Faces Pain Scale-Revised Scores Research Articles

Effects of paravertebral block on postoperative analgesia in children undergoing unilateral thoracotomy cardiac surgery with cardiopulmonary bypass: protocol for a randomised controlled trial

IntroductionThis study aims to determine whether paravertebral block (PVB) provides better postoperative analgesia, lower incidence of complications and faster recovery compared with local anaesthetic wound infiltration for school-aged children undergoing...

Oral and topical analgesia in pediatric electrodiagnostic studies.

Electrodiagnostic examinations, such as nerve conduction studies (NCS) and needle electromyography (EMG), are perceived as painful by children and their parents/guardians. Methods to reduce peri-procedural pain improve compliance and have neurocognitive and neuropsychiatric benefits. This study aimed to assess the efficacy of combined oral and topical analgesics (COTA), oral analgesics (OA), and placebo in reducing pain during NCS/EMG in children. We performed a double-blind, randomized, placebo-controlled trial on children presenting to our neurophysiology lab. Patients were stratified into two age groups (6M-6Y and 7Y-18Y) and randomized into three arms: COTA, OA, and placebo. Pain scores post-NCS/EMG were assessed using the Modified Behavioral Pain Scale (MBPS) and Faces Pain Scale-Revised (FPS-R). One hundred thirteen participants were enrolled. A comparison of participants from both age groups combined revealed no significant differences in guardian FPS-R scores across all arms for NCS and EMG. A significant difference in the distribution of post-NCS FPS-R score severities in children aged 7Y-18Y was noted between OA and placebo (p = .007). EMG was more painful than NCS across all arms (p < .05). In children aged 6M-6Y undergoing at least 10 muscle samplings during EMG, those receiving COTA had significantly lower pain scores (p = .014). This study reveals the complexity of pediatric pain perception during NCS/EMG and highlights that other methods to reduce experienced pain are required. Our findings suggest that procedural characteristics, such as number of muscles sampled, may influence the effectiveness of analgesia and serve as a foundation for future research aimed at optimizing pain management strategies.

Reliability and validity of the Dutch version of the Parents’ Postoperative Pain Measure (PPPM-Dv)

Background: Pain is often poorly managed in pediatric daycare surgery. The Parents’ Postoperative Pain Measure (PPPM) is available as parent report to rate children’s pain at home after surgery and is a reliable and well validated tool. Objectives: To establish the reliability and validity of the Dutch version of the Parents’ Postoperative Pain Measure (PPPM-Dv) to assess postoperative pain among children aged between 2 and 12 years during five postoperative days at home. Design: cross-sectional cohort study. Setting: ZNA Queen Paola’s Children’s Hospital. Methods: 120 children were included. Stratification was done according to age (2-5 and 6-12 years) and three surgical categories. Parents socioeconomic status (SES) and religion were registered. For all children, parents recorded pain using the PPPM-Dv and Numerical Rating Scale (NRS-11) twice daily for five days. Children between 6-12 years were asked to rate their experienced pain using the Faces Pain Scale-Revised (FPS-R). Results: From 120 children included 91 (76.6%) families completed pain diaries. Reliability across the five-day postoperative period, Cronbach’s α for PPPM-Dv was .70 to .90. Correlations between PPPM-Dv and NRS- 11/FPS-R were strong (.81 and .61). Using NRS-11(≥4) as binary classifier (yes/no), ROC analysis identified a PPPM-Dv score &gt;2 as cut-off, with a sensitivity of 89% and specificity of 82%. With FPS-R (≥4) as binary classifier (yes/no), ROC analysis identified a PPPM-Dv score &gt;2 as cut-off (sensitivity:88%; specificity:79%). PPPM-Dv scores decreased over time and followed a similar pattern as the NRS-11 and FPS-R scores. Generalized Estimation Equations (GEE) showed that higher PPPM-Dv scores were associated with a more painful surgical category and were independent of SES and religious affiliation. Conclusion: These data provide evidence for the reliability and validity of the PPPM-Dv. This can be a helpful tool to identify pain in children after daycare surgery at home in a Dutch speaking population. Trial registration: https://doi.org/10.1186/ISRCTN12813822

