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Pediatric Pain, Tools, and Assessment
Abstract
Inadequate pain assessment in children may lead to an underestimation of pain, and consequently, undertreatment in this population. This article provides an overview of pain assessment and describes specific measurement tools that can be used with infants, children, and adolescents. Nationally published practice guidelines and standards recommend pain assessment at regular intervals with age-appropriate tools. Pain assessment must be integrated into perianesthesia nursing practice, and nurses must develop competency in the assessment and treatment of pain in children.
... Klinik pratikte kullanımı kolay bir ölçektir (40). Çocuklar altı yaşın üzerindeki çocuklarda Görsel Analog Skala (VAS) kullanılabilir (39). ...
... Başparmak ile işaret parmağının birbirine değdiği mesafe ağrı yok, parmaklar en uzak mesafedeyken çok ağrı var olarak değerlendirilir. Aradaki mesafeye göre ağrı tahmini yapılır (39). ...
... Literatürde çocuklarda ağrı değerlendirmesi ile ilgili birçok skala olmakla birlikte bunlar kronik ağrı değerlendirmesinden ziyade daha çok postoperatif ağrıyı değerlendirmek için geliştirilmiş ölçeklerdir (39,41). ...
Herhangi bir travma veya hastalığa bağlı akut ağrının değerlendirilmesi daha anlaşılabilir olsa da özellikle ağrı deneyiminin uzaması ve kronik ağrının ortaya çıkmasıyla ağrının değerlendirilmesi bir miktar zorlaşmaktadır. Ağrının bireysel bir deneyimdir ve kronik ağrı kişinin fonksiyonelliğini, katılımını, sosyal yaşamın da etkiler. Kronik ağrılı
hastalarda uyku bozukluğu da sıktır. Bu durum kişinin psikolojik sağlığını ve enerjisini de bozar.
Kronik ağrılı hastalarda tüm bunlara bağlı gelişen fonksiyonel kısıtlılığa verilen tepkinin depresyo�na sebep olabileceği düşünülmektedir. Kronik ağrının komplike yapısı hastaların değerlendirilmesini zorlaştırmaktadır. Kronik ağrılı hastaları değerlendirmedeki zorluk yalnızca klinik pratikte değil klinik araştırmalar için de geçerlidir. Bu durum farklı kronik ağrı türleri ve farklı hasta popülasyonları için çok sayıda değerlendirme aracı geliştirilmesine sebep olmuştur (1, 2).
Kronik ağrının bu karmaşık yapısı gereği hataların öykü, fizik muayene ve tanıya özgü testlerle kapsamlı değerlendirilmesi gereklidir(1).
... A number of studies report a risk for unrecognized and unmanaged pain in children with severe neurological impairment (Hadden and von Baeyer, 2002, Carter et al., 2002, Roscigno, 2002, Ståhle-Oberg and Fjellman-Wiklund, 2009). The underestimation and undertreatment of pain appears due to inadequate pain assessment in children, based on study results (Merkel and Malviya, 2000). Healthcare professionals in Oberlander & O"Donnell, (2001) report difficulties in assessing pain. ...
... Typical pain behaviors may not reflect pain in children with neurological impairment, and idiosyncratic behaviors may; which increases the risk for misinterpretation (Breau et al., 2000, McGrath et al., 1998. A withdrawn behavior and sleeping can be misinterpreted as no pain, yet a child may attempt to control pain by reducing activity and social interactions (Merkel & Malviya, 2000). A change in the child"s tone is a significant pain cue in Hunt et al., (2003). ...
... Other descriptions of passive behaviors included: doesn"t crawl around and explore, sits still biting on toys, and does not engage in play/activities that she usually enjoys. A child may attempt to control pain by reducing activity and social interactions, yet a withdrawn behavior or sleeping may also be misinterpreted as no pain (Merkel andMalviya, 2000, Breau et al., 2007). helped a few of the children feel better when they had discomfort, as also noted in (Russo et al., 2008). ...
... Estes instrumentos facilitam a interação e comunicação entre os membros da equipe de saúde, que passam a atentar e perceber a evolução da dor em cada paciente e a verificar a resposta frente à terapia. Preferencialmente, uma única escala de avaliação da dor deve ser utilizada em cada serviço para lograr acurácia, porém, pode haver a necessidade de variar segundo a idade, capacidade e até devido à preferência da criança 6 Todas estas escalas de dor são de difícil utilização em algumas situações clínicas, como nas crianças sedadas, com restrição de movimentos, ou submetidas a intubação traqueal [9][10][11][12][13][14] . No caso das crianças de tenra idade, que não verbalizam seus sentimentos, a avaliação do profissional pode ser um fator adicional de imprecisão para aquilatar (e tratar) a dor 15,16 . ...
... Nos últimos anos, têm-se observado que atitudes, crenças e aspectos culturais podem influenciar a ação da enfermeira, em relação ao alívio da dor 28 . Um estudo mostrou que a experiência pessoal com a dor vivida pela enfermeira, ou por seu filho, aumenta, consideravelmente, a administração de analgésicos em situações clínicas 11 . ...
... Uma das dificuldades para a avaliação rotineira da dor nos hospitais é o tempo a ser dispensado neste trabalho, motivo pelo qual a escala de avaliação deve ser simples do ponto de vista da criança e da enfermeira 11,32 . Outro aspecto implicado na avaliação e tratamento da dor é o conhecimento do tema pelo profissional da saúde, o que possibilita a intervenção necessária, assim como a existência dos recursos terapêuticos no local. ...
... Pain scales and tools should be valid and reliable in clinical practice. It should adapt to the needs of the child and be easy to use 6 . Generally, the accepted standard in pain assessment is that the patient can tell his/her own pain. ...
... This scale was mainly developed to assess pain in children between the ages of 2 months and 7 years. It is a simple, consistent, easily documented, reliable pain scoring method that facilitates communication between clinician and nurse 6,7,9 . It is easy to apply in crowded clinics. ...
Purpose: The evaluation of postoperative pain in pediatrics is a true challenge. We aimed to evaluate the immediate postoperative pain management using FLACC (Face, Legs, Activity, Cry, Consolability (FLACC) Behavioral Pain Scale) scale after caudal block. Material and Methods: The anesthesia records of children aged 0–8 years who underwent caudal block under general anesthesia prior to surgery were evaluated. The intraoperative and postoperative use of opioids were obtained, as well as, the FLACC scores. Results: Seventy-eight children were included and evaluated in two groups according to ages of 1-24 (n=37) and 24-96 months (n=41). Intraoperative requirement for opioid was observed in 7.7% (n=6) of patients. Nine patients (11.5%) required fentanyl in the immediate postoperative period with FLACC ≥4. Only 1 patient required opioids both intraoperatively and in the immediate postoperative period, suggesting a success rate of 98.7%. The patients were observed to receive single dose opioid, despite FLACC ≥4 in the following postoperative 1st,2nd and 3rd hours. The subgroups of age were similar in terms of FLACC scores and the changes in these scores within the postoperative 3 hours. There were no urinary retention or motor block. However, paresthesia was recorded in 4 patients at age of 24-96 months, whereas, in none of the patients at age of 1-24 months. The uncomfortable numbness, which could not be described at age of 1-24 months may have caused the difference, as well as, leading to high FLACC scores without any opioid use. Conclusion: Our study supported that anesthetists consider FLACC scale as a part of pain assessment to administer opioid, not as a sole indicator.
... Pain scores were collected and recorded in the patient's chart using validated scales, including NRS, Wong BAKER, and FLACC [5][6][7]. Opioid administration was given following institutional protocol based on PACU nursing assessment and pain scores. Opioid consumption was calculated based on MME and patient weight. ...
... The y-axis is the postoperative pain score on a scale of 0-10. .7 ...
Vascular anomalies are a diverse group of abnormal blood vessel developments that can occur at birth or shortly afterward. Embolization and sclerotherapy have been utilized as a treatment option for these malformations but may cause moderate to severe pain. This study aims to evaluate the utilization of peripheral nerve blocks in opioid consumption, pain scores, and length of stay. A retrospective chart review was conducted at the UPMC Children's Hospital of Pittsburgh for all patients who underwent embolization and sclerotherapy between 2011 and 2020. Patient data was collected to compare opioid consumption, pain scores, and length of stay. Eight hundred fifty-four procedures were performed on 347 patients. The morphine milligram equivalent per kilogram mean ratio between groups was 0.9 (0.86, 0.95) with a p-value of <0.001. The pain score mean ratio was –1.17 (–2.2, -0.1) and a p-value of 0.027. Length of stay had a mean ratio of 0.94 (0.4, 2) and a p-value of 0.875. By decreasing opioid consumption and postoperative pain scores, peripheral nerve blocks may have utility in patients undergoing embolization and sclerotherapy while not clinically increasing the length of stay for patients. Their use should be individualized and carefully discussed with the interventional radiologist.
