Children's self-report of pain intensity: what we know, where we are headed

Abstract

The present paper provides a short, practical introduction to children's self-report measures of pain intensity, followed by an overview of principles and issues. Details on individual self-report scales were previously reported in a landmark systematic review in 2006 and will not be repeated here. Broader measurement issues discussed here include interpretation of pain scores over time, across individuals and in relation to contextual factors; special considerations affecting children younger than six years of age; social communicative functions of pain reports; cognitive developmental factors in understanding pain scales and their anchors; screening for the ability to use self-report scales and training for children who do not have this skill; level of measurement (interval versus ordinal); estimating clinically significant change for groups and individuals; and measurement of aspects of pain other than intensity. Also highlighted are areas in which there has been progress and a lack of progress since the last time this topic was featured at the International Forum on Pediatric Pain in 1996. The present article closes with an outline of key areas for further research on children's self-report of pain and a brief summary of recommendations for clinicians.

Figures

Figure 1)

An estimate of the proportion of children at different ages who are able to provide a reliable self-report of pain when given an age-appropriate scale under optimal conditions. From reference . Copyright CL von Baeyer, 2003

Figure 2)

Pain trajectories for two hypothetical postsurgical patients. One cannot conclude that Pat is experiencing more pain than Chris, but the increase in analgesia appears to be helping both patients. From reference . Copyright CL von Baeyer, 2005