Faces Pain Scale-Revised Research Articles

LO63: Humanoid robot-based distraction to reduce pain and distress during venipuncture in the pediatric emergency department: A randomized controlled trial

Introduction: Intravenous insertion (IVI) is identified by children as extremely painful and the resultant distress can have lasting negative consequences. There is an urgent need to effectively manage such procedures. Our primary objective was to compare the pain and distress of IVI with the addition of humanoid robot-based distraction to standard care, versus standard care alone. Methods: This two-armed randomized controlled trial (RCT) was conducted from April 2017 to May 2018 at the Stollery Children's Hospital emergency department (ED). Children aged 6 to 11 years who required IVI were included. Exclusion criteria included hearing or visual impairments, neurocognitive delays, sensory impairment to pain, previous enrolment, and discretion of the ED clinical staff. Primary outcomes were measured using the Observational Scale of Behavioural Distress-Revised (OSBD-R) (distress) and the Faces Pain Scale-Revised (FPS-R) (pain). A total of 426 pediatric patients were screened and 340 were excluded. Results: We recruited 86 children, of which 55% (47/86) were male; 9% (7/82) were premature at birth; 82% (67/82) had a previous ED visit; 30% (25/82) required previous hospitalization; 78% (64/82) had previous IV placement and 96% (78/81) received topical anesthesia. The mean total OSBD-R score was 1.49 ± 2.36 (standard care) compared to 0.78 ± 1.32 (robot group) (p = 0.047). The median FPS-R during the IV procedure was 4 (IQR 2,6) in the standard care group alone, compared to 2 (IQR 0,4) with the addition of humanoid robot-based distraction (p = 0.10). Change in parental state anxiety pre-procedure versus post-procedure was not significantly different between groups (p = 0.49). Parental satisfaction with the IV start was 93% (39/42) in the robot arm compared to 74% (29/39) in the standard care arm (p = 0.03). Parents were also more satisfied with management of their child's pain in the robot group (95% very satisfied) compared with standard care (72% very satisfied) (p = 0.002). Conclusion: A statistically significant reduction in distress was observed with the addition of robot-based distraction to standard care. Humanoid robot-based distraction therapy reduces distress and to a lesser extent, pain, in children undergoing IVI in the ED. Further trials are required to confirm utility in other age groups and settings.

Virtual Reality for Pediatric Needle Procedural Pain: Two Randomized Clinical Trials

To assess the efficacy and safety of a virtual reality distraction for needle pain in 2 common hospital settings: the emergency department (ED) and outpatient pathology (ie, outpatient laboratory). The control was standard of care (SOC) practice. In 2 clinical trials, we randomized children aged 4-11years undergoing venous needle procedures to virtual reality or SOC at 2 tertiary Australian hospitals. In the first study, we enrolled children in the ED requiring intravenous cannulation or venipuncture. In the second, we enrolled children in outpatient pathology requiring venipuncture. In the ED, 64 children were assigned to virtual reality and 59 to SOC. In pathology, 63 children were assigned to virtual reality and 68 to SOC; 2 children withdrew assent in the SOC arm, leaving 66. The primary endpoint was change from baseline pain between virtual reality and SOC on child-rated Faces Pain Scale-Revised. In the ED, there was no change in pain from baseline with SOC, whereas virtual reality produced a significant reduction in pain (between-group difference, -1.78; 95% CI, -3.24 to -0.317; P=.018). In pathology, both groups experienced an increase in pain from baseline, but this was significantly less in the virtual reality group (between-group difference, -1.39; 95% CI, -2.68 to -0.11; P=.034). Across both studies, 10 participants experienced minor adverse events, equally distributed between virtual reality/SOC; none required pharmacotherapy. In children aged 4-11years of age undergoing intravenous cannulation or venipuncture, virtual reality was efficacious in decreasing pain and was safe. Australia and New Zealand Clinical Trial Registry: ACTRN12617000285358p.

