-specific data to support the use of current self-report pain scales in 3- and 4-year-old children . Most preschool-aged children also lack the necessary cognitive development to use st and ard scales . We aim ed to evaluate the validity and feasibility of 2 novel simplified scales ( Simplified Faces Pain Scale , S-FPS ; Simplified Concrete Ordinal Scale , S-COS ) for preschool-aged children . These simplified scales used a 2-step self-report method : children were first asked whether they have pain ( yes/no ) ; only if yes , then pain intensity was self-reported using a 3-point scale with visual aids signifying mild/moderate/severe . We recruited 180 3- to 6-year-old children undergoing routine blood collection . Each child was r and omly assigned 2 of 3 scales-S-FPS , S-COS , Faces Pain Scale-Revised (FPS-R)-to self-report pain before venipuncture , immediately after , and 5 minutes later , using both scales at each time-point . Pain was also assessed using observation ( Face Legs Activity Cry Consolability ) at each time point . The ability to discriminate pain from no pain was improved with S-FPS and S-COS , compared with the FPS-R , among 4-year-olds , but not 3-year-olds . Correlation with Face Legs Activity Cry Consolability was moderate to strong and cooperation rates were similar for all self-report scales . The simplified scales can improve and simplify pain assessment for 4-year-olds . Quantitative pain rating remains challenging for 3-year-olds . PERSPECTIVE This study evaluated 2 novel simplified pain assessment tools for preschool-aged children undergoing blood sampling . These scales demonstrated good validity and feasibility compared with the FPS-R , suggesting these simplified pain scales may have a role in clinical practice for children as young as 4 years OBJECTIVE The main objective was to compare the utility of the Faces Pain Scale  ( Bieri et al. , 1990 ) with three alternative self-report measures of pain intensity in children , as well as with pain ratings based on observations of the child 's behavior . DESIGN Fifty children used 4 self-report scales to rate the severity of needle pain from routine immunization . Using videotapes , the child 's pain-related behavior was coded in detailed fashion , and a subset of the sample were also rated globally by 60 registered pediatric nurses . MAIN OUTCOME MEASURES  Faces Pain Scale ; Poker Chip Tool ; Visual Analogue Toy ; Verbal Rating Scale ;  behavioral checklist ( scoring observable facial , motor , verbal and vocal reactions ) . RESULTS AND CONCLUSIONS The  Faces Pain Scale  was simple to use , readily understood by the children , and showed a realistic distribution of scores with respect to the type of pain being measured . With the exception of verbal reactions ( which were not meaningfully related to self-report ) , observer ratings based on detailed coding of the child 's behavior correlated only poorly to moderately well with self-report scores ( r = .39 to r = .58 ) . Similarly , although confident in their judgments , the nurses ' ratings showed only moderate agreement with those of the children . In estimating the child 's pain , all observers appeared to appropriately weigh changes in the child 's facial behavior , which showed evidence of being the most sensitive behavioral index to the intensity of short sharp ( needle ) pain in 4 to 6 years olds UNLABELLED Cl aims regarding the ability of preschool-age children to provide accurate self-reports using st and ard pain scales are not well supported by age-specific evidence . Responses of children younger than 5 years are often idiosyncratic and subject to biases . Simplifying the task of self-report of pain would make it more developmentally appropriate for 3- to 5-year-olds . A binary question is asked : " Does it hurt ? " or an equivalent . If yes , a simplified scale is presented , comprising 3 categories representing low , medium , and high pain severity . Children aged 3 to 5 years ( N = 184 ) were recruited from preschools and day care centers . Following parental consent and child assent , children were r and omly assigned to use either the  Faces Pain Scale-Revised or a 3-face scale preceded by a yes-no question to rate pain in 9 picture stories from the Charleston Pediatric Pain Pictures portraying no pain , moderate pain , and severe pain . The  simplified pain rating task  made no difference for 5-year-olds , whose mean scores were nearly identical using the 2 approaches . However , discrimination of the 3 levels of Charleston Pediatric Pain Pictures items was significantly better in 3- and 4-year-olds with the simplified task than with the  Faces Pain Scale-Revised .  