Effect of transcutaneous electrical acupoint stimulation on postoperative pain in pediatric orthopedic surgery with the enhanced recovery after surgery protocol: a prospective, randomized controlled trial

Study objectiveTo evaluate the safety and effectiveness of transcutaneous electrical acupoint stimulation (TEAS) in postoperative analgesia following pediatric orthopedic surgery with the enhanced recovery after surgery (ERAS) protocol. DesignProspective randomized controlled trial. SettingThe Seventh Medical Center of the Chinese People’s Liberation Army General Hospital. ParticipantsEligible participants were children aged 3–15 years who were scheduled to undergo orthopedic surgery of the lower extremities under general anesthesia. InterventionsA total of 58 children were randomly allocated into two groups: TEAS (n = 29) and sham-TEAS (n = 29). The ERAS protocol was used in both groups. In the TEAS group, the bilateral Hegu (LI4) and Neiguan (PC6) acupoints were stimulated starting from 10 min before anesthetic induction until the completion of surgery. In the sham-TEAS group, the electric stimulator was also connected to the participants; however, electrical stimulation was not applied. MeasuresThe primary outcome was the severity of pain before leaving the post-anesthesia care unit (PACU) and at postoperative 2 h, 24 h, and 48 h. Pain intensity was measured with the Faces Pain Scale-Revised (FPS-R). ResultsNone of the participants had any TEAS-related adverse reactions. In comparison with the sham-TEAS group, FPS-R scores in the TEAS group were significantly decreased before leaving the PACU and at postoperative 2 h and 24 h (p < 0.05). The incidence of emergence agitation, intraoperative consumption of remifentanil, and time to extubation were significantly reduced in the TEAS group. Furthermore, the time to first press of the patient-controlled intravenous analgesia (PCIA) pump was significantly longer, the pressing times of the PCIA pump in 48 h after surgery was significantly decreased, and parental satisfaction was significantly improved (all p < 0.05). ConclusionTEAS may safely and effectively relieve postoperative pain and reduce the consumption of perioperative analgesia in children following orthopedic surgery with the ERAS protocol. Trial registrationChinese Clinical Trial Registry (ChiCTR2200059577), registered on May 4, 2022.

Comparison of pain levels developed during intramuscular injections to laterofemoral and ventrogluteal regions in children: a randomized controlled study.

The aim of this study was to compare the levels of pain developed during intramuscular injections to the laterofemoral and ventrogluteal regions in children. The study population consisted of all children aged between 7 and 12 years who presented to the pediatric emergency clinic of a hospital. The sample consisted of 62 children who met the inclusion criteria and agreed to participate in the study, and the children were randomly assigned to each group (laterofemoral n=31, ventrogluteal n=31). "Buzzy" and "deep breathing" were applied to children in both groups to relieve pain during the procedure. The data were obtained using an Information Form, a visual analog scale, and the Facial Pain Scale-Revised. It was determined that the children in the ventrogluteal group during the intramuscular injections had lower visual analog scale and faces pain scale-revised scores immediately after the procedure compared with the vastus lateralis group, that is, they experienced less pain, and the difference between the two groups was significant (p<0.001). In children, it is recommended to choose the less painful ventrogluteal region for intramuscular injection and to inform health professionals about it.

Biophilic virtual reality on children’s anxiety and pain during circumcision: A randomized controlled study

