A systematic review of faces scales for the self-report of pain intensity in children.

The landmark paper discussed in this chapter is a systematic review assessing the commonly used faces pain scales employed to aid children in the self-report of their pain intensity. The review provides a critical evaluation of the Faces Pain Scale, the Faces Pain Scale-Revised (FPS-R), the Oucher pain scale, and the Wong–Baker Faces Pain Rating Scale (WBFPRS). The reviewers found that the psychometric properties of the FPS-R supported its superiority for use in research. Although they found that children, and many staff, expressed a preference for the WBFPRS, the reviewers had major concerns about this scale confounding pain intensity with affect. They also noted the paucity of research in younger children, and concluded that future research should not focus on developing more pain scales for paediatric use but on examining the appropriate application of existing scales in a wider range of clinical settings.

Numerical rating scale for self-report of pain intensity in children and adolescents: Recent progress and further questions

Dental pain exerts a considerable impact on the psychosocial well-being of children; reliable management of pain depends on the ability to assess pain intensity. To validate and compare a new memojis pain assessment scale with the Faces Pain Scale-Revised (FPS-R) and Wong-Baker FACES Pain Rating Scale (WBFPS) in assessing dental pain experienced by children. Two hundred and fifty healthy children aged 5-9 years without any past dental experience and requiring local anaesthesia (LA) administration were recruited. Three different scales [FPS-R, WBFPS and Memojis Pain Scale (MPS)] were applied to assess the children's pain during LA administration. The preferences of each child based on the ease of understanding the faces were recorded. Pearson correlation test was performed to determine the correlation between MPS with WBFPS and MPS with FPS-R. A strong correlation was seen when comparing MPS with WBFPS (r= .966; p< .001) and MPS with FPS-R (r= .969; p< .001), and 81.6% of the children preferred MPS. The Memojis Pain Scale was an effective pain assessment tool. It can be employed as an alternative scale for pain assessment in children.

Difficulties assessing pain in individuals who cannot use self-report scales has led to their exclusion from clinical trials and rendered them vulnerable to undertreatment of pain. Although several observational pain scales are available for use in these populations, many lack the characteristics necessary for routine implementation into practice or research. The Face, Legs, Activity, Cry And Consolability pain scale was developed as a simple measure of pain intensity in young children. It has been validated in the postoperative setting in children 2–7 years of age and children aged 4–18 years with varying degrees of cognitive impairment. With minor revisions, the Face, Legs, Activity, Cry and Consolability pain scale may be useful to assess acute pain across populations of children and adults who are unable to self-report their pain.

The Faces Pain Scale – Revised: toward a common metric in pediatric pain measurement

Pain intensity is considered as the fifth vital sign. However, it is the only vital sign which is subjective, with there being many pain measurement tools for adults to rate their level of pain. Additionally, there is an increasing number of aging populations throughout the world, and pain measurement in this group of people is challenging as geriatrics have both physical and cognitive impairment.&#x0D; The most frequently utilized pain measurement tools are; the Visual Analogue Scale (VAS), Verbal Rating Scale (VRS), Numerical Rating Scale (NRS); and faces scales [Faces Pain Scale (FPS) and Faces Pain Scale-Revised (FPS-R) are the faces scales studied most often] tend to be valid for measuring pain severity in cognitively intact elderly. When problems arise, the VAS is the pain measurement tool found to have more difficulties (including higher rates of failure) than the other tools. In elderly with cognitive deficits, fewer difficulties tend to occur as the tools become simpler, with the most valid and useful tools in the following order: the FPS/FPS-R, the VRS, the 0-10 NRS, and the VAS. Furthermore, simpler pain measurement tools tend to be favored over more complicated tools. Keywords: aging; elderly; geriatrics; older; pain measurement; pain measurement tools

Measurement of self-reported pain intensity in children and adolescents

Comparison of Four Pain Scales Among Hmong Patients with Limited English Proficiency