Simplifying the task improved preschool-age children 's ability to estimate pain intensity . PERSPECTIVE St and ard self-report pain scales with 6 faces are confusing for many 3- and 4-year-olds . In basic preparatory research for future development of a preschool self-report pain scale , we simplified the task . This simplification made no difference for 5-year-olds but improved the performance of 3- and 4-year-olds & NA ; A new instrument was design ed to provide a practical clinical measure for assessing children 's pain intensity and pain affect .  The pocket size measure includes a Coloured Analogue Scale ( CAS ) to assess intensity and a facial affective scale to assess the aversive component of pain . Both scales have numerical ratings on the back , so that the person administering it can quickly note the numbers that represent a child 's pain . This study was conducted to determine : the validity of the new instrument by evaluating the psychophysical properties of the intensity scale and by evaluating the discriminant validity of the intensity and affective scales . Since visual analogue scales ( VAS ) are valid and reliable measures for assessing children 's pain , children 's ability to use the new analog scale was compared with their performance on a VAS . Children 's ability to rate pain affect using an affective scale , in which the 9 faces on a Facial Affective Scale ( FAS ) are presented in an ordered sequence from least to most distressed , was compared to their performance on the original FAS , in which the same faces were presented in a r and om order . Using a parallel groups design , 104 children ( 5–16 years ; 60 female , 44 male ; 51 healthy and 53 with recurrent headaches ) were r and omized into two groups : CAS or VAS . Children used the assigned scale to complete a calibration task , in which they rated the sizes of 7 circles varying in area ( 491 , 804 , 1385 , 2923 , 3848 , 5675 and 7854 mm2 ) . The psychophysical function relating perceived circle size to actual physical size was determined for the CAS and VAS . Children 's  CAS and VAS  responses on the calibration task yielded similar mathematical relationships ; & PHgr;cas = 0.035I0.87 , & PHgr;vas = 0.027I0.89 , where & PHgr ; = perceived magnitude and I = stimulus intensity . The R2 values were 0.921 and 0.922 for the CAS and VAS groups , respectively . Analyses of covariance revealed no significant differences in the characteristics of these relationships , i.e. , R2 , slope , or y intercept , by scale type . Children used the same scale to complete the Children 's Pain Inventory ( CPI ) , in which they rated the intensity and affect of 16 painful events ( varying in nature and extent of tissue damage ) . Children 's  CAS and VAS  responses on the CPI were similar . Analyses of covariance indicated that there were no differences in either intensity or affective ratings by scale type . However , the mean number of painful events experienced by children increased significantly with age ( P = 0.0001 ) . Intensity ratings decreased significantly with age ( P = 0.002 ) , but affective ratings did not vary with age . The new instrument has equivalent psychometric properties to a 165 mm VAS . However , the CAS was rated as easier to administer and score than the VAS , so it may be more practical for routine clinical use . Since the CAS has fulfilled the first two criteria for a pain measure ( psychophysical properties and discriminant validity ) , it is ethical to proceed with the formal definitive test for construct validity , in which children from various clinical population s use the CAS scale to assess their own pain OBJECTIVE To augment available validation data for the Faces Pain Scale - Revised ( FPS-R ) and to assess interscale agreement and preference in comparison with the Coloured Analogue Scale ( CAS ) in pediatric acute pain . METHOD The present prospect i ve , multicentre study included 131 in patients five to 15 years of age ( mean age 8.8 years ; 56 % male ) seen in postoperative recovery . They provided CAS and FPS-R pain scores before and after administration of analgesic medication . Nurses and physicians used the same tools as observational scales . Children and health care providers indicated which scale they preferred . RESULTS  FPS-R scores for the intensity of postoperative pain correlated highly with the corresponding CAS scores in all age groups ( 0.66 < or= r < or= 0.88 ) . There were no significant mean differences in any age group between the scales . Scores on the two scales differed by 210 or less in 81 % to 91 % of children , depending on age . Both scales demonstrated expected changes in postoperative pain following administration of an analgesic . Scores at the upper end point were given by approximately 20 % of children five to six years of age on both scales , compared with 2 % to 9 % in the older age groups . Health care providers ' observational ratings were significantly lower than self-ratings . The FPS-R was preferred over the CAS by most children in all age groups and both sexes . Global satisfaction of the health care providers was similar for both tools . DISCUSSION These results support the use of the FPS-R for most children five years of age or older in the postoperative period . Further research is needed to identify young children , particularly those younger than seven years of age , who have difficulty with self-report tools , and to establish methods for training them in the reliable use of these measures BACKGROUND AND OBJECTIVES : The Faces Pain Scale – Revised ( FPS-R ) and Color Analog Scale ( CAS ) are self-report pain scales commonly used in children but insufficiently vali date d in the emergency department setting . Our objectives were to determine the psychometric properties ( convergent validity , discriminative validity , responsivity , and reliability ) of the FPS-R and CAS , and to determine whether degree of validity varied based on age , sex , and ethnicity . METHODS : We conducted a prospect i ve , observational study of English- and Spanish-speaking children ages 4 to 17 years . Children with painful conditions indicated their pain severity on the FPS-R and CAS before and 30 minutes after analgesia . We assessed convergent validity ( Pearson correlations , Bl and -Altman method ) , discriminative validity ( comparing pain scores in children with pain against those without pain ) , responsivity ( comparing pain scores pre- and postanalgesia ) , and reliability ( Pearson correlations , repeatability coefficient ) . RESULTS : Of 620 patients analyzed , mean age was 9.2 ± 3.8 years , 291(46.8 % ) children were girls , 341(55 % ) were Hispanic , and 313(50.5 % ) were in the younger age group ( < 8 years ) . Pearson correlation was 0.85 , with higher correlation in older children and girls . Lower convergent validity was noted in children < 7 years of age . All subgroups based on age , sex , and ethnicity demonstrated discriminative validity and responsivity for both scales . Reliability was acceptable for both the FPS-R and CAS . CONCLUSIONS : The FPS-R and CAS overall demonstrate strong psychometric properties in children ages 4 to 17 years , and between subgroups based on age , sex , and ethnicity . Convergent validity was question able in children < 7 years old BACKGROUND : Self-reported pain scores are used widely in clinical and research setting s , yet little is known about their interpretability in children . In this prospect i ve , observational study we evaluated the relationship between 0 to 10 numerical rating scale ( NRS ) pain scores and other self-reported , clinical ly meaningful outcomes , including perceived need for medicine ( PNM ) , pain relief ( PR ) , and perceived satisfaction ( PS ) with treatment in children postoperatively . METHODS : This study included children ages 7 to 16 years undergoing surgery associated with postoperative pain . One to 4 observations were recorded in each child within the first 24 hours postoperatively . At each assessment , children rated their pain with the NRS , stated their PNM , and rated their satisfaction with  pain management .  Assessment s were repeated within 1 to 2 hours , and children additionally rated their PR as the same , better , or worse in comparison with the earlier assessment . Receiver operator characteristic curves were developed to examine potential NRS cut-points for PNM and PS , and the minimum clinical ly significant difference ( MCSD ) in pain score associated with PR was calculated . RESULTS : Three hundred ninety-seven observations ( including 189 pairs ) were recorded in 113 children .  