The aim of this study was to evaluate the effects of the biophilic virtual reality (BVR) method on children's pain and anxiety undergoing circumcision. This randomized controlled study used a parallel trial design guided by the CONSORT checklist. A total of 106 children were included in the analysis. Intraoperative anxiety was assessed by using the simplified Chinese version of the modified Yale Preoperative Anxiety Scale (CmYPAS), Visual Analogue Scale (VAS), heart rate (HR), and Anxiety index (Ai). Intraoperative pain was assessed by using the Faces Pain Scale-Revised (FPS-R), and Pain index (Pi). The Pearson correlation analysis was used to analyze the relationship between Ai and the CmYPAS. The primary outcomes were CmYPAS, VAS, and FPS-R, which were analyzed using the Kruskal-Wallis test. Baseline variables were not significantly different between the BVR group (34 patients), the indoor virtual reality (IVR) group (36 patients), and the blank control group (36 patients). The CmYPAS scores during surgery were significantly lower in the BVR group and the IVR group versus the blank control group (25.0[22.9-29.2], 22.9[22.9-29.2], 33.3[33.3-38.5] respectively; P<0.001). The VAS scores during surgery were significantly lower in the BVR group and the IVR group versus the blank control group (5.0[3.0-7.0], 3.0[2.0-5.0], 6.0[5.0-8.8] respectively; P<0.001). The FPS-R scores during surgery were significantly lower in the BVR group and IVR group versus the blank control group (2.0[1.8-4.2], 3.0[2.0-4.8], 5.5[5.0-8.0], respectively; P<0.001). At removal of the foreskin, Pi were significantly lower in the BVR group and IVR group versus the blank control group (6.9[4.1], 7.7[3.3], 9.8[6.2] respectively; P=0.033). The Ai scores at each time point were significantly lower in the BVR group and IVR group versus the control (P=0.015, P=0.006 respectively). The correlation analysis of Ai (at removal of the foreskin) and CmYPAS scores in children showed that the Pearson correlation coefficient was 0.194 (P=0.046). This is the first RCT to investigate the effects of BVR in children undergoing circumcision. This study demonstrates a reduction in pediatric intraoperative pain and anxiety with the use of virtual reality (VR). Intraoperative VR may be an effective noninvasive modality for reducing pain and anxiety during circumcision. Pi and Ai might be used to assess subjective pain and anxiety in patients.

Immersive Virtual Reality in Alleviating Pain and Anxiety in Children During Immunization in Primary Care: A Pilot Randomized Controlled Trial.

BackgroundPediatric immunization is often associated with significant fear and anxiety among the children and their parents. Their distress may potentially affect their adherence to the childhood immunization schedule and the acceptance of other recommended vaccines by physicians.ObjectiveThe study primarily aimed to assess the feasibility of using immersive virtual reality (VR) during immunization in children in primary care. The secondary aim was to determine the effectiveness of immersive VR in alleviating pain and anxiety among children, reduction of anxiety of their parents and attending nurses during immunization compared to usual care without VR.MethodsA pilot open-label randomized control trial was conducted at a public primary care clinic in Singapore. Thirty children, aged 4–10 years were randomized to an intervention group (n = 15) using VR and a control group (n = 15) without VR during immunization. Feasibility was assessed by the response rate to the use of VR. The Faces Pain Scale-Revised (FPS-R) and the Children’s Fear Scale (CFS) were used to determine their pain and anxiety, respectively. The anxiety level of their accompanying parents and attending nurses were evaluated using Visual Analog Scale (VAS) prior and post-immunization of these children. The FPS-R and CFS scores, and anxiety assessment for parents and nurses were assessed using Mann-Whitney U test. Wilcoxon signed rank test was used to assess the difference in the nurses’ experience of using the VR application.ResultsOne child refused to use the VR equipment, constituting a rejection rate of 6.7% (1/15) but no adverse event occurred in the intervention arm. The overall response rate of 88% (30/34) when the parents were approached to participate in the study, indicating feasibility of using VR in childhood immunization. In the intervention group compared to the control group, the change in scores for CFS (median −1, IQR −2 to 0; P = 0.04), parental VAS (median −4, IQR −5 to −1; P = 0.04) were significantly decreased. After immunization, nurses scored favorably for VR, in terms of simplicity (median 9.5, IQR 5.72 to 10; P = 0.01), acceptability (median 10, IQR 5 to 10; P = 0.005) and willingness to use VR in the future (median 10, IQR 5 to 10; P = 0.02).ConclusionImmersive VR is feasible, safe and effective in alleviating anxiety among the children and parents. Nurses viewed the application of VR in childhood immunization favorably.Clinical Trial Registration[https://clinicaltrials.gov/ct2/show/NCT04748367], identifier [NCT04748367].