Validation of Pediatric Self-Report Pain Scales in Sub-Saharan Africa: A Systematic Review

Faces scales are commonly used to obtain self-reports of pain intensity from children. Previous research using hypothetical vignettes and pain following venepuncture has found differences in children's pain ratings as a function of the type of faces scale used. The purpose of the present study was to determine whether scales beginning with a smiling rather than neutral "no pain" face would produce higher ratings in the assessment of postoperative pain intensity in children and to compare ratings using different faces scales to those reported with an additional independent measure of pain intensity. Participants were 78 children between the ages of 5 and 13 years undergoing surgery, one of their parents, and their postoperative care nurse. Following surgery, children were asked to provide a rating of their current pain intensity using a set of 5 successively administered faces scales and the Colored Analog Scale (CAS). Parents and nurses provided independent ratings using the same measures. Results showed that parents and nurses rated significantly more pain when using scales with a smiling rather than a neutral "no pain" face. This pattern was not as clear for the children's ratings, although their highest ratings were provided when using a smiling "no pain" faces scale. Children's and nurses' ratings on the CAS were generally more similar to their ratings using scales with neutral "no pain" faces, whereas parents' CAS ratings tended to fall in between ratings provided on the smiling and neutral "no pain" faces scales. Scale preference, age and sex differences in pain ratings, and child-parent-nurse agreement in pain ratings are also examined. Children's and parents' ratings of postoperative pain intensity are influenced by the presence of a smiling "no pain" face at the beginning of faces scales, with such scales producing significantly higher ratings than scales with neutral "no pain" faces. Ratings on the independent CAS measure were more comparable to those provided on faces scales with neutral "no pain" faces. Nurses are also susceptible to the influencing effect of a smiling face at the beginning of a faces scale.

Aim: The first aim was to compare the performance of three pain intensity scales, the combined Visual Analogue Scale / Numerical Rating Scale (VAS/NRS), NRS, and Faces Pain Scale - Revised (FPS-R), in Czech women in the Obstetrics & Gynaecology Intensive Care Unit. The second aim was to compare the women's overall pain scale preference rankings and preference rankings by education level and age. Design: The design was cross-sectional. Methods: Seventy-four women evaluated their acute postoperative pain using the three pain scales and subsequently ranked them according to ease of responding. The data were described and analysed using descriptive statistics and the Spearman rank order correlation coefficient. Results: Spearman correlations ranged from 0.905 (p < 0.001) between the VAS/NRS and the FPS-R to 0.945 (p < 0.001) between the VAS/NRS and the NRS. As for overall preference, the NRS and the FPS-R were ranked first (n = 32; 43% in both cases). Conclusion: Correlations across all three scales were high. Therefore, the scales appeared equivalent. Overall, preference rankings of the NRS and FPS-R were comparable and were better than those obtained for the VAS/NRS. Therefore, both scales could be recommended for clinical use in the Czech Republic.

To what degree can facial expression scales help children differentiate between the sensory and emotional aspects of the pain experience? This study examined the relationship between children's ratings on the Faces Pain Scale (an intensity measure), the Facial Affective Scale (an affective measure), and a paired mechanical visual analogue (MVAS) method for measuring the intensity and unpleasantness of pain. It was predicted that ratings on the Faces Pain Scale should correlate best with the MVAS measure of pain intensity rather than unpleasantness. Likewise, ratings on the Facial Affective Scale should correlate best with the MVAS measure of pain unpleasantness (assumed to reflect an emotional dimension) rather than intensity. Eighty children scheduled for blood sampling were selected in two age groups: 4 to 6, and 7 to 10 years. Children rated needle pain using each pain scale. As hypothesized, ratings on the Faces Pain Scale correlated more highly with the MVAS ratings for intensity (r =0.77) than for unpleasantness (r =0.52). A smaller reverse finding was confirmed for the Facial Affective Scale which correlated more highly with the MVAS for unpleasantness (r =0.64) than for intensity (r =0.51). Factor analysis indicated that 'pain dimension' (intensity vs affect) was a relatively weak factor as compared with shared instrument variance (two MVAS vs two face scales). No systematic age effects were observed. In conclusion, the Faces Pain Scale and the Facial Affective Scale may partly measure different aspects of the pain experience in children, although it remains to be determined to what degree the obtained differences are clinically meaningful. Copyright 1999 European Federation of Chapters of the International Association for the Study of Pain.