NRS scores associated with PNM were significantly higher than “ no need ” ( median 6 vs. 3 ; P < 0.001 ) . NRS scores > 4 had good sensitivity ( 0.81 ) and specificity ( 0.70 ) to discriminate PNM , but with a large number of false positives and negatives ( e.g. , 42 % of children with scores > 4 did not need analgesia ) . The MCSD in NRS scores was −1 ( 95 % confidence interval [ CI ] −0.5 to 1 ) or + 1 ( CI 0.5 to 2.7 ) in relation to feel “ a little better ” or “ worse , ” respectively ( P < 0.001 vs. the same ) . NRS scores > 6 had a sensitivity of 0.82 and specificity of 0.76 in discriminating dissatisfaction with treatment , yet 46 % and 24 % of children with scores > 6 , respectively , were somewhat to very satisfied with their analgesia . CONCLUSIONS : This study provides important information regarding the clinical interpretation of NRS pain scores in children . Data further support the NRS as a valid measure of pain intensity in relation to the child 's PNM , PR , and PS in the acute postoperative setting . However , the variability in scores in relation to other clinical ly meaningful outcomes suggests that application of cut-points for individual treatment decisions is inappropriate In a previous study it was proved impossible to evaluate the validity of a system modified according to McGrath et al. for measuring  postoperative pain in children . Three reasons were postulated for this result . The analgesics used did not modulate the pain in such a manner that the statistical analysis was effective ; or the postoperative pain had an acute onset or fluctuated and the regular observations did not allow detection of the pain peaks ; or the system used did not measure pain . Therefore , a new and different approach was adopted to evaluate the reliability and validity of a scoring system for the measurement of  postoperative pain in small children . MATERIAL . Sixty children classed as ASA I and II and aged between 1 and 5 years were r and omly allocated to 2 groups : one group received Tramadol ( 0.5 mg/kg ) after the induction of anesthesia and the other group received placebo . Premedication and anesthesia were st and ardized . All indications were accepted except for urgent operations and painful diseases . For 1 h after the operation the children were continuously observed by an experienced pediatric anesthetist who did not know what drugs had been given . Every 15 min and when the observer was convinced that the children were in pain and needed analgesics the following items were scaled : wakefulness , wake-up reaction , crying , facial expression , position of the trunk , position of the legs , muscle tone , making contact , verbal communication on being asked about pain , special defense against stimuli and consolability . The items were included in a factor analysis ( principal components ) . The number of the factors was detected using the Scree test . The only items accepted as reliable were those that had a substantial load of at least 0.4 at each measurement . The reliability coefficient was computed with the split-half technique ( odd-even ) . The validity was estimated with a multifactorial analysis of variance with repeated measurements . When the observer was convinced that any child was in pain , Metamizol ( 15 mg/kg ) was administered . Significance was assumed at P less than 0.05 . The study was accepted by the ethical committee of the Ruhr University , Bochum . RESULTS . A replication verified the results of the previous study : the factor analysis result ed in a one-factorial solution . Of the 8 items ( wakefulness , wake-up reactions , crying , position of the trunk , position of the legs , verbal communications on being asked about pain , special defense against stimuli ) only 4 had a sufficiently substantial load on all measurements ( crying , facial expression , position of the trunk and position of the legs ) . ( ABSTRACT TRUNCATED AT 400 WORDS Objective To evaluate the psychometric properties of 4 measures of acute pain in youth with sickle cell disease ( SCD ) during a medical procedure . Methods Heart rate , child self-report , parent proxy-report , and observable pain behaviors were examined in 48 youth with SCD ages 2 to 17 years . Criterion validity for acute pain was assessed by responsiveness to a st and ardized painful stimulus ( venipuncture ) in a prospect i ve pre-post design . Convergent validity was evaluated through the correlation across measures in reactivity to the stimulus . Results Child self-reported pain , parent proxy-report , and behavioral distress scores increased in response to venipuncture ( concurrent and convergent validity ) . In contrast , heart rate did not reliably change in response to venipuncture . Extent of change in response to venipuncture showed moderate intercorrelation across child and parent pain ratings , and behavioral distress . Preprocedure pain ratings correlated with pain experienced during the procedure . An item analysis of observable pain behaviors suggested differences in the presentation of pain in SCD compared with