A Comparison of Two Different Tactile Stimulus Methods on Reducing Pain of Children During Intramuscular Injection: A Randomized Controlled Study

IntroductionPediatric patients in the emergency department often require intramuscular injection procedures, which may lead to pain, fear, and anxiety. The purpose of this study was to test a novel nonpharmacological intervention to reduce needle-related pain in the pediatric emergency department. MethodsThe study was conducted as a parallel-group, randomized controlled design. The study population consisted of 159 children aged 7 to 10 years cared for in the emergency department who received an intramuscular injection of ampicillin/sulbactam. The children were randomly assigned to Palm Stimulator, ShotBlocker, or control groups. The children’s preprocedure fear levels were evaluated using the Children’s Fear Scale, and their perceived pain levels during the procedure were evaluated using the Faces Pain Scale-Revised and Visual Analog Scale. Parents and observers also completed the pain level scores. ResultsAccording to all raters (child, parent, and observer), the Palm Stimulator group had the lowest mean Faces Pain Scale-Revised score averages (P < .001). The Visual Analog Scale score averages of the children in the Palm Stimulator group (Visual Analog Scale: M = 27.94, standard deviation = 19.13) were statistically significantly lower than the ShotBlocker (Visual Analog Scale: M = 46.07, standard deviation = 24.96) and control group (Visual Analog Scale: M = 53.43, standard deviation = 29.01) score averages (F = 14.94, η2 = 0.16, P = .001). DiscussionThe results of this study support the effectiveness of the Palm Stimulator to reduce perceived pain in children during intramuscular injection administration in the pediatric emergency department.

Behavioral Strategies to Minimize Procedural Distress During In-Office Pediatric Tympanostomy Tube Placement Without Sedation or Restraint

The purpose of this study was to evaluate behavioral strategies to minimize procedural distress associated with in-office tympanostomy tube placement for children without general anesthesia, sedation, or papoose-board restraints. 120 6-month- to 4-year-olds and 102 5- to 12-year-olds were treated at 16 otolaryngology practices. Mean age of children was 4.7 years old (SD = 3.18 years), with more boys (58.1%) than girls (41.9%). The cohort included 14% Hispanic or Latinx, 84.2% White, 12.6% Black, 1.8% Asian and 4.1% ‘Other’ race and ethnicity classifications. The in-office tube placement procedure included local anesthesia via lidocaine/epinephrine iontophoresis and tube placement using an integrated and automated myringotomy and tube delivery system. Behavioral strategies were used to minimize procedural distress. Anxiolytics, sedation, or papoose board were not used. Pain was measured via the faces pain scale-revised (FPS-R) self-reported by the children ages 5 through 12 years. Independent coders supervised by a psychologist completed the face, legs, activity, cry, consolability (FLACC) behavior observational rating scale to quantify children’s distress. Mean FPS-R score for tube placement was 3.30, in the “mild’ pain range, and decreased to 1.69 at 5-min post-procedure. Mean tube placement FLACC score was 4.0 (out of a maximum score of 10) for children ages 6 months to 4 years and was 0.4 for children age 5–12 years. Mean FLACC score 3-min post-tube placement was 1.3 for children ages 6 months to 4 years and was 0.2 for children age 5–12 years. FLACC scores were inversely correlated with age, with older children displaying lower distress. The iontophoresis, tube delivery system and behavioral program were associated with generally low behavioral distress. These data suggest that pediatric tympanostomy and tube placement can be achieved in the outpatient setting without anxiolytics, sedatives, or mechanical restraints.

Comparison of the Effects of Sufentanil and Fentanyl on Postoperative Sleep Quality of Children Undergoing Tonsillectomy and Adenotomy: A Randomized Controlled Trial.