... Observe the child for signs of irritability through vocalizations, facial expressions, or color changes. Merkel and Malviya (2000) have described several other useful pediatric pain scales [21]. ...
... Observe the child for signs of irritability through vocalizations, facial expressions, or color changes. Merkel and Malviya (2000) have described several other useful pediatric pain scales [21]. ...
Hypophosphatasia (HPP) is a rare inborn error of metabolism resulting in undermineralization of bone and subsequent skeletal abnormalities. The natural history of HPP is characterized by rickets and osteomalacia, increased propensity for bone fracture, early loss of teeth in childhood, and muscle weakness. There is a wide heterogeneity in disease presentation, and the functional impact of the disease can vary from perinatal death to gait abnormalities. Recent clinical trials of enzyme replacement therapy have begun to offer an opportunity for improvement in survival and function. The role of physical therapy in the treatment of the underlying musculoskeletal dysfunction in HPP is underrecognized. It is important for Physical Therapists to understand the disease characteristics of the natural history of a rare disease like HPP and how the impairment and activity limitations may change in response to medical interventions. An understanding of when and how to intervene is also important in order to optimally impact body function, lessen structural impairment, and facilitate increased functional independence in mobility and activities of daily living. Individualizing treatment to the child's needs, medical fragility, and setting (home/school/hospital), while educating parents, caregivers, and school staff regarding approved activities and therapy frequency may improve function and development in children with HPP.
... Pain scores were collected and recorded in the patient's chart using validated scales, including NRS, Wong BAKER, and FLACC [5][6][7]. Opioid administration was carried out following the institutional protocol based on the PACU nursing assessment and pain scores. Opioid consumption was calculated based on MMEs and patient weight. ...
Vascular anomalies are a diverse group of abnormal blood vessel developments that can occur at birth or shortly afterward. Embolization and sclerotherapy have been utilized as a treatment option for these malformations but may cause moderate-to-severe pain. This study aims to evaluate the utilization of peripheral nerve blocks in opioid consumption, pain scores, and length of stay. A retrospective chart review was conducted at the UPMC Children’s Hospital of Pittsburgh for all patients who underwent embolization and sclerotherapy between 2011 and 2020. Patient data were collected to compare opioid consumption, pain scores, and length of stay. In total, 854 procedures were performed on 347 patients. The morphine milligram equivalent per kilogram mean difference between groups was 0.9 (0.86, 0.95) with a p-value of <0.001. The pain score mean ratio was −1.17 (−2.2, −0.1) with a p-value of 0.027. The length of stay had an incident rate ratio of 0.94 (0.4, 2) and a p-value of 0.875. By decreasing opioid consumption and postoperative pain scores, peripheral nerve blocks may have utility in patients undergoing embolization and sclerotherapy while not clinically increasing the length of stay for patients. Their use should be individualized and carefully discussed with the interventional radiologist.
... I tillegg ble det utført en spørreundersøkelse ved Barneintensivenheten for å finne ut hvorvidt sykepleiere kjente til slike metoder. Det finnes flere metoder for systematisk bedømming av smerte og sedasjon hos barn på respirator (35)(36)(37). "COMFORT scale" er et validert verktøy for å vurdere barns smerte og sedasjonsbehov (38)(39)(40). Spørreundersøkelsen viste at sykepleierne ved Barneintensivenheten manglet kunnskap om metoder for systematisk bedømming av smerte inspira 1 2 00 9 S I D E 12 og ubehag av barn på respirator, men ønsket å få det. ...
Dette er en fulltekst av tidsskriftet Inspira nummer 1, 2009. Merk at tidsskriftet publiseres av Cappelen Damm Akademisk fra og med 15. januar 2021. Tidsskriftet ble godkjent som vitenskapelig publiseringskanal i november 2018. Innhold Leder: Anne-Marie og Hildegunn Maskeventilering av langtkomne KOLS-pasienter: Steinar Mathias Svimbil Mørken Klinisk stige på Barneintensivenheten: Tove Gjellum, Hanne Birgit Alfheim Informasjon til foreldre: Dag-kirurgisk inngrep med narkose: Eilif K.Eckhoff Problemer med postoperativ urinretensjon: Karin Jensvold Videreutdanning i prehospitalt arbeid er i gang!: Ellen Lunde Postoperativ smertebehandling: Alfhild Dihle Reisebrev fra Firenze: Lise Toubro Bratber ALNSF – nytt NSFLIS – nytt
... The Likert scales for discomfort were the same for adults and children, but the Likert scale for pain in children showed faces with different expressions to aid accuracy of results in young children. These scales are standard, validated scales commonly used to evaluate patient discomfort and pain [25][26][27]. The practicality questionnaire also monitored the time taken to collect each sample type and the occurrence of nosebleeds when collecting nasal fluid. ...
Longitudinal, community-based sampling is important for understanding prevalence and transmission of respiratory pathogens. Using a minimally invasive sampling method, the FAMILY Micro study monitored the oral, nasal and hand microbiota of families for 6 months. Here, we explore participant experiences and opinions. A mixed methods approach was utilised. A quantitative questionnaire was completed after every sampling timepoint to report levels of discomfort and pain, as well as time taken to collect samples. Participants were also invited to discuss their experiences in a qualitative structured exit interview. We received questionnaires from 36 families. Most adults and children >5y experienced no pain (94% and 70%) and little discomfort (73% and 47% no discomfort) regardless of sample type, whereas children ≤5y experienced variable levels of pain and discomfort (48% no pain but 14% hurts even more, whole lot or worst; 38% no discomfort but 33% moderate, severe, or extreme discomfort). The time taken for saliva and hand sampling decreased over the study. We conducted interviews with 24 families. Families found the sampling method straightforward, and adults and children >5y preferred nasal sampling using a synthetic absorptive matrix over nasopharyngeal swabs. It remained challenging for families to fit sampling into their busy schedules. Adequate fridge/freezer space and regular sample pick-ups were found to be important factors for feasibility. Messaging apps proved extremely effective for engaging with participants. Our findings provide key information to inform the design of future studies, specifically that self-sampling at home using minimally invasive procedures is feasible in a family context.
... Some research has found that validated measures are misused, such as measures used with age-inappropriate groups (Stevens et al., 2012). For example, younger children have limited language and cognitive abilities and thus, pain measures developed for older children may be misunderstood by younger populations (Merkel and Malviya, 2000). Although our study examined how frequently healthcare professionals use validated pain assessment measures, it did not assess if these measures were used appropriately, which is a further limitation of the survey's self-report methodology. ...
Children who have been maltreated are at an increased risk of having their pain under-recognized and undertreated by healthcare professionals, and thus, are more susceptible to adverse outcomes associated with undertreated pain. This study's aims were to examine: (1) if healthcare professionals' pediatric pain knowledge is associated with their pain assessment methods, (2) if maltreatment-specific pain knowledge is associated with consideration of child maltreatment when deciding on a pain management strategy, and (3) if pediatric pain knowledge would relate to maltreatment-specific pain knowledge. A sample (N = 108) of healthcare professionals responded to a survey designed to examine their current knowledge and utilization of pediatric pain assessment and management with emphasis on the effects of child maltreatment. Findings revealed healthcare professionals' knowledge of pediatric pain is independent of their pain assessment and management practices. However, general pain knowledge was associated with maltreatment-specific pain knowledge and generally, healthcare professionals were knowledgeable of child maltreatment's impact on pediatric pain. Participants who considered a history of maltreatment were also more likely to employ sensitive questioning strategies when asking children about their pain.
... Objective pain rating scales have been demonstrated to be incredibly useful, as children may not be able to express their pain accurately, but significant signals can be gained from their reactions, facial expressions, and crying. 26 The FLACC Scale was utilized in the present study, and its reliability and efficacy have been validated even among young and impaired people. Furthermore, the PRS was utilized to determine a subjective evaluation of pain. ...
Background:
Needle-free injection systems can contribute to the prevention of needle-related pain during palatal infiltration anesthesia (PIA) in children. Research on this topic in children is required.
Aim:
The purpose of this clinical study was to evaluate the effectiveness and patient preference of a needle-free system versus traditional anesthesia on pain perception during PIA in children.