previous pediatric research . Conclusions Criterion and convergent validity were demonstrated for child-report , parent-report , and observable pain behaviors . These measures seem to tap into distinct , yet overlapping aspects of the pain experience . Assessment of acute procedural pain responses in SCD requires evaluation of preprocedural pain due to the frequent presence of low-level , baseline pain The present study cross-vali date d self-report pain scales : Verbal Rating Scale ( VRS  ) ,  Facial Expression Scale ( FACES  ) ,  Color Analogue Scale ( CAS ) and Poker Chip Tool ( PCT ) in Thai children aged 5 - 12 years . The concordance with observational measure , Children 's Hospital of Eastern Ontario Pain Scale ( CHEOPS ) was also tested . Among 100 students , test-retest reliability of all self-report measures was moderate to good ( K = 0.501 - 0.712 ) and only FACES yielded acceptable face validity(IC > 0.5 ) . Validation in 87 patients , all scales showed construct and concurrent validity . FACES was the most preferred scale . Agreement of self-report measures and CHEOPS was better in the age group 5 - 8 years ( K = 0.417 - 0.826 ) than 9 - 12 years ( K = 0.231 - 0.529 ) . In conclusion , FACES is a valid , reliable and practical tool . Self-report measures are more in concordance with CHEOPS in the younger age group Objectives : To evaluate clinical feasibility of the Pain-QuILT ( previously known as the Iconic Pain Assessment Tool ) from the perspective of adolescents with chronic pain and members of their interdisciplinary health team . The Pain-QuILT ( PQ ) , a web-based tool that records the visual self-report of sensory pain in the form of time-stamped records , was directly compared with st and ard interview questions that were transformed to a paper-based tool . Methods : Qualitative , semi-structured interviews were used to refine the PQ . Adolescents with chronic pain aged 12 to 18 years used the PQ and comparator tool ( r and omized order ) to self-report pain before a scheduled clinic appointment , and then took part in a semi-structured interview . The health team used these pain reports ( PQ and comparator ) during patient appointments , and later participated in focus group interviews . Interview audio recordings were transcribed verbatim and underwent a simple line-by-line content analysis to identify key concepts . Results : A total of 17 adolescents and 9 health team members completed the study . All adolescents felt that the PQ was easy to use and underst and . The median time required for completion of the PQ and comparator tool was 3.3 and 3.6 minutes , respectively . Overall , 15/17 ( 88 % ) of adolescents preferred the PQ to self-report their pain versus the comparator . The health team indicated that the PQ was a clinical ly useful tool and identified minor barriers to implementation . Discussion : Consultations with adolescents and their health team indicate that the PQ is a clinical ly feasible tool for eliciting detailed self-report records of the sensory experience of chronic pain OBJECTIVES The objective was to determine the minimum and ideal clinical ly significant differences ( MCSD , ICSD ) in  pain intensity in children for the Faces Pain Scale-Revised ( FPS-R ) and the Color Analog Scale ( CAS ) and to identify any differences in these estimates based on patient characteristics . METHODS This was a prospect i ve study of children aged 4 to 17 years with acute pain presenting to two urban pediatric emergency departments . Participants self-reported their pain intensity 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 intensity ( 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 intensity . 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 intensity , therefore limiting their potential generalizability & NA ; Altogether 553 children ( 195 first grade rs , mean age 6.8 years , and 358 third grade rs , mean age 8.7 years ) participated in the development of a self‐report measure to assess the intensity of children 's pain .  