Pain research & management : the journal of the Canadian Pain Society = journal de la société canadienne pour le traitement de la douleur
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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. ⋯ 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.
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Review Historical Article
Assessing pain by facial expression: facial expression as nexus.
The experience of pain is often represented by changes in facial expression. Evidence of pain that is available from facial expression has been the subject of considerable scientific investigation. The present paper reviews the history of pain assessment via facial expression in the context of a model of pain expression as a nexus connecting internal experience with social influence. ⋯ Applications of facial assessment in the study of adult and pediatric pain are also reviewed, focusing on how such techniques facilitate the discovery and articulation of novel phenomena. Emerging applications of facial assessment in clinical settings are also described. Alternative techniques that have the potential to overcome barriers to the application of facial assessment arising out of its resource intensiveness are described and evaluated, including recent work on computer- based automatic assessment.
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Pain is largely accepted as being influenced by social context. Unlike most other developmental stages throughout the lifespan, infancy is marked by complete dependence on the caregiver. The present paper discusses the primary importance of understanding the caregiver context when assessing infant pain expression. ⋯ As a result of infants' inability to give a self-report of their pain experience, caregivers play a crucial role in assessing the pain and taking appropriate action to manage it. Caregiver behaviours and predispositions have been shown to have a significant impact on infant pain reactivity and, accordingly, should not be ignored when assessing the infant in pain.
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Behavioural assessment methods have been used to signal the need for intervention and to evaluate treatment effectiveness. Direct observation and rating scales have been used to assess pain and distress associated with acute medical procedures, postoperative pain, critical care, analogue pain induction procedures and other sources. Two recent scholarly reviews of behavioural assessment methods were conducted by the Society of Pediatric Psychology Evidence-Based Assessment Task Force and the Pediatric Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials, which classified various instruments as well established, approaching well established or promising. ⋯ There is considerable overlap among the behavioural indicators of pain used in the different scales. Furthermore, the behavioural codes indicative of pain may occur before, during and after painful events. Recommendations for future research are provided, including using behavioural assessment to focus on children's coping and adults' behaviours, as well as pain.
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Review
Improving the assessment of pediatric chronic pain: harnessing the potential of electronic diaries.
Current methods for evaluating chronic pain in children suffer from methodological problems. Real-time data capture approaches using electronic diaries have been proposed as a new standard for pain measurement. However, there is limited information available regarding the development, feasibility and validity of these approaches in children. The present paper reviews problems with current measures; rationale for developing real-time data capture approaches using electronic diaries; mechanics of developing electronic pain diaries; current evidence regarding their usability, feasibility and validity; and discusses future directions for research in this area.