The Utility and Construct Validity of Four Measures of Pain Intensity: Results from a University-Based Study in Spain.

Pain intensity is the most commonly assessed domain in pain research and clinical settings. To facilitate cross-cultural research, knowledge regarding the psychometric properties of pain intensity measures in individuals from different countries is needed. However, the majority of this research has been conducted in English-speaking countries. Survey study. University. Four hundred nineteen college students. Participants were asked to complete four measures assessing average pain intensity: 1) the 0-10 numerical rating scale (NRS-11), 2) the 100-mm visual analog scale (VAS), 3) the four-point verbal rating scale (VRS-4), and 4) the Faces Pain Scale-Revised (FPS-R). The rates of incorrect completion of the four scales were uniformly low (range = 1-2%). The NRS-11 had the highest preference rate (31%), although a substantial number of participants also preferred each of the other three scales (range = 22-24%). The findings support the utility and construct validity of all four pain intensity scales in this Spanish-speaking sample. When considered in light of research from other non-English-speaking samples indicating significant psychometric weaknesses for the NRS-11 and VAS and relative strengths of the FPS-R in some groups, the findings suggest that the FPS-R might be the most appropriate pain intensity scale to use when comparisons across populations from different countries is a goal. More research is needed to determine the extent to which demographic (i.e., age, education levels, socioeconomic status) vs cultural factors (i.e., country of origin) influence the reliability, validity, and utility of different pain measures.

Changes in Pain Score Associated With Clinically Meaningful Outcomes in Children With Acute Pain.

Identifying changes in pain score associated with clinically meaningful outcomes is necessary when using self-report measures to assess pain in children. We aimed to determine the changes in pain score associated with a minimum clinically significant difference (MCSD), ideal clinically significant difference (ICSD), and patient-perceived adequate analgesia (PPAA) and to evaluate for differences based on initial pain intensity and patient characteristics. This was a cross-sectional study of children 6 to 17 and 4 to 17 years old who were assessed using the Verbal Numerical Rating Scale (VNRS) and Faces Pain Scale-Revised (FPS-R), respectively. Children qualitatively described any endorsed change in pain score; those who received an analgesic were asked if they wanted additional analgesics to decrease their pain intensity. We used a receiver operating characteristic curve-based methodology to identify changes in pain score associated with "a little less" and "much less" pain (MCSD and ICSD, respectively) and patients declining additional analgesics because of adequate analgesia (PPAA). We enrolled 431 children with painful conditions. For the VNRS, raw change and percent reductions in pain scores associated with MCSD, ICSD, and PPAA were 2/10 and 20%, 3/10 and 44%, and 2/10 and 29%, respectively, and for the FPS-R, 2/10 and 33%, 4/10 and 60%, and 4/10 and 40%, respectively. Raw change in pain scores increased with increasing initial pain intensity, but percent reductions remained stable. There were no significant differences based on patient characteristics such as age, sex, and race/ethnicity. Our findings provide patient-centered outcomes in children that are suitable for designing trials and are generalizable across patient characteristics.

Effect of concomitant administration of oxycontin and amitriptyline on patients with severe cancer pain and depression

Purpose: To study the effects of oxycontin combined with amitriptyline on patients with severe cancer pain and depression.Methods: Patients with severe cancer pain and depression (n = 46) were randomly divided into two groups. The study group was given oxycontin combined with amitriptyline, while the control group received only oxycontin, each over a period of 4 weeks. Analgesic effect and depression relief were evaluated using FPS-R (Faces Pain Scale–Revised) and HAMD17 (Hamilton Depression Rating Scale 17-Item). In addition, the dose of medication and adverse drug reactions were monitored.Results: Pain in patients in the two groups were significantly relieved after treatment (p < 0.01). Symptoms in the study group were significantly improved, when compared with the situation before treatment, while HAMD17 scores significantly decreased (p < 0.01). The mean dosage of oxycontin in the study group in the fourth week after treatment was significantly lower than that of the control group (p < 0.01). There were no obvious differences in adverse reactions between patients in the two groups.Conclusion: Oxycontin combined with amitriptyline effectively controls severe cancer pain, and ameliorates depression and improves the quality of life of patients with advanced cancer.Keywords: Cancer pain, Depression, Oxycodone, Amitriptyline, FPS-R, HAMD17 scores

