There is more to pain measurement in children than "ouch".

Abstract

AbstractPain measurement in children has made important advances in the past decade. There are now excellent self report measures of pain for children over the age of about five years of age. In addition, there are both broad band and fine grained behavioral measures that have been extensively studied. Among the fine grained measures, facial action scales appear to be most sensitive. At this time, cry measures are not developed to the point of being able to distinguish a pain cry. Broad band behavioral measures have been shown to be valid and sensitive for short, sharp pain and for pain in the recovery room in infants and children. There is evidence that these measures habituate when a child is in pain for several hours. Moreover, some measures are not specific to pain and may also reflect anxiety and depression. Although the progress has been impressive, there are significant deficiencies in the measurement of longer term pain when self report measures cannot be used. The major technical problems are that both biological and behavioral measures tend to habituate over time and that measures may not be specific to pain. Development of new measures will require different approaches than those currently in use.There are significant economic and political barriers to adequate pain measurement that are as important as our current technical problems. The low priority that pain has in hospitals and the lack of education about pain in medical and nursing schools combine with highly prevalent myths about pain to prevent adequate assessment and management of pain.Children in hospitals deserve adequate pain control and the implementation of pain measurement is a critical step in this process.I often say that when you can measure what you are speaking about, and express it in numbers, you know something about it, but when you cannot measure it, when you cannot express it in numbers, your knowledge is of a meagre and unsatisfactory kind; it may be the beginning of knowledge, but you have scarcely, in your thoughts advanced to the state of science whatever the matter may be (Lord Kelvin, quoted in Thomas, 1983, pp. 143 - 144).Measurement of pain is a prerequisite to scientific investigation of pain. Without reliable and valid measures, we cannot examine the nature, origins, and correlates of pain. Nor can we evaluate psychological or pharmacological interventions for pain. Finally, we need valid and reliable measurement to develop understanding and propose theories regarding causation of pain problems. Measurement is the foundation of progress in this area.If measurement is the foundation of progress in pediatric pain, the engine driving progress, the motivation for new developments, has been caring and concern for children. An important source of this motivation has come from parents who have demanded that clinicians and scientists develop better treatments for their children. The lobbying efforts of parents have encouraged us to make progress. Parents understand that pain in children should be treated because of humanitarian reasons. We now know that there are good medical reasons for treating pain. Untreated pain may lead to destabilization of sick children and may even result in increased mortality (Anand & Hickey, 1992). Untreated pain may also encourage tumour growth (Leibskind, 1991) and pain may sensitize the brain to more easily experience pain in the future (Grunau, Whitfield, Petrie & Fryer, 1994; Taddio, Goldbach, Ipp, Stevens & Koren, 1995).The search for valid measures of pain in children impinges on many areas of psychological theory and practice. Pain measurement has, to some extent, made use of developmental psychology and experimental methods. The interaction between laboratory and clinical methods will, in my opinion, be critical to further development of pediatric pain measurement. For the scientist, the measurement of pain is a difficult and intriguing challenge. …