Design:
The study was designed as a randomized, controlled cross-over clinical study with 48 children aged 6 to 12 years requiring dental treatment with PIA in bilateral maxillary primary molars. Traditional anesthesia (TA) was applied on one side and the Comfort-in™ injection system (CIS) on the other side in two separate sessions. Then patient preference was recorded. The pain perception during PIA was evaluated using the Wong-Baker FACES Pain Rating Scale (PRS) and the Face, Legs, Activity, Cry, Consolability (FLACC) Scale. The data were analyzed for statistical significance (p<0.05).
Results:
There were statistically significant differences between the TA and the CIS according to the PRS and FLACC Scale scores. On both scales, significantly higher pain ratings were observed in the TA group during PIA (p < 0.001). There was a statistically significant difference in terms of patient preference (p < 0.001). While 77.1% (n = 37) of the children preferred the CIS, 22.9% (n = 11) preferred the TA. Moreover, patient preference for the CIS was significantly higher in older children (p < 0.01).
Conclusions:
The application of a needle-free system during PIA ensured a decrease in pain perception in children.
... If the time required for the use of clinical pain scales and documentation of results is high, the likelihood of adoption and regular use is low [35]. Subsequently, inadequate pain assessment in children may result in underestimation and under-treatment of pain [36]. ...
Objectives
Children hospitalized in a pediatric intensive care unit (PICU) are frequently exposed to distressing and painful medical procedures and interventions. There is a lack of clinical scales to measure procedural pain-related distress in ventilated children. The Behavioral Pain Scale (BPS) was initially developed to detect procedural pain in critically ill adults. This study aims to assess the BPS’s discriminant properties for measuring procedural pain-related distress in ventilated pediatric patients incorporating two instruments validated for pediatric patients.
Methods
This prospective exploratory study was performed with ventilated children admitted to the interdisciplinary 14-bed PICU of the University Children’s Hospital, University Medical Center Hamburg-Eppendorf, Germany. The nurse in charge and an independent observer simultaneously assessed the patients using German versions of the BPS, the COMFORT-B scale (CBS), and the modified Face, Legs, Activity, Cry, Consolability (mFLACC) scale immediately before and during endotracheal suctioning.
Results
We analyzed 170 parallel assessments in n=34 ventilated children. Patients were (mean ± SD) 9.5 ± 4.8 years old. Internal consistency for the BPS was excellent (α=0.93). We found a high rater agreement for all clinical scales (BPS: k=0.73, CBS: k=0.80, mFLACC: k=0.71). Strong correlations were identified between BPS and CBS (r=0.89) and BPS and mFLACC (r=0.79). The BPS cutoff values showed likewise excellent results (area under the curve CBS >16: 0.97; mFLACC >2: 0.91).
Conclusions
In our population of ventilated children, the BPS was well suited to detect procedural pain-related distress compared with two validated pain scales. Further extensive validation studies should follow to support our findings.
... Moreover, accurate comprehension and expression of pain levels require a mental development that not every child aged below six has necessarily reached. Younger children have experienced fewer painful incidents; thus, there is a higher tendency to report more intense pain levels when compared to older children (52). Therefore, conducting this study on children older than six has more reliability regarding the reported pain levels. ...
To evaluate the impact of photobiomodulation therapy (PBMT) on injection pain perception and compare it with a topical oral anesthetic gel. A total of 30 patients of six to nine years old seeking pulpotomy treatment of maxillary secondary primary molars of both sides were considered for this split‐mouth triple‐blind randomized clinical trial. On one side of the maxilla, the low‐level‐laser (diode laser, 808 nm, 250 mW; 16.25 J; 32.5 J/cm2) was irradiated upon the buccal gingiva of the tooth, while a Benzocaine 20% topical anesthetic gel was applied on the other side. A gel with the same taste (strawberry) was applied for the placebo. The Wong‐Baker Faces Pain Rating Scale was used to evaluate the injection pain and post‐operation pain at two timestamps, one hour and 24 hours after treatment. Patients' heart rate was also evaluated. Paired‐T, Wilcoxon‐signed‐rank test, McNemar and Friedman tests were used for statistical analyses. Results demonstrated that PBMT could significantly decrease the injection pain perception and heart rate alternations compared to the topical anesthetic gels (P=0.000). However, no significant differences were documented between the two methods concerning the 1hour (P=0.26) and 24‐hours (P=1.00) post‐operation pain. PBMT can be an effective non‐pharmacological technique for controlling injection pain.
... One reason to explain this situation would be that young children have had fewer pain experiences to use as reference to compared with the pain that they may feel in the dentist's office. 30 Hence, an advantage was gained by conducting the present study with patients aged 6 and over to improve the reliability of the reported pain scores. ...
Background:
The use of Low-Level-Laser-Therapy (LLLT) to reduce injection pain of the dental local anesthesia is reported in limited number of studies in adults. Research on children is needed.
Aim:
This study aims to evaluate the effects of topical anesthesia + LLLT on injection pain, anesthesia efficacy and duration in local anesthesia applications of children who are undergoing pulpotomy.
Design:
The study was conducted as a randomized, controlled-crossover, double-blind clinical trial with 60 children aged 6-9 years. Before local infiltration anesthesia, only topical anesthesia was applied in one side (control group/CG), and topical anesthesia plus LLLT (a diode laser-810nm; continuous-mode; 0.3W; 20-sec; 69-J/cm2 ) was applied in the contralateral side (LG) as pre-anesthesia. The injection pain and anesthesia efficacy were evaluated subjectively and objectively using the Wong Baker Faces Pain Rating Scale (PRS) and the Face, Legs, Activity, Cry, Consolability (FLACC) Scale, respectively. Data were analyzed for statistical significance (p<0.05.) RESULTS: The 'no pain' and 'severe pain' rates in PRS were 41.7% and 3.3% for LG and 21.7% and 11.7% for CG, respectively, during the injection. Similarly, in the FLACC data, the number of 'no pain' responses was higher for LG than CG (40%, 33.3%) and no 'severe pain' rate was observed in both group. The only statistically significant difference was found for PRS (p<0.05). The median pain score was '0' for LG and CG in the FLACC data for the anesthesia efficacy evaluation and there was no statistically significant difference between the groups in terms of pain and anesthesia duration (p>0.05). Also, most of the children preferred injection with topical anesthesia + LLLT (66.7%).
Conclusions:
It has been determined that the application of topical anesthesia + LLLT with an 810-nm diode laser before local infiltration anesthesia has reduced the injection pain and did not have an effect on anesthesia efficacy and duration in children.
... Inadequately controlled pain negatively affects the quality of children's life, recovery and increases the risk of post-surgical complications. Since pain is subjective and complex, pain intensity is mainly examined by the self-report in verbal children and adults (1). Several postoperative pain management interventions and strategies are available, and they are applied by accurate pain assessment. ...
Context: Acute procedural pain is a very prevalent problem among post-operative children. However, it is still under-assessed and under-treated due to pain assessment complexity of and delayed treatment of pain in post-operative children. Assessing post-operative pain using valid tools to guide child pain management decisions. Despite multiple research studies of postoperative pain in children, it remains unclear whether using one-dimensional alone or multi-dimensional tools contributes to effective assessment and prompt adequate treatment pain in children. Objectives: This study examined whether there is any difference in time of pain interventions administration between post-operative children assessed with face pain scale alone and those assessed with face pain scale and physiological parameters. Methods: The sample population consisted of 150 children randomly assigned into study groups (control=75, Intervention=75) using an excel table of sequential randomization. Participants in the control group assessed for post-operative pain using a one-dimensional tool (WBFPS). Participants in the intervention group were assessed using a multi-dimensional scale that included the face pain scale and physiological measurements (HR, RR, O2 Sat, and B/P). The study was conducted at surgical floors, and Paediatric Intensive Care Unit (PICU) in a single-site case setting (King Abdullah University Hospital) Results: Data from a total of 150 participants were analysed. There was a statistically significant difference in the mean pain score level between the two groups. The mean pain score in the control group was 1.45±1.09 and in the experimental group was 2.96±1.95. The mean time of pain intervention administration in minutes in the experimental group was 30.89 ±23.1, while the mean of the administration time in the control group was 44.69 ±19.5. The mean pain score difference between groups was found to be statistically significant (p= 0.00). The 24.5% of changes in the dependent variables are affected by independent variables. The multi regression used showed a significant impact of the type of assessment tools (p=0.004), type of surgery (0.054), and intraoperative opioids (p=0.000) concerning the duration of pain intervention administration. Conclusion: The study results show significant positive differences in pain level according to assessment tool type. The use of multi-dimensional instruments that included physiological measurements was more accurate. It led to more effective pain management than one-dimensional instruments that only had face pain scale.
... In pediatric medical settings, valid pain assessment tools are available, and although adjustments should be made to cognitive development of the child (Drendel et al., 2011), are recommended for all ages (Baxt et al., 2004;Blount & Loiselle, 2009;Merkel & Malviya, 2000). Nevertheless, findings show that assessment of pain is lacking in 20% to more than 50% of cases, especially with younger children (Drendel et al., 2006). ...