Randomised prospective study of using intraoperative, intraincisional and intraperitoneal ropivacaine for the early discharge of post-laparoscopic cholecystectomy patients as a day case in a cost-effective way in government setup of low-income and middle-income countries: Opening new horizons

BackgroundPain is the main reason for staying overnight at hospital after an uncomplicated laparoscopic cholecystectomy.ObjectivesA randomised prospective study was planned to compare the efficacy of intraincisional and intraperitoneal use of...

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.

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.

Effectiveness of Breastfeeding on reduction of pain level during Immunization among infants in selected Primary Health Centre at Rajkot

Child is a precious gift which has lot of potentials within, which can be the best resource for the nation if raised and molded in a good manner. Healthy children can become healthy citizens constituting healthy nation. The study was conducted to assess the effect of breastfeeding on reduction of pain level during immunization among infants at selected primary health centre, Rajkot. The research design used for the present study was quasi-experimental non-equivalent control group post test only design. By using non-probability purposive sampling technique for 60 samples were selected and effectiveness of breastfeeding on pain level during immunization was assessed by faces pain scale-revised (FPS-R). Breastfeeding given to experimental group during vaccination process and level of pain was assessed after vaccination, whereas in control group samples were assessed level of pain without giving breastfeeding. The obtained data was analyzed using ‘t’ test. The mean score of experimental and control group was 3.47 and 7.2 and the standard deviation was 2.12 and 1.83 respectively with mean difference of 3.73. The calculated ‘t’ test value 7.32 was less than the table value at 0.05 level of significance. Hence, it was concluded that provision of breastfeeding during immunization was effective to reduce the level of pain among infants.

Adaptation of pain scales for parent observation: are pain scales and symptoms useful in detecting pain of young children with the suspicion of acute otitis media?

BackgroundThe assessment of ear pain is challenging in young, mostly preverbal children. Our aim was to investigate whether pain scales are useful tools for parents to detect pain in their young children with the suspicion of acute otitis media (AOM), and to assess associations between 16 symptoms and the severity of pain.MethodsThis cross-sectional study included 426 children (6–35 months) with symptoms suggestive of AOM. We surveyed symptoms and pain via parental interview. As part of the interview, parents assessed their child’s pain by using two pain scales: The Faces Pain Scale-Revised (FPS-R) and the Face, Legs, Activity, Cry, Consolability (FLACC) Scale. The outcome of interest was moderate/severe pain. We used the χ2 test or Fisher’s test as applicable to compare the severity of pain between three parental pain assessment methods (the parental interview, the FPS-R and the FLACC Scale). We also used multivariable logistic regression models to study the association between the severity of pain and AOM and to study the association between symptoms and the severity of pain.ResultsIn children with AOM (n = 201), pain was assessed by parents as moderate/severe in 65% via interview; 90% with the FPS-R; and 91% with the FLACC Scale (P < 0.001). In children without AOM (n = 225), the percentages were 56, 83 and 88%, respectively (P < 0.001). Between children with and without AOM, the occurrence of moderate/severe pain did not differ with any of the pain evaluation methods. Of symptoms, ear pain reported by child and restless sleep were significantly associated with moderate/severe pain, regardless of the pain evaluation method.ConclusionsIt seems that nearly all the children with respiratory tract infection, either with or without AOM, might suffer from moderate/severe pain. Without pain scales, parents may underestimate their child’s pain. Of symptoms, ear pain reported by child and restless sleep might indicate pain in children with respiratory tract infection. We suggest that the adaptation of pain scales for parent observation is a possibility in children with respiratory tract infection which, however, requires further studies.Trial registrationwww.clinicaltrials.gov, identifier NCT00299455. Date of registration: March 3, 2006.

