Children's self-reports of pain intensity: scale selection, limitations and interpretation

Abstract

Most children aged five years and older can provide meaningful self-reports of pain intensity if they are provided with age-appropriate tools and training. Self-reports of pain intensity are an oversimplification of the complexity of the experience of pain, but one that is necessary to evaluate and titrate pain-relieving treatments. There are many sources of bias and error in self-reports of pain, so ratings need to be interpreted in light of information from other sources such as direct observation of behaviour, knowledge of the circumstances of the pain and parents' reports. The pain intensity scales most commonly used with children - faces scales, numerical rating scales, visual analogue scales and others - are briefly introduced. The selection, limitations and interpretation of self-report scales are discussed.

Figures

Figure 1)

The Faces Pain Scale – Revised (18). Scored 0, 2, 4, 6, 8 and 10. Available with instructions in many languages at www.painsourcebook.ca>. Reprinted with permission. © 2001 International Association for the Study of Pain

Figure 2)

An estimate of the proportion of children at different ages who are able to provide reliable self-report of pain when given an age-appropriate scale under optimal conditions. © CL von Baeyer, 2004

Figure 3)

Pain trajectories for two hypothetical postsurgical patients. One cannot conclude that Pat is experiencing more pain than Chris, but the analgesics appear to be helping both patients. PCA Patient-controlled analgesia; VAS Visual analogue scale. © CL von Baeyer, 2006