The first step was the derivation , from children 's drawings of facial expressions of pain , of 5 sets of 7 schematic faces depicting changes in severity of expressed pain from no pain to the most pain possible . With the set of faces that achieved the highest agreement in pain ordering , additional studies were conducted to determine whether the set had the properties of a scale . In one study , children rank‐ordered the faces on 2 occasions , separated by 1 week . All 7 faces were correctly ranked by 64 % ( retest 1 week later , 61 % ) of grade 1 children and by 86 % ( retest 89 % ) of grade 3 children . In a second study , the faces were presented in all possible paired combinations . All 7 faces were correctly placed by 62 % ( retest 86 % ) of the younger and by 75 % ( retest 71 % ) of the older subjects . A third study asked children to place faces along scale : a procedure allowing a check on the e quality of intervals . The fourth study checked on whether pain was acting as an underlying construct for ordering the faces in memory . We asked whether children perceived the set as a scale by asking if memory for an ordered set of faces was more accurate than for a r and om set . The final study checked , with 6‐year‐old children , the test‐retest reliability of ratings for recalled experiences of pain . Overall , the faces pain scale incorporates conventions used by children , has achieved strong agreement in the rank ordering of pain , has indications that the intervals are close to equal , and is treated by children as a scale . The test‐retest data suggest that it may prove to be a reliable index over time of self‐reported pain OBJECTIVE Visual analog pain scales are reliable measures in older children and adults ; however , pain studies that include young children often rely on parental or practitioner assessment s for measuring pain severity . The authors correlated patient , parental , and practitioner pain assessment s for young children with acute pain . METHODS This was a prospect i ve , descriptive study of a convenience sample of 63 emergency department patients aged 4 - 7 years , with acute pain result ing from acute illness or painful invasive procedures . A trained research assistant administered a structured pain survey containing demographic and historical features to all parents/guardians . Children assessed their pain severity using a vali date d ordinal scale that uses five different faces with varying degrees of frowning ( severe pain ) or smiling ( no pain ) . Each face was converted to a numeric value from 0 ( no pain ) to 4 ( severe pain ) . Parents and practitioners independently assessed their child 's pain using a vali date d 100-mm visual analog scale ( VAS ) marked " most pain " at the high end . Pairwise correlations between child , parent , and practitioner pain assessment s were performed using Spearman 's or Pearson 's test as appropriate . The association between categorical data was assessed using chi(2 ) tests . RESULTS Sixty-three children ranging in age from 4 to 7 were included . Mean age ( + /-SD ) was 5.7 ( + /-1.1 ) ; 42 % were female . Fifty-seven successfully completed the face scale . The distribution of the children 's scores was 0 - 17 % , 1 - 9 % , 2 - 30 % , 3 - 14 % , and 4 - 30 % . Mean parental and practitioner scores ( + /-SD ) on the VAS were 61 ( + /-26 ) mm and 37 ( + /-26 ) mm , respectively ( maximal = 100 mm ) . Correlation between child and parent scores was 0.47 ( p < 0.001 ) . Correlation between child and practitioner scores was 0.08 ( p = 0.54 ) . Correlation between parent and practitioner scores was 0.04 ( p = 0.001 ) . CONCLUSIONS There is poor agreement between pain ratings by children , parents , and practitioners . It is unclear which assessment best approximates the true degree of pain the child is experiencing OBJECTIVE To quantify , using two pain assessment scales , the amount of change in pain severity required to achieve a clinical ly significant improvement in pain in children presenting to a pediatric emergency department ( ED ) with pain . METHODS Prospect i ve , descriptive study involving all children presenting to a pediatric ED between 5 and 16 years of age inclusive with acute pain . Children were excluded if they 1 ) were intoxicated or had altered sensorium , 2 ) were clinical ly unstable , 3 ) were non-English-speaking , or 4 ) were developmentally delayed . Written informed consent was obtained . Children were asked to mark their current pain severity on the st and ardized Color Analogue Scale ( CAS ) and Faces Pain Scale ( FPS ) . After each pain control intervention the child was asked to repeat these measurements and to describe whether his or her pain was " much less , " " a little less , " " about the same , " " a little worse , " or " much worse " compared with before . This process was repeated until the child was discharged from the ED or had a score of zero . The main outcome measure was the smallest change on the CAS or FPS necessary to cause the child to describe his or her pain as a " little less . " This was defined as the clinical ly significant change in pain . The " ideal " change in