The association between psychological and social factors and spinal pain in adolescents.

Spinal pain, back pain, and/or neck pain begins early in life and is strongly associated with spinal pain in adulthood. Understanding the relationship between psychological and social factors and adolescent spinal pain may be important in both the prevention and treatment of spinal pain in this age group. We aimed to determine if psychological and social factors were associated with spinal pain in a cross-sectional study of a school-based cohort of 1279 Danish adolescents aged 11-13, who were categorized into "any" and "substantial" spinal pain. "Substantial spinal pain" was defined as a lifetime frequency of "sometimes" or "often" and a pain intensity of at least two on the revised Faces Pain Scale. Logistic regression analyses, stratified by sex, were conducted for single and all variables together. Eighty-six percent of participants reported "any spinal pain" and 28% reported "substantial spinal pain". Frequency of psychological and social factors was significantly higher in those with spinal pain compared to those without. As the frequency of psychological and social factors increased, the odds of both "any spinal pain" and "substantial spinal pain" also increased.Conclusion: Psychological and social factors may be important determinants in adolescent spinal pain. What is Known: • Spinal pain begins early in life to reach adult levels by age 18. Spinal pain in adolescence is strongly associated with spinal pain in adulthood. • In adults, psychological and social factors and spinal pain are strongly related; however, this relationship in adolescence is poorly understood. What is New: • Adolescents with spinal pain reported a significantly higher frequency of psychological factors and loneliness and lower levels of pupil acceptance. • Adolescents reporting higher levels of loneliness, lower levels of pupil acceptance, and increased frequency of psychological factors had increased odds of reporting "substantial spinal pain".

Postoperative pain after spinal surgery in the paediatric population.

Postoperative pain is a major aftereffect of surgery. Especially severe occurs after extensive operations within the spine. The goal of the study was to investigate the laboratory predictive factors of intensive postoperative pain in children undergoing extensive surgery Patients and methods: We recruited 41 children, age median 13 years (IQR:10-15 years) undergoing extensive spine surgery. The subjects were divided into two groups based on the intensity of postoperative pain measured using the 10-point numerical rating scale (NRS), visual analog scale (VAS) or faces pain scale-revised (FPS-R). Patients with a score of 5 or higher were included in the study group and those with NRS of less than 5 were included in the control group. We collected detailed clinical and laboratory data before, during and after surgery. The highest intensity of pain was observed in the first 6 hours after surgery. The postoperative pain was associated with a higher drop in hemoglobin concentration and hematocrit level in peri-operative period (p=0.006 and p=0.019 respectively) as well as higher changes in mean arterial pressure during surgery. Additionally, we found that children with intensive pain had higher total protein concentration after surgery. We reported that the drop in hemoglobin and hematocrit level, fluctuation in mean arterial pressure as well as total protein concentration could be useful prognostic factors of early postoperative pain. < p > < /p >.

Effectiveness of Two Different Methods for Pain Reduction During Insulin Injection in Children With Type 1 Diabetes: Buzzy and ShotBlocker.