A comparison of the Faces Pain Scale and the Facial Affective Scale for children's estimates of the intensity and unpleasantness of needle pain during blood sampling

Background: Children with abdominal pain in the emergency department (ED) are at particular risk of suboptimal analgesia due to fears of missing appendicitis and absent guidelines. Many still experience pain at discharge. Acetaminophen is the most commonly used analgesic and efficacy of hyoscine butylbromide (HBB) is supported by adult evidence. However, no evidence exists for either agent in children with abdominal pain. Objective: To determine if HBB is superior to acetaminophen for abdominal pain in children. Methods: We will consecutively recruit children 8-17 years presenting to the ED with presumed non-surgical abdominal pain rated &amp;gt;4/10 on the Faces Pain Scale – Revised (FPS-R) and described as colicky, excluding:-Suspected appendicitis or bowel obstruction-Anticholinergic, analgesic, or antispasmodic &amp;lt;12 hours-Peritoneal inflammation-Unable to swallow pills-Hypersensitivity to either intervention-Medically unstable-Previous bowel obstruction, abdominal surgery, myasthenia gravis, liver disease, glaucoma, or recent abdominal trauma (&amp;lt;48 hours)-Toxin ingestion (&amp;lt;24 hours)-Vomiting-Pregnancy Randomization and allocation concealment will be pharmacy-controlled and performed using a computerized random number generator and sequentially numbered, opaque, sealed envelopes, respectively. The physician, research assistant, nurse, and participant will be blinded. Due to perceptible differences, participants will be randomized in a double-dummy approach to:-HBB 10 mg tablet + acetaminophen placebo OR-Acetaminophen 15 mg/kg liquid (maximum 975 mg) + HBB placebo. The primary outcome will be the difference from baseline on the FPS-R at 120 minutes, reflecting HBB’s time to peak plasma concentration. The FPS-R has been validated in children &amp;gt;five years. Secondary outcomes include:-Pain scores at 15, 30, 45, 60, 80, 100, and 120 minutes post-intervention (FPS-R and 100 mm visual analog scale)-Discharge pain score-Rescue analgesia-Time to achieve a 20% reduction in pain-Adverse effects-Recidivism &amp;lt;48 hours-Missed surgical diagnoses (National Ambulatory Care Reporting System (NACRS) database)-Caregiver satisfaction (five-item Likert scale). Using the intention to treat principle, ordinal, ratio, and categorical data will be analyzed using the Mann-Whitney, paired t-test, and Pearson’s chi-square, respectively and summarized using 95% confidence intervals. Assuming a standard deviation of 2 faces, 83 children per group will be required to detect a 1-face difference at 5% significance with 90% power. Increasing by 20% equals 100 participants per group. P values &amp;lt;0.05 will be considered significant. An institutional audit revealed 380 eligible patients per year during research assistant availability. Given a 30% refusal rate, we expect five participants enrolled per week for 40 weeks. Importance: Our findings will guide evidence-based analgesic choices for children with non-surgical abdominal pain in the ED.

Pain negatively affects quality of life and requires accurate assessment methods. The present study aimed to evaluate acute pain in Brazilian children after procedures and surgeries, using two psychometric scales: the Facial Pain Scale - Revised (FPS-R) and the Color Analog Scale (CAS), which are recommended to measure pain intensity in children. A total of 130 children who underwent venipuncture and minor surgeries participated in the study, using the FPS-R and CAS to assess pain. The results emphasized the importance of evaluating pain perception in children to guide effective strategies for managing acute pain.