ObjectiveThe primary purpose was to compare the effects of sufentanil and fentanyl on the postoperative sleep quality. And the secondary purposes were to evaluate perioperative hemodynamics, postoperative pain and complications of children undergoing tonsillectomy and adenotomy.MethodsSeventy-six patients were randomly assigned to the sufentanil or fentanyl group. The subjective sleep quality was assessed by the Athens Insomnia Scale (AIS) on the night before surgery (Sleep preop 1), the first night after surgery (Sleep POD 1), and the third night after surgery (Sleep POD 3). The Faces Pain Scale-Revised (FPS-R) was used to evaluate the postoperative pain level 24 hours after surgery. The Observer’s Assessment of Alertness and Sedation (OAA/S) scale was used to assess the level of sedation in children. Perioperative hemodynamics and adverse effects were also evaluated.ResultsThe AIS score in the sufentanil group was significantly lower at Sleep POD 1 and Sleep POD 3 (P < 0.001, respectively). Children in the sufentanil group had significantly lower FPS-R scores at 2, 4, and 6 hours after surgery (P = 0.004, P = 0.004, and P = 0.001, respectively). The intraoperative hemodynamic parameters were more stable (P < 0.05, respectively) and the OAA/S scores at 2 hours after surgery were lower in the sufentanil group (P < 0.05). There was no significant difference in the incidence of postoperative nausea and vomiting between the two groups (P = 0.435).ConclusionChildren undergoing tonsillectomy and adenotomy after general anesthesia who received sufentanil had better postoperative sleep quality and less postoperative pain at 2, 4, and 6 hours post operation. Moreover, children who received sufentanil showed better hemodynamic stability during surgery. Therefore, sufentanil should be considered as a better choice to facilitate rapid recovery in children following tonsillectomy and adenotomy.

Efficacy of Distraction for Reducing Pain and Distress Associated With Venipuncture in the Pediatric Posttransplant Population: A Randomized Controlled Trial.

Distraction can reduce pain and distress associated with painful procedures but has never been studied in children with solid organ transplants. We aimed to determine whether there is a difference in pain and distress associated with venipuncture in pediatric posttransplant patients who receive distraction compared with those who do not. Randomized controlled trial of children aged 4 to 17 years with solid organ transplants undergoing venipuncture in the outpatient setting. Patients were randomized to receive distraction or no distraction. The primary outcome was the Faces Pain Scale-Revised. Secondary outcomes were the Observational Scale of Behavioral Distress-Revised; Faces, Leg, Activity, Cry, Consolability; and Children's Hospital of Eastern Ontario Pain Scale. Exploratory outcomes included the number of venipuncture attempts, time to successful venipuncture, and satisfaction of phlebotomists and parents. Median age of the 40 children enrolled was 11.5 years. Type of transplants included the heart (67.5%), kidney (22.5%), liver (7.5%), and more than 1 organ (2.5%). There was no difference between the Faces Pain Scale-Revised scores in distraction and no distraction groups (1.4; 95% confidence interval, 0.9-1.9; and 1.3, 95% confidence interval, 0.5-2.1, respectively). There was also no difference in the Observational Scale of Behavioral Distress-Revised; Faces, Leg, Activity, Cry, Consolability; and Children's Hospital of Eastern Ontario Pain Scale scores, number of venipuncture attempts, or time to successful venipuncture. Phlebotomists were more satisfied with the venipuncture when distraction was implemented. In children with solid organ transplants, there was no difference in pain and distress associated with venipuncture between those who did and did not receive distraction. There was also no difference in other procedure-related outcomes except for greater phlebotomist satisfaction when distraction was implemented.

The validity of simplified self-report pain intensity assessment tools in preschool-age children undergoing adenotonsillectomy.

To assess the validity of simplified pain scales, including the Simplified Faces Pain Scale (S-FPS) and Simplified Concrete Ordinal Scale (S-COS) in preschool-age children who underwent adenotonsillectomy (T&A) by comparing the values of simplified pain scales with the Faces Pain Scale-Revised (FPS-R) and the Faces, Legs, Activity, Cry, Consolability (FLACC) observational pain scale. The present study consisted of 100 pediatric patients between the ages of 3 and 6years old who had T&A. A two-step pain assessment approach with S-FPS and S-COS and FPS-R and FLACC pain scales was performed with children with the help of their parents or caregivers at the 1st, 6th and 12thhours, and over the 7days after surgery. The mean scores of S-FPS and S-COS were higher than the mean FPS-R scores for each time point for all age groups. The total number of children reporting no pain was higher for FPS-R than S-FPS and S-COS for each age group and the difference was significant for 3-, 4- and 5- year olds. S-FPS, S-COS and FPS-R showed a moderate correlation with FLACC in all age groups, whereas the correlation values were not significantly different between the tests. In the present study, we found that S-FPS and S-COS were valid options for estimating pain in preschool children including 3- and 4-year-olds who underwent T&A.