Repeated injections may prevent children from performing insulin administration (skip dosing) and may cause anxiety. To compare the effect of ShotBlocker and the combination of vibration and cold application (Buzzy) in reducing pain during insulin administration in children. This research was designed as a randomized controlled experimental study. The study sample consisted of 60 children aged between 6 and 12years who were diagnosed as having type 1 diabetes and received insulin from the Child Endocrinology Department of the medical faculty in Eskisehir Osmangazi University between May 2015 and June 2017. The children were randomized into the Buzzy (n=20), ShotBlocker (n=20), and control (n=20) groups. Three instruments were used to obtain the research data: Interview and Observation Form, Children's Anxiety and Pain Scale (CAPS), and Faces Pain Scale-Revised (FPS-R). The mean age of the children was 9.43±2.18years (range 6-12years). There were no significant differences among preprocedural anxiety levels of the study groups in terms of self-, parent-, and observer-reported levels (p=.935, p=.374, and p=.680, respectively). Children in the control group had higher levels of pain than children in the Buzzy and ShotBlocker groups (p=.008, p=.007, and p>.001, respectively). There was a significant difference between the groups with procedural anxiety levels reported by the family and observer (p=.006 and p=.002, respectively), favoring the intervention groups. Nurses should be aware of pain during insulin injection and use methods for pain relief accordingly. ShotBlocker is recommended as a helpful option in cases where a pain control method is required.

Psychometric Properties of a Modified Version of the Faces Pain Scale-Revised (Modified FPS-R) to Evaluate Worst Pain in Children and Adolescents With Sickle Cell Anemia.

We evaluated psychometric properties (validity, reliability, and responsiveness) of a modified Faces Pain Scale-Revised (FPS-R) in 257 patients with sickle cell anemia (SCA) 7 to below 18 years old in a randomized, multinational clinical study. The modified FPS-R asks patients to report, by daily diary, their worst intraday SCA-related pain. Intraclass correlation coefficient assessed test-retest reliability between month 1 and month 2. Pearson correlations between monthly mean SCA-related pain intensity, activity interference score, analgesic use, and opioid use assessed convergent validity. Responsiveness was assessed with correlations of changes of monthly pain rate or intensity and changes in analgesic use or activity interference score from month 1 to month 9. Intraclass correlation coefficients for pain intensity and pain rate were 0.777 and 0.820, respectively, indicating agreement among stable patients. Moderate associations were shown between mean pain intensity and analgesic use (r=0.39) and opioid use (r=0.44), and between monthly pain rate and analgesic use (r=0.38). Moderate-to-large associations were observed between change in mean pain rate or intensity and changes in analgesic use (r=0.38 to 0.39, both P<0.001) and in activity interference scores (r=0.82 to 0.92, both P<0.001). These results support use of the modified FPS-R across cultures in children and adolescents aged 7 to below 18 years with SCA.

Defining No Pain, Mild, Moderate, and Severe Pain Based on the Faces Pain Scale-Revised and Color Analog Scale in Children With Acute Pain.

The aims of this study were to define the Faces Pain Scale-Revised (FPS-R) and Color Analog Scale (CAS) scores associated with no pain, mild pain, moderate pain, and severe pain in children with acute pain, and to identify differences based on age, sex, and ethnicity. We conducted a prospective observational study in 2 pediatric emergency departments of children aged 4 to 17 years with painful and nonpainful conditions. We assessed their pain intensity using the FPS-R, CAS, and qualitative measures. Pain score cut points that best differentiated adjacent categories of pain were identified using a receiver operating characteristic-based method. Cut points were compared within subgroups based on age, sex, and ethnicity. We enrolled 620 patients, of whom 314 had painful conditions. The mean age was 9.2 years; 315 (50.8%) were in the younger age group (aged 4-7 years); 291 (46.8%) were female; and 341 (55%) were Hispanic. The scores best representing categories of pain for the FPS-R were as follows: no pain, 0 and 2; mild pain, 4; moderate pain, 6; and severe pain, 8 and 10. For the CAS, these were 0 to 1, 1.25 to 2.75, 3 to 5.75, and 6 to 10, respectively. Children with no pain frequently reported nonzero pain scores. There was considerable overlap of scores associated with mild and moderate pain. There were no clinically meaningful differences of scores representing each category of pain based on age, ethnicity, and race. We defined pain scores for the FPS-R and CAS associated with categories of pain intensity in children with acute pain that are generalizable across subgroups based on patient characteristics. There were minor but potentially important differences in pain scores used to delineate categories of pain intensity compared to prior convention.