pain was defined as the amount of change necessary for the child to describe the pain as " much less " or at which point the child thought he or she no longer required any medicine to help the pain go away . RESULTS One hundred twenty-one children were enrolled with a mean age of 9.8 years ( SD + /- 3.15 ) . Males accounted for 56 % . Pain was traumatic in 65 % and nontraumatic in 35 % . A total of 153 pain comparisons were made using the CAS and 154 using the FPS . Only three children complained that their pain got worse ( two a little worse and one much worse ) . Pain was described as " the same " in 20 . Of the 60 pain comparisons judged to be a " little less , " the CAS score changed by a median of 2.0 cm [ interquartile ratio ( IQR ) 1 - 3 ] , and the FPS by 1.0 face ( IQR 1 - 2 ) . In the 71 children who judged their pain to be " much less , " the CAS decreased by a median of 4.0 cm ( IQR 2 - 5 ) and the FPS by 2.0 faces ( IQR 2 - 3 ) . CONCLUSIONS The assessment and treatment of  pain in children are an important component of pediatric practice , especially in the ED . This study provides health care professionals and clinical investigators the information necessary to assess whether their method of pain control in children is clinical ly relevant OBJECTIVE To determine the construct , content , and convergent validity of 2 self-report pain scales for use in the untrained child in the emergency department ( ED ) . METHODS A prospect i ve study was conducted of all children who presented to an urban ED between 5 and 16 years of age inclusive after written informed consent was obtained . Children were excluded if they were intoxicated , had altered sensorium , were clinical ly unstable , did not speak English , or had developmental delays . Children marked their current pain severity on a st and ardized Color Analog Scale ( CAS ) and a 7-point Faces Pain Scale ( FPS ) . They were then asked whether their pain was mild , moderate , or severe . Children were then administered an analgesic at the discretion of the attending physician and asked to repeat these measurements . For assessing content validity , the scales were also administered to age- and gender-matched children in the ED for nonpainful conditions . Convergent validity was assessed by determining the Spearman correlation coefficient between the 2 pain scales . RESULTS A total of 60 children were enrolled , 30 with pain and 30 without , with a mean age of 9.3 + /- 3.3 years . Boys accounted for 38 of the enrollees ( 63.3 % ) . The median score before analgesic administration was 6.0 cm ( interquartile range [ IQR ] : 4.0 - 8.0 ) on the CAS and 3.0 faces ( IQR : 2.0 - 5.0 ) on the FPS ; after analgesic administration , the median scores decreased to 3.1 cm ( IQR : 1.1 - 4.3 ) and 2.0 faces ( IQR : 1.0 - 3.0 ) , respectively . As the reported pain intensity increased , so did the scores on the 2 pain scales . The 30 children with no pain had a median score on the CAS of 0.0 ( IQR : 0.0 - 1.0 ) and on the FPS of 0.0 ( IQR : 0.0 - 1.0 ) , whereas the 13 children with severe pain had a median CAS of 7.0 ( IQR : 6.0 - 8.0 ) and a median FPS of 5.0 ( IQR : 4.0 - 6.0 ) . The Spearman correlation coefficient between the CAS and the FPS was positive and strong ( r = 0.894 ) . CONCLUSION The CAS and the FPS exhibit construct , content , and convergent validity in the measurement of acute pain in children in the ED
Based on available evidence , the NRS-11 , FPS-R , and CAS were strongly recommended for self-report of acute pain .
Only weak recommendations could be made for self-report measures for postoperative and chronic pain .
No measures were recommended for children younger than 6 years , identifying a need for further measurement refinement in this age range .
Abstract In 2006 , PAIN published a systematic review of the measurement properties of self-report pain intensity measures  in children and adolescents ( Stinson JN , Kavanagh T , Yamada J , Gill N , Stevens B. Systematic review of the psychometric properties , interpretability and feasibility of self-report pain intensity measures for use in clinical trials in children and adolescents .
Key developments in pediatric pain necessitate an up date of this work , most notably growing use of the 11-point numeric rating scale ( NRS-11 ) .
Our aim was to review the measurement properties of single-item self-report pain intensity measures in children 3 to 18 years old .
A secondary aim was to develop evidence -based recommendations for measurement of child and adolescent self-report of acute , postoperative , and chronic pain .