The literature on child sexual abuse (CSA) has contributed significantly to the understanding of its characteristics, epidemiology, and consequences. Considerably less attention has been dedicated, however, to the subjective experiences of the abused children, and more specifically to their experiences of pain. The current study explored the way children perceive and describe pain during and shortly following incidents of sexual abuse. The sample was comprised of 35 transcripts of forensic interviews following alleged CSA. Thematic analysis of the children's narratives identified three themes: (a) pain during the abusive incidents, described using words indicating its intensity and quality; (b) pain shortly after the abusive incidents, including weeks later, and (c) pain as embedded within the complex dynamic with perpetrator. The children struggled to localize the pain, mainly using words such as "inside" and "deep." Moreover, they testified that in the course of the abusive incidents, they were often silenced when trying to communicate their pain to the perpetrators. The children's narratives provided us with a unique opportunity to learn about the pain not only during the abusive incidents but also following it. Additionally, children described suffering from pain in areas that were not directly injured during the CSA incidents, mainly referring to the head, abdomen and legs. The discussion addresses the potential intervening factors in peritraumatic CSA pain, as well as its potential links with chronic post-traumatic physical and mental morbidity. This study illuminates the necessity to address the complicated links between short- and long-term physical, emotional, cognitive, and interpersonal manifestations of CSA.
... The scores established with the COMFORT Behavior Scale-Spanish version were classified as follows: 10 points, absence of discomfort; 11e22 points, discomfort; and !23 points, severe discomfort. 23 These cut-offs are similar to those reported by the authors of the original scale in relating COMFORT scores to pain. 27 To gather the other 11 variables, we used a form developed by the research team. ...
Introduction
The care of critically ill children is usually invasive and aggressive, requiring numerous traumatic procedures that may cause fear, pain, and discomfort.
Objectives
The aim of this study was to analyse the level of discomfort of patients admitted to the paediatric intensive care unit of a specialist children's hospital and to determine the sociodemographic and clinical variables that influence the degree of discomfort experienced by critically ill paediatric patients.
Methods
We performed a descriptive observational cross-sectional study that included a total of 311 children with a median age of 5.07 y (interquartile range = 0.9–11.7). A team of 10 paediatric critical care nurses assessed the degree of discomfort once for each shift (morning, afternoon, and night) on 2 successive days using the COMFORT Behavior Scale—Spanish version.
Results
In total, 49.8% (n = 155) of the patients were free of discomfort (score ≤10 points) vs. 50.2% (n = 156) who experienced discomfort. There was a significant negative correlation between discomfort and the length of stay in days (Rho = 0.16; p = 0.02), that is, the longer the stay, the less discomfort the patient felt. The correlation between age and degree of discomfort was found to be both positive and significant (Rho = 0.230, p < 0.001); the greater the age, the greater the discomfort. In comparison of all children who received analgosedation (n = 205), with discomfort levels of 10.77 ± 2.94, with those who did not receive analgosedation (n = 106), with discomfort levels of 11.96 ± 2.80, we did find a statistically significant difference (χ² = −4.05; p < 0.001).
Conclusions
Half of the patients admitted to the paediatric intensive care unit experienced discomfort. Age and analgosedation were the two most important variables involved with a high degree of discomfort. Clinical care practices must consider these factors and try to plan activities designed to relieve discomfort in all critically ill paediatric patients.
... Due to these factors, it may be necessary to use multiple scales to measure the pain of children. It has been shown that objective pain assessment scales are very beneficial, as children may not specify their pain precisely, but crucial clues can be obtained from his/her facial expression, movements, grimacing, and crying [26]. In the present study, the FLACC scale, the reliability and effectiveness of which have been proven even among young and disabled individuals, was used. ...
Objective
The aim of this study was to compare the effectiveness of pain control between a needle-free system and topical anesthesia applied prior to inferior alveolar nerve block (IANB).Materials and methodsThe present study was designed as a randomized controlled cross-over clinical study on 60 children (aged 6 to 12 years) requiring dental treatment with IANB in bilateral mandibular molars. As pre-anesthesia, topical anesthesia (TA) was applied on one side and the Comfort-in™ injection system (CIS) on the other side in two separate sessions before IANB. The injection pain during IANB, at both the needle insertion and solution deposition phases, was analyzed using the Wong-Baker Faces Pain Rating Scale (PRS) and the Face, Legs, Activity, Cry, Consolability Scale (FLACC). The data were analyzed using the Wilcoxon signed-rank test, Spearman correlation, and Mann–Whitney U test.ResultsThere were statistically significant differences between TA and CIS in subjective and objective pain evaluations during both the needle insertion and solution deposition. The use of a needle-free system in pre-anesthesia yielded a significant decrease in subjective and objective pain scores (p < 0.001). No statistical difference was found between TA and CIS in terms of patient preference, but patient preference for CIS was significantly higher in older patients (p < 0.01).Conclusions
It was determined that the use of a needle-free system in pre-anesthesia yielded a decrease in injection pain of IANB.Clinical relevancePediatric dentists should be aware of the new injection system in order to decrease the level of injection pain.
... Inadequate pain assessment can lead to underestimation and undertreatment of pain in the pediatric population (25). In one study, it was determined that pediatric surgical nurses did not have enough knowledge about infants' pain assessment (26). ...
Aim:Pediatric nurses play a crucial role in the assessment and management of a child’s pain. The main purpose of nursing care is to eliminate pain and improve the quality of life. The aim of this study was to evaluate the knowledge, practice and beliefs of pediatric nurses about pain.Materials and Methods:The current study using a descriptive research design included 102 pediatric nurses working at Akdeniz University Hospital who agreed to participate in the study. Data were collected using a questionnaire developed by the researchers via a face to face interview method also by the researchers.Results:Approximately half of these pediatric nurses (40.2%) are in the 20-29 age group, 51% are married and 80.4% are bachelor’s degree holders. In this study, 56.9% of the nurses stated that they did not receive any education about pain and 51% stated that they had insufficient knowledge about the evaluation of pain. Although 67.6% of these nurses state that they have a pain scale in their clinics, 65.6% of the nurses in our study group do not know the name of the scale. Although pain is subjective, only 68.6% of the nurses believed that the child/mother had expressed the pain and 22.5% stated that the cause of the pain was always an illness. In the study, 88.2% of nurses stated that analgesia should not be given before the onset of pain.Conclusion:It is very important to make in-service training programs for pain which is considered as a vital finding. It is recommended that nurses increase their level of knowledge to counter false beliefs/practices about pain. It is hoped that the results of this study will be a reference for the development and updating of nursing education, curricula and clinical training.
... The scale is commonly used to measure pain severity in children aged 3 to 18 years. Pain is scored according to numerical values assigned to faces showing a spectrum of expressions: The smiley face represents lack of pain (0 points), whereas the crying face represents severe pain (10 points) (Merkel & Malviya, 2000). Validity and reliability studies of this scale were conducted previously (Wong & Hockenberry, 2003), as were construct, discriminant (Keck, Gerkensmeyer, Joyce, & Schade, 1996), and concurrent validity (Luffy & Grove, 2003) and testeretest reliability (Keck et al., 1996;Luffy & Grove, 2003) studies. ...
Background:
Venous blood sampling is a common procedure in the hospital setting and cause significant pain and stress for children.
Aim:
This study was conducted to determine and compare the effects of balloon inflation, ball squeezing, and coughing methods on levels of pain and fear during venipuncture in children aged 7-12 years.
Design:
Experimental, randomized controlled study.
Setting:
The study was conducted at a state hospital in Turkey between March and July 2017.
Participants/subjects:
The study population comprised children 7-12 years of age who were subjected to venous blood sampling in the phlebotomy unit of a state hospital. The study sample included 120 children for a confidence interval of 95% and statistical power of 80%.
Methods:
The children were assigned to one of four groups (balloon inflation, ball squeezing, coughing, and control groups), each including 30 participants. The children's pain and fear were rated before and after the procedure by the children themselves, their parents, and a researcher using the Wong-Baker FACES Pain Rating Scale and Children's Fear Scale, respectively.
Results:
Mean scores for pain and fear after the procedure were lower in all intervention groups compared with the control group (p = .001). There was no statistical difference in pain or fear scores between the intervention groups; however, the children in the coughing group had the lowest scores for both pain and fear.
Conclusion:
Balloon inflation, ball squeezing, and coughing were all effective in reducing pain and fear associated with venipuncture in children aged 7-12 years. These are simple, rapid, and cost-effective methods that nurses can implement during venipuncture with minimal equipment and preparation.