Scaling properties of pain intensity ratings in paediatric populations using the Faces Pain Scale-revised: Secondary analyses of published data based on the item response theory

BackgroundThe Faces Pain Scale-revised (FPS-r) has been developed as an interval scale. For other pain measurement instruments, several studies found evidence for and against an interval level of measurement. ObjectivesThe primary aim of the current study was to evaluate the scale properties of the FPS-r using an item response theory approach. DesignSecondary analysis of published data. SettingThree studies; Study 1 and study 2: One university hospital; Study 3: international pain registry. ParticipantsStudy 1: n = 246, female: 41%, age: 11–18 years, 3 pain items; Study 2: n = 240, female: 43%, age: 11–18 years, 9 pain items; Study 3: n = 2266, female: 41%, age: 4–18 years, 3 pain items. MethodsThe rating scale model (interval scale), the graded response model (no interval scale, ordered response categories) and the partial credit model (no interval scale) were used to scale the data. ResultsIn all three studies, the rating scale model was outperformed by the graded response model or the partial credit model in terms of model fit. Overlapping response categories were found in items associated with less pain. Response category widths were wider for categories associated with low pain intensity and smaller for categories associated with high pain intensities. Smallest response categories were 1%–67% smaller compared to the widest response category of the same item. ConclusionAccording to these findings, the interval scale properties of the FPS-r may be questioned. Item response theory methods may help to solve the problem of missing linearity in pain intensity ratings using FPS-r.

Can motor development at age seven predict spinal pain at age eleven?

Introduction The combination of three arguments has led us to hypothesize that improvement of early motor skills might have potential for prevention of spinal pain: –a large body of experimental and clinical research implicates disordered motor control, or core stability, in adults with low back pain; –there is evidence that spinal pain originates in childhood or adolescence; –motor development deficits observed in childhood have been shown to track into adolescence. This study is a first step in this line of inquiry and aims to investigate the relationship between motor skills and coordination at age seven and spinal pain at age eleven. Methods The mothers of 43,000 seven-year-old children answered the Developmental Coordination Disorder Questionnaire (DCDQ), which has three subscales: ‘control during movement’, ‘fine motor skills’ and ‘general coordination’. At age eleven, 30,000 of these children answered a questionnaire (YSQ) about frequency and intensity of cervical, thoracic and lumbar pain. Pain was described as either ‘pain’ or ‘severe pain’, both with a frequency of ‘sometimes’ or ‘often’. ‘Pain’ required an intensity of ≥ 2 on the FacesPainScale-Revised (FPS-R) (equivalent to ≥ 3 on an 11-point scale) and ‘severe pain’ ≥ 3 on the FPS-R (equivalent to ≥ 5 on an 11-point scale). Associations were explored by logistic regression analyses and all estimates were adjusted for sex, mother's schooling, height, and weight at age 7. Results The total DCDQ score was significantly associated with spinal pain (OR: 1.29; 95% CI: 1.10–1.50). This association was driven by associations with cervical and thoracic pain; there was no association with lumbar pain detected. The general coordination subscale score was the strongest predictor of pain. Compared to the children in the top 10%, those in the bottom 10% had higher odds of cervical (OR: 1.42, 95% CI: 1.18–1.69), and thoracic pain (OR: 1.51; 95% CI: 1.18–1.92). The results were almost identical for severe pain. Conclusions Other health-related aspects or psychological factors are not included in these analyses and their influence on the shown associations is unknown. Future research should explore the relationship between motor skills, health and psychological measures to optimize strategies for improving spinal health. In the prevention of spinal pain, motor- and coordination skills may be a possible risk indicator and a potential target for intervention.