Comparison of Pain Perception Using Conventional Versus Computer-Controlled Intraligamentary Local Anesthetic Injection for Extraction of Primary Molars.

This study was conducted to compare pain perception of intraligamentary anesthesia (ILA) using a computer-controlled local anesthetic delivery system (CCLADS) versus a conventional intraligamentary injection for extraction of primary molars. A randomized controlled trial was designed where 82 children requiring 102 primary molar extractions were given ILA of 2% lidocaine with 1:80,000 epinephrine with either the conventional method or a CCLADS. Pain during injection and extraction was assessed using the Sound, Eye, Motor (SEM) scale and heart rate recording. Faces Pain Scale-Revised (FPS) scores were self-reported by patients. The Mann-Whitney test was used for evaluation of FPS and SEM scores and Student's t test for evaluation of heart rate readings. Heart rate values during injection were found to be higher, but not statistically significantly higher (p = .077), for conventional injection versus CCLADS; however, heart rate values during extraction were significantly higher for the conventional method (p = .009). Both FPS and SEM values were found to be significantly higher for conventional ILA technique (p < .05). ILA can be an effective alternative means of anesthesia for primary molar extractions, and CCLADS devices can make ILA more effective and less painful.

Burdened by the bag: A school-based cross-sectional survey

Background: The demands of education in our country have led to an increase in the loads children carry on a daily basis to school. Research evidence confirms that excessive loads lead to musculoskeletal problems in children, predisposing them to chronic back pain in adulthood. This problem becomes pertinent in primary school children, owing to the development of the spine at this age. Objectives: This study aims to assess the magnitude of the issue of heavy schoolbags, by measuring schoolbag weights and the factors affecting the ≤10% of body weight recommendation, and the children's perception of discomfort and pain. Study Design: Cross-sectional survey design was chosen for the research. Methods: Two schools with different syllabi, Indian Certificate of Secondary Examination and Central Board of Secondary Examination were approached and the schoolbags of children from Grades 1 to 5, aged 6-12-year (n = 776; boys = 402 and girls = 374), were weighed, and followed up over a week. Children were asked to rate their pain on the Faces Pain Scale-Revised and teachers' responses were collected through a teacher reported questionnaire prepared by the authors, which assessed their knowledge and control regarding the issue. Results: Majority of children carried a backpack and a separate lunch bag to and from school. A large percentage, 97.8% of schoolbags, weighed more than the recommended limit of ≤ 10% of the body weight. The mean weight of schoolbags carried was 5.9 ± 1.5 kg. Boys carried on an average 5.91 ± 1.48 kg and girls 5.98 ± 1.55 kg. Forty-eight percent of the children reported that carrying the schoolbag was causing discomfort and musculoskeletal pain and 77% of them reported discomfort at the shoulder region. Faces Pain Scale-Revised score ranged from 2 to 9 with 8 as an average intensity. Eighteen children reported absenteeism from school ranging from 1 to 5 days over the last term. The perception of teachers regarding the problem of schoolbag weights was mixed. Conclusion: This study concludes that heavy schoolbags are a problem in both the schools, with different syllabi. Being forced to carry heavy bags may lead to “schoolbag syndrome” in children. Thus, stringent measures need to be undertaken to reduce the bag burden and protect the health of children.

Eye Movement Distraction: A New Distraction Technique for Management of Dental Anxiety during Intraoral Local Anesthesia Administration in Children.

ABSTRACTBackgroundTo evaluate the efficacy of eye movement distraction (EMD) in reducing anxiety during intraoral local anesthetic administration in needle-phobic children.Materials and methodsA total of 228 children aged 8–13 years were divided into two groups: group I (EMD) and group II (control), and subjective feelings of each child were recorded with a faces pain scale-revised (FPS-R) score. Both the groups (I and II) were compared using the Chi-square test.ResultsChildren in the EMD group showed low FPS-R scores, which is statistically significant when compared to the control group (p < 0.0001).ConclusionEye movement distraction can be used as an effective distraction modality to reduce anxiety during local anesthesia administration in needle-phobic children.How to cite this articleTirupathi S, Krishna N, Rajasekhar S, et al. Eye Movement Distraction: A New Distraction Technique for Management of Dental Anxiety during Intraoral Local Anesthesia Administration in Children. Int J Clin Pediatr Dent 2019;12(6):507–509.