... Bunlar; öz bildirim ağrı ölçekleri, davranışsal-gözlemsel ağrı ölçekleri ve fizyolojik göstergelerdir. 10,[12][13][14] Fakat şuna dikkat etmek gerekir ki bir ölçeğin belirli bir yaş aralığı ve kültürde geçerli olması, diğer bir yaş aralığı ve kültürde geçerli olacağı anlamına gelmemektedir. 10 güçlü olmadığına inanılmakta idi. ...
... One reason to explain this situation would be that young children have had fewer pain experiences to use as reference to compared with the pain that they may feel in the dentist's office. 30 Hence, an advantage was gained by conducting the present study with patients aged 6 and over to improve the reliability of the reported pain scores. ...
Objective:
This study evaluated the effect of low-level laser therapy (LLLT) on postoperative pain in children undergoing primary molar extraction.
Materials and methods:
This randomized, controlled-crossover, double-blind clinical trial was conducted with 37 children requiring bilateral extraction of primary molars. In one tooth (LLLT group), a GaAlAs diode laser (wavelength, 810 nm; continuous mode, output power 0.3 W; 180 sec, 4 J/cm(2)) was applied intraorally 1 cm from the target tissue immediately following extraction. In the contralateral tooth (control group), the hand piece was applied, but without laser activation. Children and parents rated postoperative pain on the first three evenings following extraction using, respectively, the Wong-Baker FACES(®) Pain Rating Scale (PRS) and the Visual Analogue Scale (VAS). Parents also reported if their children received analgesics. Data were analyzed using χ(2) and Mann-Whitney U tests.
Results:
Mean VAS scores were higher for the control group than for the LLLT group on the first and second evenings, and PRS scores were higher for the control group than for the laser group on the first evening, but the differences were not statistically significant (p > 0.05). More analgesics were given to children in the control group on the first evening; however, both groups received equal amounts on the next two evenings (p > 0.05).
Conclusions:
Within the limitations of this study, LLLT application following primary molar extraction was not found to affect postoperative pain in children.
... 27,[33][34][35][36][37] Objektif değerlendirme skalaları çocuk ağrıyı tam ifade edemese bile, çocukların bakışlarından, hareketlerinden, yüzlerini buruşturmalarından, kasılmalarından yola çıkarak önemli bilgiler verdiği için değerli oldukları, ancak hiçbir skalanın tek başına kullanıldığında diğerine üstünlüğü olmadığı bildirilmiştir. 38 Bu nedenle bu çalışmada, objektif değerlendirme için güvenirliliği ve etkililiği küçük ya da engelli bireylerde dahi gösterilmiş bir skala olan FLACC ve enjeksiyon ağrısının değerlendirilmesinde çocuğun ağrı ile ilişkili duygularını kendisinin ifade edebileceği Wong Baker yüz ifadesi ağrı skalası kullanıldı. [22][23][24] Çalışmamızda FLACC skalasına göre elde ettiğimiz verilerde DentalVibe ile gerçekleştirilen enjeksiyon ağrısının daha düşük olduğu, ancak istatistiksel olarak bu düşüşün anlamlı olmadığı saptandı. ...
... Att bedöma barns smärta kan vara svårt. Merkel och Malviya (2000) beskriver olika metoder för skattning av barns smärta. Skattning av vitala parametrar såsom hjärtfrekvens, blodtryck, andningsfrekvens och mönster varierar beroende på andra faktorer än smärta och bör därför kompletteras med andra metoder. ...
... Pain being a subjective and complex in its nature, the intensity of pain is then primarily assessed through self-report in both adults and children (Merkel & Malviya, 2000). ...
Caudal epidural block (CEB) is one of the most preferred pediatric regional anesthesia methods for infants and children who need operations under umbilicus level, for example urogenital, rectal, inguinal, lower extremity surgeries. CEB is relatively easy to perform and provides efficient analgesia for both intraoperative and postoperative period. Although there are some studies which report caudal anaesthesia as the sole anaesthetic method in particular cases for infants and children, caudal anaesthesia is still combined with general anaesthesia for most of the cases
... On the day before data collection, a brief information session was held to instruct the participating children on how to complete a Body Discomfort Chart (BDC) and Visual Analogue Scale (VAS) (Merkel and Malviya, 2000). The children were asked to complete the BDC and VAS before leaving for school the following morning. ...
Schoolbag carriage is a common occurrence and has been associated with musculoskeletal discomfort in children. The current study investigated the relationship between schoolbag-related musculoskeletal discomfort and individual, physical and psychosocial risk factors in primary school children in Ireland. A cross-sectional survey and pretest-posttest quasi-experimental design was used. The site and intensity of musculoskeletal discomfort was assessed before and after schoolbag carriage to provide a dose-response assessment of schoolbag-related discomfort for the first time. Objective measurements of the children, schoolbags and other additional items were made, and a researcher assisted questionnaire was completed on arrival at school. A total of 529 children (male 55.8%: female 44.2%) with a mean age of 10.6 years ± 7.14 months were included. The majority had backpacks (93.8%) and 89.7% (n = 445) carried the backpack over 2 shoulders. The mean schoolbag weight (4.8 ± 1.47 kgs) represented a mean % body weight (%BW) of 12.6 ± 4.29%. Only 29.9% carried schoolbags that were ≤10%BW. A significantly greater proportion of normal weight children carried schoolbags that were >10%BW compared to overweight/obese children (p < 0.001). The mean %BW carried was 18.3 ± 5.03 for those who had an additional item. The majority (77.5%) carried schoolbags to school for ≤10 min. The prevalence of baseline musculoskeletal discomfort was high (63.4%). Schoolbag-related discomfort was reported more frequently in the shoulders (27.3%) than in the back (15%). The dose-response assessment indicated that both statistically and meaningfully significant increases in discomfort were observed following schoolbag carriage. Multiple logistic regression models indicated that psychosocial factors and a history of discomfort were predictors of schoolbag-related back discomfort, while gender (being female) and a history of discomfort were predictors of schoolbag-related shoulder discomfort. None of the physical factors (absolute/relative schoolbag weight, carrying an additional item, duration of carriage, method of travel to school) were associated with schoolbag-related discomfort. This study highlights the need to consider the multi-factorial nature of schoolbag-related discomfort in children, and also the need to identify background pain as its presence can inadvertently influence the reporting of 'schoolbag-related' discomfort if it is not accounted for.
Copyright © 2015 Elsevier Ltd and The Ergonomics Society. All rights reserved.
... Children's pain can be difficult to be quantified and qualified. Many methods for assessing the level of pain have been developed [9,10]. Among them, this study used the NRS, The complications of ketorolac include ulcer bleeding, renal dysfunction, and bleeding problem [12,13]. ...
Both ketorolac and propacetamol are used postoperatively to control mild to moderate pain. This study compared the analgesic efficacy of ketorolac and propacetamol delivered either preoperatively or postoperatively, and assessed the preemptive analgesic effect of ketorolac and propacetamol for adenotonsillectomy.
... In utilising this methodology, the context plays an important role, which is explained below, referring to a child abuse and homicide case that was tried in theSince there is no relevant measuring scale or data for the assessment and measurement of pain post-mortem, and since this has never been done in a court of law anywhere in the world, a four-step methodology based on a literature review (Baker & Wong, 1987:13;Coffman, Alvarez, Pyngolil, Petit, Hall & Smyth, 1997:224-225;Franck, Smith-Greenberg & Stevens, 2000:491;Herr, Coyne, Key, Manworden, McCaffery, Merkel, Pelosi-Kelly & Wild, 2006:47-48;Merkel & Malviya, 2000:409-410) was constructed, using paediatric pain assessment as a point of departure. ...
Child abuse and homicide are on the increase worldwide. Often the burden falls upon social workers to argue the case of victims without being able to quantify the pain the children have suffered. A case study approach was used in which a High Court case was utilised as base to describe the proposed methodology to assess the level of pain, post-mortem, a victim could have gone through. The application was a four-step methodology constructed by using paediatric pain assessment. This study found that there is a need for the development of post-mortem pain scales to aid social workers.
... As a result, pediatric surgical nurses did not have enough knowledge about infant's pain assessment. Inadequate pain assessment can lead to underestimation and undertreatment of pain in the pediatric population (Merkel & Malviya, 2000). Several guidelines have recently been developed to improve pain assessment in infants. ...