MP42: Validation of the Stoplight Pain Scale tool in the Canadian emergency setting

Introduction: Introduction: A variety of pain assessment tools exist for children, however none of the current scales were created specifically for family use. Further, none provide direct guidance with regards to pain treatment threshold. This study aimed to validate a novel, three faced, coloured coded (red, yellow, green), family-friendly pain tool, the Stoplight Pain Scale, by comparing it to the widely accepted and validated Faces Pain Scale-Revised (FPS-R). This novel tool has the capability to guide families with regards to treatment, as well as measure pain. Methods: Methods: A prospective observational cohort study was conducted at the Stollery Childrens Hospital emergency department (ED) (Edmonton, Alberta) from November, 2014 to February, 2017. Demographic information was collected, and patients (3-12 years) and their caregivers were asked to rate their pain using the novel Stoplight Pain Scale as well as the FPS-R. Pain was measured at presentation to the ED, immediately following painful procedures, and thirty minutes after analgesia administration. Patients and their caregivers also indicated their preferred scale for assessing pain. Results: Results: A purposeful random sample of 227 patients were included for analyses; 61/227 (26.9%) of patients were 3-5 years old and 166/227 (73.1%)were 6-12 years old. 53/227 (23.3%) of patients had been previously hospitalized. Correlation between the two pain scales was consistently fair to moderate; using Kappa Statistics, a baseline correlation for Stoplight and FPS-R was fair for both caregivers (0.38, 95% CI 0.28 0.48) and patients (0.36 95% CI 0.27-0.45). The Stoplight Pain Scale had fair to moderate correlation between caregiver and patient scores, (0.37, 95% CI 0.27-0.47), compared to FPS-R which showed poor to fair agreement between caregiver and child scores (0.20, 95% CI 0.12-0.29). Regardless of age or hospitalization status, 64% of patients (139/218) and 54% caregivers (118/220) preferred the Stoplight Pain scale (p=0.001). Conclusion: Conclusions: The Stoplight Pain Scale correlates moderately well with FPS-R, a validated pain assessment tool for children and shows good correlation between patients and caregivers assessment of reported pain. The Stoplight Pain Scale is a simple, easy to administer tool that may have a role in empowering family involvement in ED pain management. Future research should focus on at-home study of the tool.

Need of analgetics in children aged 2-12 years after tonsil surgery

Tonsil surgery is one of the most painful operations in childhood. The Children's and Infants' Postoperative Pain Scale (CHIPPS), the Faces Pain Scale-Revised (FPS-R) and the little-known German version of the parents' postoperative pain measure (PPPM-D) are age-appropriate measures. Children undergoing intracapsular tonsillectomy (TO) or extracapsular tonsillectomy (TE) received the non-opioids ibuprofen (IBU) and paracetamol (PCM) on a "as needed"-basis requested by parents. A pain service checked pain scales and applied piritramide as rescue medication (RM) if required. Objective was evalution of sufficient analgesia. Endpoints were number of patients (PAT) needing the RM, doses of requested non-opioids, consistency of indications in different pain scales and correlation between pain and efficacy of the premedication or duration of the intervention. 3 measures were carried out daily: CHIPPS for PAT ≤ 4 years old, FPS-R from the age of 5. Parents completed the PPPM-D. Exceeding a cut-off score of 4 in CHIPPS or FPS-R or 6 in PPPM-D was rated as indication for RM. We included 68 PAT in an interim analysis. Mean daily doses of non-opioids within the first 3 postoperative days were as follows: PAT undergoing TE got 14,1-16,3 mg/Kg IBU and 4,2-12,4 mg/Kg PCM. PAT undergoing TO got 10,8-14,7 mg/Kg IBU and 5,2-8,8 mg/Kg PCM. On 212 visits PAT required RM, but 121 times it was detected in the PPPM-D only. After exclusion of potentially false-positive results remained 67 % PAT after TE and 48 % PAT after TO with at least 1 indication for RM. The study was terminated due to the high need for RM. The need of non-opioids was underrated. Combining the PPPM-D with established measures may improve the postoperative pain therapy.

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.