Qualitative Assessment of Face Validity and Cross-Cultural Acceptability of the Faces Pain Scale: "Revised" in Cameroon.

The Faces Pain Scale-Revised (FPS-R) is a self-report pain scale validated in numerous countries, but not in Cameroon. We postulated that while cultural factors influence pain perception and expression, the FPS-R should remain culturally acceptable for pediatric use. A convenience sample of 36 pediatric patients, aged 4 to 16 years, representing three primary language groups, was enrolled at Mbingo Baptist Hospital (MBH). Pre- and postanalgesia FPS-R scores and vital signs were obtained. Audio-recorded cognitive interviews were performed with each participant. Written questionnaires were also provided to physicians, nurses, and caretakers to further explore cultural perceptions of pain. Four independent reviewers analyzed interview transcripts and questionnaires using inductive reasoning and identified common themes pertaining to gender differences, societal roles, and pain perception. Basic comprehension of the FPS-R was present across language groups, vital sign changes corresponded with FPS-R alterations, and the FPS-R appears intuitive for pediatric use.

Validity and Reliability of the Verbal Numerical Rating Scale for Children Aged 4 to 17 Years With Acute Pain

The Verbal Numerical Rating Scale is the most commonly used self-report measure of pain intensity. It is unclear how the validity and reliability of the scale scores vary across children's ages. We aimed to determine the validity and reliability of the scale for children presenting to the emergency department across a comprehensive spectrum of age. This was a cross-sectional study of children aged 4 to 17 years. Children self-reported their pain intensity, using the Verbal Numerical Rating Scale and Faces Pain Scale-Revised at 2 serial assessments. We evaluated convergent validity (strong validity defined as correlation coefficient ≥0.60), agreement (difference between concurrent Verbal Numerical Rating Scale and Faces Pain Scale-Revised scores), known-groups validity (difference in score between children with painful versus nonpainful conditions), responsivity (decrease in score after analgesic administration), and reliability (test-retest at 2 serial assessments) in the total sample and subgroups based on age. We enrolled 760 children; 27 did not understand the Verbal Numerical Rating Scale and were removed. Of the remainder, Pearson correlations were strong to very strong (0.62 to 0.96) in all years of age except 4 and 5 years, and agreement was strong for children aged 8 and older. Known-groups validity and responsivity were strong in all years of age. Reliability was strong in all age subgroups, including each year of age from 4 to 7 years. Convergent validity, known-groups validity, responsivity, and reliability of the Verbal Numerical Rating Scale were strong for children aged 6 to 17 years. Convergent validity was not strong for children aged 4 and 5 years. Our findings support the use of the Verbal Numerical Rating Scale for most children aged 6 years and older, but not for those aged 4 and 5 years.

Effects of audiovisual distraction in children with special healthcare needs during dental restorations: a randomized crossover clinical trial.

Audiovisual distraction using video eyeglasses is useful in managing distress and reducing fear and anxiety in healthy children during dental treatments. To evaluate the effect of audiovisual distraction on behavior and self-reported pain of children with special healthcare needs (SHCN) without intellectual disability during dental restorations and its influence on the operator stress and the time of the appointment. This randomized controlled crossover trial comprised 48 children with SHCN requiring at least two dental restorations. One restoration was done wearing the video eyeglasses and one wearing conventional behavior management techniques. Subjective and objective pain was evaluated using the Faces Pain Scale - Revised (FPS-R) and the revised Face, Leg, Activity, Cry, and Consolability scale (r-FLACC). The operator stress using a VAS, the time of the appointment, and the child satisfaction were recorded. The use of video eyeglasses significantly reduced the operator stress. The bivariate analysis showed that the mean FPS-R score and the mean r-FLACC score were significantly lower using the video eyeglasses only during the second clinical session. Audiovisual distraction could be useful in managing distress in SHCN children without intellectual disability but cannot replace the conventional behavior management techniques.