Effective pain management requires accurate knowledge, attitudes, and assessment skills. The purpose of the present study was to describe Turkish pediatric surgical nurses' knowledge and use of pain assessment and nonpharmacologic and environmental methods in relieving newborn's pain in hospital. The sample consisted of 111 pediatric surgical nurses employed in pediatric surgical unit in 15 university hospitals located in Turkey. A questionnaire was used to measure the nurses' knowledge and use of pain assessment, nonpharmacologic, and environmental methods. Data were analyzed with the use of descriptive statistics. Of the nurses that participated in the study, 83.8% were between the ages of 20 and 35 years, 54.1% had a bachelor degree, and 75.7% had a nursing experience ≤10 years. 50.5% stated that physiologic and behavioral indicators used in the assessment of pain in infants. The most commonly used nonpharmacologic methods were giving nonnutritive sucking, skin-to-skin contact, and holding. The most commonly used environmental methods were avoiding talking loudly close to the baby, minimal holding, care when opening and closing of the incubator, avoiding making noise when using wardrobe, drawers, trash, or nearby devices, such as radio and television, avoiding sharp fragrances, such as alcohol, perfume, near the baby, and reducing light sources. Although Turkish pediatric surgical nurses used some of the nonpharmacological and environmental methods in infant's pain relief, there remains a need for more education about pain management and for more frequent use of these methods in clinical care.
Extensive research has been conducted on the link between trauma, child maltreatment (CM), and chronic pain. Although the risk of suffering from chronic pain among CM survivors has been established, much less is known about the experience of pain during CM incidents or whether such peritraumatic pain sensations are associated with later chronic pain. This scoping review was conducted to synthesize the existing literature on pain during and a short time following CM (i.e., peritraumatic pain). Utilizing the preferred reporting items for systematic reviews and meta-analyses guidelines, the current review included 11 manuscripts, which met the following criteria: (a) refer to physical pain experienced during or a short time after CM, (b) were published in peer-reviewed journals, and (c) were written in English. The review demonstrated that most of the included studies were not intentionally focused on peritraumatic pain, the majority used qualitative research methods, and all were cross-sectional. Furthermore, although validated questionnaires are available, most of the studies did not utilize such measures. Those that intentionally reported pain demonstrated its high intensity and prevalence in CM incidents, indicating that pain is inherently embedded in the experience of maltreatment. The findings spotlight an underdeveloped research realm on a phenomenon that may hold significant empirical, clinical, and legal implications. Research endeavors should initiate interdisciplinary bodies of knowledge to establish well-validated research methodologies that properly quantify peritraumatic pain in trauma and CM.
Background:
Children presenting to hospitals for healthcare are often exposed to venous blood draw procedures which cause significant pain and stress for children.
Objectives:
Tactile stimulation and active distraction methods can be used during procedural pain management in children. This study was conducted to determine and compare the effects of tactile stimulation and active distraction methods on levels of pain and anxiety during venous blood draw procedure in children.
Methods:
A randomized controlled study design was adopted with a parallel trial design to compare four different intervention groups with a control group. The children's anxiety levels were evaluated using the Children's Fear Scale, and their perceived pain levels were evaluated using the Wong Baker Pain Scale.
Results:
The results of the child and observer evaluations revealed the perceived level of pain during the procedure to be lower in the intervention groups than in the control group, and lower in the spiky ball groups than in the round ball groups. The level of anxiety during the procedure was found to be significantly lower than that recorded prior to the procedure, based on the self-evaluation of the child and the evaluation of the observer in the intervention groups. A positive correlation was found between pain and anxiety levels during the procedure.
Practice implications:
The results of this study support the effectiveness of the spiky ball method to reduce perceived pain and anxiety in children during venous blood draw procedures in the pediatric blood draw units.
Background: Music therapy as a nonpharmacological means of managing patient pain, anxiety, and
discomfort is a recognised technique, although it is not widely used in the paediatric intensive care unit
(PICU).
Aim: The aim of this study was to assess the clinical effect of a live music therapy intervention on vital
signs and levels of discomfort and pain for paediatric patients in the PICU.
Methods: This was a quasi-experimental pretesteposttest study. The music therapy intervention was
carried out by two music therapists who were specifically trained, each possessing a master's degree in
the field of hospital music therapy. Ten minutes before the start of the music therapy session, the investigators recorded the vital signs of the patients and assessed their levels of discomfort and pain. The
procedure was repeated at the start of the intervention; at 2, 5, and 10 min during the intervention; and
at 10 min following the conclusion of the intervention.
Results: Two hundred fifty-nine patients were included; 55.2% were male, with a median age of 1 year (0
e21). A total of 96 (37.1%) patients suffered a chronic illness. The main reason for PICU admission was
respiratory illness, at 50.2% (n=130). Significantly lower values were observed for heart rate (p=0.002),
breathing rate (p < 0.001), and degree of discomfort (p
< 0.001) during the music therapy session.
Conclusions: Live music therapy results in reduced heart rates, breathing rates, and paediatric patient discomfort levels. Although music therapy is not widely used in the PICU, our results suggest that using interventions such as that used in this study could help reduce patient discomfort.
Purpose:
In this study, we aimed to evaluate the relationship between the analgesia nociception index (ANI) device and pain scales used in the postoperative pain assessment of pediatric patients who underwent laparoscopic appendectomy.
Design:
The study was designed as a correlation observational pilot study.
Methods:
Postoperative pain was evaluated using pediatric pain scales (face, legs, arms, cry, consolability scale; numerical rating scale; Wong-Baker scale) and ANI device in school-aged children and adolescents.
Results:
The mean age of the children was 14.00 ± 1.63 years, and the mean BMI was 22.52. We found a statistically significant positive correlation between the pain scale scores and a statistically significant negative relationship between the pain scale score and the ANI.
Conclusions:
The ANI device can be used safely and constantly for the objective assessment of postoperative pain in pediatric patients.
Introduction:
Constipation is one of the major issues faced by children with neuro-developmental disorder (NDD). The aims of the study were to: 1) examine the effectiveness of a structured physiotherapy program on constipation in children with NDD; and 2) compare if conventional physiotherapy along with structured physiotherapy intervention has any combined effect on constipation in children with NDD.
Method:
Thirty-five children with neurodevelopmental disorder were assessed and randomly allotted into two groups. Twenty-two completed the intervention for 2 weeks and were statistically analyzed at baseline and post 4 weeks at a single tertiary center. The outcome measures used were Pediatric quality of life inventory (PedsQL), Peds QL Gastrointestinal symptoms scale, Bristol stool form scale, and defecation frequency. Group A received the conventional treatment, whereas group B received structured physiotherapy along with the conventional treatment.
Results:
Group A had no significant outcomes, whereas in group B there were statistically significant differences for all outcome measures. Comparatively, a statistically significant change was noted for PedsQL GI symptoms scale (p = .045) and its constipation sub-scale (p = .002) in group B along with change in the Bristol stool form.
Conclusion:
Combined effect of structured along with conventional physiotherapy was better in terms of form of stool, constipation, and its associated quality of life factors as compared to conventional physiotherapy alone.
Aim
The main aim of this investigation was to analyse the specificity and sensibility of the COMFORT Behaviour Scale (CBS-S) in assessing grade of pain, sedation, and withdrawal syndrome in paediatric critical care patients.
Method
An observational, analytical, cross-sectional and multicentre study conducted in Level III Intensive Care Areas of 5 children's university hospitals. Grade of sedation was assessed using the Spanish version of the CBS-S and the Bispectral Index on sedation, once per shift over one day. Grade of withdrawal was determined using the CBS-S and the Withdrawal Assessment Tool-1, once per shift over three days.
Results
A total of 261 critically ill paediatric patients with a median age of 5.07 years (P25:0.9-P75:11.7) were included in this study. In terms of the predictive capacity of the CBS-S, it obtained a Receiver Operation Curve of .84 (sensitivity of 81% and specificity of 76%) in relation to pain; .62 (sensitivity of 21% and specificity of 78%) in relation to sedation grade, and .73% (sensitivity of 40% and specificity of 74%) in determining withdrawal syndrome.
Conclusions
The Spanish version of the COMFORT Behaviour Scale could be a useful, sensible and easy scale to assess the degree of pain, sedation and pharmacological withdrawal of critically ill paediatric patients.
Resumen
Objetivo
El objetivo principal de la investigación fue analizar la especificidad y sensibilidad de la escala COMFORT Behavior Scale-Versión española (CBS-ES) en la determinación del grado de dolor, sedación y síndrome de abstinencia.
Método
Se llevó a cabo un estudio observacional, analítico y transversal y multicéntrico en unidades de cuidados intensivos pediátricas de 5 hospitales españoles. Se valoró el grado de sedación del paciente crítico pediátrico de forma simultánea empleando para ello la CBS-ES y registrando los valores del Bispectral Index Sedation, una vez por turno durante un día. El grado de abstinencia se determinó una vez por turno, durante 3 días, empleando de forma simultánea la CBS-ES y la Withdrawal Assessment Tool-1.
