A Quantitative Examination of Extreme Facial Pain Expression in Neonates: The Primal Face of Pain across Time

Many pain assessment tools for preschool and school-aged children are based on facial expressions of pain. Despite broad use, their metrics are not rooted in the anatomic display of the facial pain expression. We aim to describe quantitatively the patterns of initiation and maintenance of the infant pain expression across an expressive cycle. We evaluated the trajectory of the pain expression of three newborns with the most intense facial display among 63 infants receiving a painful stimulus. A modified “point-pair” system was used to measure movement in key areas across the face by analyzing still pictures from video recording the procedure. Point-pairs were combined into “upper face” and “lower face” variables; duration and intensity of expression were standardized. Intensity and duration of expression varied among infants. Upper and lower face movement rose and overlapped in intensity about 30% into the expression. The expression reached plateau without major change for the duration of the expressive cycle. We conclude that there appears to be a shared pattern in the dynamic trajectory of the pain display among infants expressing extreme intensity. We speculate that these patterns are important in the communication of pain, and their incorporation in facial pain scales may improve current metrics

Commentary: Impact of an interdisciplinary and international research training initiative: the Pain in Child Health program

First paragraph: The field of pediatric pain has grown substantially since its inception in the early 1980s, which is reflected in an increasing number of publications, key textbooks, international meetings and training programs. We recently published a review summarizing meta-trend and bibliometric characteristics of the pediatric pain literature between 1975 and 2010, which confirmed a continuous, substantial increase in published research on pain processes in children between 0 and 18 years. The majority of the literature investigated pain characterization, intervention or assessment techniques in clinical samples of children between 6 and 18 years (Caes et al., 2016). A strength of our comprehensive review is the freely available dataset, which allows for more indepth analyses that go beyond the general conclusions drawn in the paper

Electronic and paper versions of a faces pain intensity scale: concordance and preference in hospitalized children

<p>Abstract</p> <p>Background</p> <p>Assessment of pain in children is an important aspect of pain management and can be performed by observational methods or by self-assessment. The Faces Pain Scale-Revised (FPS-R) is a self-report tool which has strong positive correlations with other well established self-report pain intensity measures. It has been recommended for measuring pain intensity in school-aged children (4 years and older). The objective of this study is to compare the concordance and the preference for two versions, electronic and paper, of the FPS-R, and to determine whether an electronic version of the FPS-R can be used by children aged 4 and older.</p> <p>Methods</p> <p>The study is an observational, multicenter, randomized, cross-over, controlled, open trial. Medical and surgical patients in two pediatric hospitals (N = 202, age 4-12 years, mean age 8.3 years, 58% male) provided self-reports of their present pain using the FPS-R on a personal digital assistant (PDA) and on a paper version. Paper and electronic versions of the FPS-R were administered by a nurse in a randomized order: half the patients were given the PDA version first and the other half the paper version first. The time between the administrations was planned to be less than 30 minutes but not simultaneous. Two hundred and thirty-seven patients were enrolled; 35 were excluded from analysis because of misunderstanding of instructions or abnormal time between the two assessments.</p> <p>Results</p> <p>Final population for analysis comprised 202 children. The overall weighted Kappa was 0.846 (95%CI: 0.795; 0.896) and the Spearman correlation between scores on the two versions was r_s= 0.911 (p < 0.0001). The mean difference of pain scores was less than 0.1 out of 10, which was neither statistically nor clinically significant; 83.2% of children chose the same face on both versions of the FPS-R. Preference was not modified by order, sex, age, hospitalization unit (medical or surgical units), or previous analgesics. The PDA was preferred by 87.4% of the children who expressed a preference.</p> <p>Conclusion</p> <p>The electronic version of the FPS-R can be recommended for use with children aged 4 to 12, either in clinical trials or in hospitals to monitor pain intensity.</p

Children’s self-reports of pain intensity: Scale selection, limitations and interpretation

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

Children’s Self-Report of Pain Intensity: What We Know, Where We Are Headed

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

Support for a Common Metric for Pediatric Pain Intensity Scales

Institutional adoption of routine measurement of pediatric pain has been impeded partly by the profusion of different metrics (eg, 0 to 5, 0 to 6, 0 to 10, 0 to 100) for reporting pain intensity on various instruments.  The present paper discusses the importance of adopting a common metric, that is, a single numbering system on which estimates of pain intensity from various sources can be recorded. To explore both support and reservations concerning the adoption of a common metric, a survey questionnaire was sent in 1999 to an estimated 600 subscribers to the Pediatric Pain Internet Mailing List. Individuals working in pediatric institutions where children's pain is routinely measured, or where adoption of such measures is planned, were requested to respond by e-mail or mail. Responses (n=37) were from nurses (49%), physicians (24%), psychologists (7%) and others/unlisted (20%) on four continents. Adoption of a common metric was endorsed by 81% of respondents. Among the possible numbering systems, the 0 to 10 system was strongly favoured (70%) over other options. Respondents commented that adoption of a common metric would improve communication and consistency in measurement both within and among institutions.  Some disadvantages, such as staff resistance to altering existing systems, were also suggested. The majority of respondents thought that it would be desirable to adopt a common metric. Among the possible numbering systems, the 0 to 10 system is by far the most favoured. Adopting a common 0 to 10 standard, and adapting existing tools to that metric, would be positive steps toward identifying and relieving children's pain

Pain, somatic focus, and emotional adjustment in children of chronic headache sufferers and controls

Recent epidemiological studies have indicated that as many as 78% of individuals with chronic pain come from families in which at least one other family member has chronic pain. This suggests that children of individuals with chronic pain may be at particular risk for developing chronic pain conditions in the future. This study examined the relationship between parental chronic pain and children's general adjustment. A group of parents reporting chronic tension or migraine headache and their children were compared to a group of illness-free parents and their children. Results revealed that children of chronic headache sufferers were more somatically focused than their control counterparts. It is suggested that this heightened concern with their health status may be either a reaction to, or a means of coping with ongoing stress. A number of significant correlations between parents' and their children's level of emotional adjustment are also reported. the implications of these findings for general family health status, and characteristic ways of dealing with illness are discussed.family coping familial pain children's adjustment