Comparison of Ultrasonography-guided Bilateral Intercostal Nerve Blocks and Conventional Patient-controlled Intravenous Analgesia for Pain Control After the Nuss Procedure in Children: A Prospective Randomized Study.

Objectives:Patients experience severe pain after pectus excavatum (PE) surgery. The aim of this prospective, randomized study was to compare analgesic effects of ultrasonography-guided bilateral intercostal nerve blocks (UG-ICNBs) with those of conventional patient-controlled intravenous analgesia (PCIA) on acute pain after the Nuss procedure for PE repair in children.Methods:A prospective randomized study was performed in children with PE who were scheduled for the Nuss procedure. Participants were randomly assigned to receive either UG-ICNBs or PCIA for postoperative analgesia. Faces Pain Scale-Revised scores, opioid consumption, analgesia-associated side effects (respiratory depression, pruritus, nausea, vomiting) during the first 24 hours, and lengths of stay in the postanesthesia care unit (PACU) and hospital were recorded after the surgery.Results:Sixty-two children undergoing the Nuss procedure were enrolled in the trial. Faces Pain Scale-Revised scores were significantly decreased in the UG-ICNBs group compared with the PCIA group for up to 6 hours after surgery. The opioid doses required in the PACU and during the first 24 hours after surgery were significantly greater in the PCIA group compared with the UG-ICNBs group. Accordingly, patients in the UG-ICNBs group showed a lower incidence of analgesia-associated side effects and faster PACU discharge compared with the PCIA group.Conclusions:Our study suggests that UG-ICNBs might be more effective than PCIA for postoperative analgesia in children who undergo the Nuss procedure for PE.

A randomized study of local anesthesia for pain control during intra-articular corticosteroid injection in children with arthritis.

BackgroundIntra-articular corticosteroid injections (IACI) are routinely used by pediatric rheumatologists in the treatment of chronic arthritis. Frequently, topical anesthetics are used to control procedural pain, but their relative efficacy has not been reported. In this study, we evaluated the level of pain associated with different anesthetic methods, Numby® 900 Iontophoretic Drug Delivery System, or EMLA® cream, with or without subcutaneous buffered lidocaine (SQBL), during IACI of the knee in children with arthritis.MethodsWe conducted a prospective study of patients, ages 4 to 21 years old, followed at three pediatric rheumatology centers who were undergoing IACI of a knee joint. Patients were randomized into two treatment groups: 1) topical anesthetic only (EMLA® or Numby® (E/N)), or 2) topical anesthetic (E/N) and SQBL. Pain was assessed at baseline, during topical anesthetic placement, and following the IACI (post-procedure). The Faces Pain Scale-Revised (FPS-R), the Face, Leg, Activity, Cry, Consolability (FLACC) behavioral scale and the parental global assessment (PGA) (0 = best experience, 10 = worst experience) were determined.ResultsSixty-three patients (44 females) with a median [IQR] age of 10.8 [IQR = (8.2–14.4)] years (range 4.7–20 years) with active knee arthritis were consented. FPS-R post-procedure (P = 0.03), FLACC (P = 0.02) and PGA (P = 0.01) scores were significantly lower in females treated with E/N plus SQBL compared to patients treated with E/N only. Females in the E/N only group had a significant worsening of their baseline pain (p < 0.0004) and a greater magnitude of change in their baseline FPS-R scores (p < 0.001) from the procedure compared to females in the E/N plus SQBL group who had no worsening of their baseline pain. No significant change in pain level or PGA score was found among males in either treatment group. Pain scores overall were similar to the oligoarthritis patients, a more homogeneous group of patients. Both EMLA® (n = 33) and Numby® (n = 29) were equally well tolerated with no significant difference in median FPS-R administration scores overall.ConclusionOur results suggest that a topical anesthetic plus SQBL is more effective for injection pain control than topical anesthesia only. Further studies addressing pain and anxiety will help determine the optimal method of pain control for IACI.