Resultados
Se incluyeron en el estudio un total de 261 pacientes críticos pediátricos con una mediana de 1,61 años (P25: 0,35-P75: 6,55). Por lo que a la capacidad predictiva de la CBS-ES se refiere se obtuvo un área bajo la curva de 0,84 (sensibilidad del 81% y especificidad del 76%) con relación al dolor; de 0,62 (sensibilidad del 27% y especificidad del 78%) en el caso de la sedación, y de 0,73 (sensibilidad del 40% y especificidad del 74%) en el del síndrome de abstinencia.
Conclusiones
Se ha podido contrastar que la CBS-ES podría ser un instrumento sensible, útil y fácil de emplear para valorar el grado de dolor, sedación y síndrome de abstinencia farmacológico del paciente crítico pediátrico.
It is fundamental to rethink care given to children living with pain. This paper seeks to bring some ideas on this issue, highlighting various dimensions of care for children in pain and for their families. Scientific investigation on this issue will guide the professional competence through the application of the results for the children's well-being.
Child abuse and homicide are on the increase worldwide. Often the burden falls upon social workers to argue the case of victims without being able to quantify the pain the children have suffered. A case study approach was used in which a High Court case was utilised as base to describe the proposed methodology to assess the level of pain, post-mortem, a victim could have gone through. The application was a four-step methodology constructed by using paediatric pain assessment. This study found that there is a need for the development of post-mortem pain scales to aid social workers.
REVIEW QUESTION / OBJECTIVE
The objectives of the review are to evaluate evidence on:
1) the accuracy of self-report pain assessment tools;
2) the accuracy of a bundled approach (combined self-report and behavioral/observational pain assessment tools) in identifying acute pain intensity among hospitalized pediatric patients between the ages of six and 15 years.
More specifically, the review question is:
Is a bundled self-report and behavioral pain assessment tool more accurate in identifying acute pain intensity among hospitalized children aged six to 15 years of age compared to a self-report pain assessment tool?
INCLUSION CRITERIA
Types of participants
This review will consider studies that include pediatric patients with acute pain, hospitalized between the ages of six and 15 years. Exclusions include children with chronic pain, Intensive Care Unit patients who are sedated or intubated, and patients being treated for pain with cancer. Studies will be excluded if the focus is on children with developmental delays, infants or children experiencing chronic pain or pain associated with cancer, neonatal patients and adult patients.
Types of intervention(s)/phenomena of interest
This review will consider studies that evaluate acute pain in hospitalized children utilizing self-report pain assessment tools compared to a combination of behavioral/observational pain assessment tools, and self-report tools.
Types of outcomes
This review will consider studies that include the following outcome measures: presence or absence of pain, pain intensity rating (measured by a score on a self-report tool by self or by proxy), analgesic use as measured by type, dosage and frequency of administration, TRUNCATED AT 250 WORDS
Objective: The experience of pain is common among children undergoing surgery. Hospitalization and surgery are stressful experiences for children and their parents. This research was conducted to investigate and analyze the non-pharmacological methods mothers use to relieve their children's postoperative pain. Materials and Methods: The research sample consisted of 150 mothers whose children had undergone a surgical procedure at one of two hospitals in eastern of Turkey. Researchers used a questionnaire and Visual Analog Scale (VAS) to collect the data. To assess the data, descriptive statistics and the chi square test were used. Results: According to the results, 37 percent of mothers noted that their children' postoperative pain was severe, and mothers used strategies that provided emotional support as the main non-pharmacological method for reducing their children's pain (these strategies included being near their children constantly (70.6 percent) and touching them (81.3 percent). There was a statistically significant difference among the mothers' education levels, working statuses, and assessments of their children' pain levels as well as differences among their children's genders, their children's types of surgery, and some non-pharmacological methods used by the mothers (p<0.05). Conclusion: The experience of pain is common among children undergoing surgery, and families are overwhelmingly positive about being involved in the postoperative care of their children after day surgery. Therefore, nurses should provide information and guidance to mothers in pain management and provide them with an opportunity to be aware of their role in their children's pain care.
The goal of this study was to compare the laparoscopic procedure for ovariohysterectomy (OVH) with the conventional approach. Parameters such as duration of the surgery, complications (hemorrhages, visceral and vascular lesions), technical difficulties and the extending incision required for removing internal organs were evaluated during the intra-operative phase. The costs of both approaches were compared as well. A total of thirty non-defined breed bitches weighting between 6,5 and 19,0kg were randomly distributed into two groups of 15 animals each. Group I was subjected to laparoscopic OVH and group II to the conventional approach. The duration of the surgery was longer and the degree of bleeding was lesser in the laparoscopy than in the conventional approach. Splenic lesions were observed in three animals due to the use of Veress needle or trocar. Extension of the original incision was required in both groups to remove uterus and ovaries. Conversion of the technique was not indicated. In conclusion, both approaches are safe and efficient for OVH in bitches. The surgical time was larger and the occurrence of hemorrhage was less intense with the laparoscopic procedure. Surgical costs were higher with the laparoscopy.
The Face, Legs, Activity, Cry, Consolability (FLACC) scale is a five-item tool that was developed to assess postoperative pain in young children. The tool is frequently used as an outcome measure in studies investigating acute procedural pain in young children; however, there are limited published psychometric data in this context.
To establish inter-rater and intrarater agreement of the FLACC scale in toddlers during immunization.
Participants comprised a convenience sample of toddlers recruited from an immunization drop-in service, who were part of a larger pilot randomized controlled trial. Toddlers were video- and audiotaped during immunization procedures. The first rater scored each video twice in random order over a period of three weeks (intrarater agreement), while the second rater scored each video once and was blinded to the first rater's scores (inter-rater agreement). The FLACC scale was scored at four timepoints throughout the procedure. Intraclass correlation coefficients were used to assess agreement of the FLACC scale.
Thirty toddlers between 12 and 18 months of age were recruited, and video data were available for 29. Intrarater agreement coefficients were 0.88 at baseline, 0.97 at insertion of first needle, and 0.80 and 0.81 at 15 s and 30 s following the final injection, respectively. Inter-rater coefficients were 0.40 at baseline, 0.95 at insertion of first needle, and 0.81 and 0.78 at 15 s and 30 s following the final injection, respectively.
The FLACC scale has sufficient agreement in assessing pain in toddlers during immunizations, especially during the most painful periods of the procedure.
Avaliou-se a evolução clínica pós-operatória de 30 cadelas sem raça definida, durante sete dias, aleatoriamente distribuídas em dois grupos de 15 animais, submetidas à ovário-histerectomia (OVH) pelas abordagens laparoscópica (grupo I) e aberta (grupo II). Avaliaram-se os parâmetros de comportamento, fisiológicos e de complicações na ferida cirúrgica. Foi utilizada uma escala descritiva para avaliação da dor e das complicações pós-operatórias. Não foram encontradas diferenças significativas entre os grupos quanto às variáveis: locomoção, postura, interferência na ferida cirúrgica, tensão abdominal, vocalização, apetite, evacuação, freqüências cardíaca e respiratória e temperatura corporal. Quando as variáveis de comportamento e fisiológicas foram avaliadas em conjunto (escore 1), observou-se maior dor pós-operatória apenas no segundo dia do pós-operatório nas cadelas submetidas à cirurgia aberta. Quando as complicações das feridas cirúrgicas foram avaliadas em conjunto (escore 2), observou-se maior ocorrência dessas nos animais do grupo 1. O escore total (somatória dos escores 1 e 2) mostrou que a recuperação pós-operatória foi semelhante nas duas abordagens estudadas.
Pain is a common experience during childhood. Despite the magnitude of effects that pain can have on a child, it is often inadequately assessed and treated. Numerous myths, insufficient knowledge among caregivers, and inadequate application of knowledge contribute to the lack of effective management. The pediatric pain experience involves the interaction of physiologic, psychologic, behavioral, developmental, and situational factors. Pain is an inherently subjective multifactorial experience and should be assessed and treated as such. Pediatric Dentists are responsible for eliminating or assuaging pain and suffering in children when possible. To accomplish this, we need to expand our knowledge, use appropriate assessment tools and techniques, anticipate painful experiences and intervene accordingly. As an assessment of pain which constitutes the foundation for all pain treatment, developing valid measures is both a clinical and research challenge. Clinicians and researchers should select measures with full knowledge of their psychometric strengths and weakness, as well as in keeping with their explicit conceptual model of pain. The purpose of this paper is to address potential sources of pain measurement, and responses to pain control and distractions based on the pediatric developmental stages.
The present study aimed at investigating and comparing patients suffering from beta-thalassemia
minor with normal individuals in regard to their performances in the short version of Wechsler
test. In this cross-sectional study, a total of sixty individuals were divided into two equal groups
of beta-thalassemia minor and normal subjects; they were then studied by Wechsler subscales.
The mean performance scores of the normal group in the subtests of arithmetic and vocabulary
(p<0.01) and picture completion (p<0.05) were higher than those of the thalassemia group. In
fact, the mean performance score and ability of the normal group on the verbal scale was higher
in comparison to the thalassemia group (p<0.05), while on the nonverbal scale, there was no
significant difference between the two groups. It can be concluded that beta-thalassemia minor
negatively influences verbal fluency, reasoning and conceptualization, chaining and sequencing
tasks, perceptual skill, prediction of social situations and abstract thinking.
Key words: Cognitive ability, Beta-thalassemia minor, verbal ability, performance ability
IntroductionIn the PPACUThe post-operative environmentOxygen deliverySuctionPhysiological assessment and management of the paediatric post-anaesthesia patientA – Airway management and B – BreathingRespiratory complications and nursing interventionsC – CirculationThermoregulation and temperature abnormalitiesPost-operative nausea and vomitingPain management in the PPACUInfection controlFluid and electrolyte balanceWounds and dressingsPatient positioningLatex allergyChildren with epilepsyDelayed emergenceEmergence deliriumDischarge of the patient from the PPACUPsychological assessmentReferences
Paediatric pain assessment presents unique challenges to the healthcare team. Nursing staff provide the most frequent and ongoing assessment of pain and are responsible for reporting any problems or concerns to the physician-led services. A variety of tools are available to assist with pain assessment. Understanding when these should be used is an essential component of care. The nurse must consider verbal and non-verbal assessment techniques. An understanding of the peak effect of common analgesics is also important. Each patient needs an individualised plan of care. An effective pain assessment is a key component of appropriate pain management. Poorly controlled pain can result in adverse short- and long-term consequences.
The purpose of this study was to describe the current practice and perception of pain assessment in US accredited advanced pediatric dentistry residency programs, as reported by directors of these programs.
A questionnaire was sent out to 68 accredited US pediatric dentistry residency programs. Responses were statistically analyzed to find significant correlations between the actual practice of pain assessment and the perceived usefulness of pain assessment.
Forty-four surveys (65% response rate) were completed and returned. Sixty-eight percent of program directors stated that pain is assessed at all types of appointments. A statistically significant correlation exists between program directors who regard pain assessment scales as useful and those who teach the use of such resources in their programs (chi-square = 3.73, P = .05). A statistically significant correlation exists between program directors who regard preoperative pain assessment as clinically beneficial and those who report a need to place more emphasis on pain assessment (chi-square = 6.22, P = .01).
Pediatric dentistry residency program directors generally regard pain assessment as clinically beneficial in patient treatment. Implementing increased pain assessment teaching in pediatric dentistry residency programs could improve the confidence and skills of residents in assessing the pain of young children and those with special health care needs.
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The silent confounds of the Main Effects Model as used in adoption research are individual difference driven self-selection and choice along with intermediary and birthparent selections. Two Chain-of-Choices Models -one for adoptive parents and one for birthparents and adoptees -are presented as possible frameworks within which to consider the role of individual differences, choices, and selections in understanding both the process of adoption and adoption outcomes. The article concludes with an extensive discussion of the research and practice implications which follow from the Chain-of-Choices Models and the emphasis on pre-existing individual differences.
This study evaluates the reliability and validity of the Toddler-Preschooler Postoperative Pain Scale (TPPPS), an observational scale developed to be a clinically useful measure of postoperative pain in children aged 1-5 years. The TPPPS consists of 7 items divided among 3 pain behavior categories: (1) Vocal pain expression; (2) Facial pain expression; and (3) Bodily pain expression. These items were derived from preliminary studies by the authors and from other observational studies of children's pain behavior. Seventy-four children between the ages of 12 and 64 months seen for inguinal hernia or hydrocele repair were the subjects of the study. Subjects were observed postoperatively for six 5-min intervals, commencing with their awakening from anesthesia, using the TPPPS. Two raters independently observed 28 of the children to assess inter-rater reliability. Validity was assessed by relating TPPPS scores to the timing and type of analgesics used, visual analog and numerical scale pain ratings made by parents and nurses, and perioperative vital signs. The TPPPS was found to possess satisfactory internal reliability (Cronbach's alpha = 0.88). Inter-rater reliability was good, with kappas for the pain behavior items ranging from 0.53 to 0.78. Preliminary evidence of the scale's validity is provided by the sensitivity of the scale to analgesic regimen, the convergence between TPPPS scores and nurse and parent ratings of postoperative pain, and the associations found between TPPPS scores and perioperative vital signs.
The location, intensity, and quality of pediatric postoperative pain were assessed in a convenience sample of 65 multiethnic children and adolescents, 8 to 17 years old. Pain was measured daily for 5 days during hospitalization using the Adolescent Pediatric Pain Tool (APPT). Mean pain intensity scores and mean number of pain descriptors (quality) decreased over time, but there was no significant change over time for the number of body segments marked (location). The findings provided valid and reliable estimates of adolescents' and children's self-reports of the location, intensity, and quality of postoperative pain.
To evaluate the reliability and validity of the FLACC Pain Assessment Tool which incorporates five categories of pain behaviors: facial expression; leg movement; activity; cry; and consolability.
Eighty-nine children aged 2 months to 7 years, (3.0 +/- 2.0 yrs.) who had undergone a variety of surgical procedures, were observed in the Post Anesthesia Care Unit (PACU). The study consisted of: 1) measuring interrater reliability; 2) testing validity by measuring changes in FLACC scores in response to administration of analgesics; and 3) comparing FLACC scores to other pain ratings.
The FLACC tool was found to have high interrater reliability. Preliminary evidence of validity was provided by the significant decrease in FLACC scores related to administration of analgesics. Validity was also supported by the correlation with scores assigned by the Objective Pain Scale (OPS) and nurses' global ratings of pain.
The FLACC provides a simple framework for quantifying pain behaviors in children who may not be able to verbalize the presence or severity of pain. Our preliminary data indicates the FLACC pain assessment tool is valid and reliable.
The purpose of this study was to determine the ability of children aged eight to 12 years to differentiate between the sensory and affective components of pain and to rate both components on three measurement scales. The Wong Faces Scale, Visual Analogue Scale (VAS), and a verbal numeric scale were used. A Word Sort Task tested the children's comprehension of pain sensation and emotion. Seven of ten correct answers were required for acceptance into the study. The three scales were used to rate preoperative and postoperative pain after osteotomy or spinal fusion. Results showed the children correctly sorted the pain descriptors, used the scales to measure imaginary pain appropriately, and rated preoperative and postoperative pain as expected clinically. The conclusions were that children can differentiate between the components of pain and can use the scales to rate both sensory and affective components of preoperative and postoperative pain. The scales demonstrated good predictive validity (p < 0.007) and high concurrent validity when measuring real pain (P > 0.007).
Objective.
—To develop quality improvement (QI) guidelines and programs to improve treatment outcomes for patients with acute pain and cancer pain.Participants.
—Twenty-four members of the American Pain Society (APS) participated in preparing the statement, including 15 nurses (oncology, general medical-surgical nursing, pediatrics, and QI research), seven physicians (clinical pharmacology, neurology, anesthesiology, radiation oncology, and physiatry), one psychologist, and one statistician. Participants were self-selected from the 3000 members of the APS, which supported the process and held annual open committee meetings and scientific symposia beginning in 1988.Evidence.
—MEDLINE was searched (1980 to 1995) to identify all articles on pain assessment, treatment of acute pain or cancer pain, and QI or education related to pain.Consensus Process.
—Following panel discussions, one member (M.B.M.) prepared successive drafts and circulated them to the panel and APS membership for comments. After publication of a prototype version in 1991,14 panelists carried out formal studies of implementation of the guidelines at three medical centers. This article was prepared based on this research, a new literature review, and suggestions from 50 pain clinicians and researchers.Conclusions.
—Quality improvement programs to improve treatment of acute pain and cancer pain should include five key elements: (1) Assuring that a report of unrelieved pain raises a "red flag" that attracts clinicians' attention; (2) making information about analgesics convenient where orders are written; (3) promising patients responsive analgesic care and urging them to communicate pain; (4) implementing policies and safeguards for the use of modern analgesic technologies; and (5) coordinating and assessing implementation of these measures. Several short-term studies suggest that this QI approach may improve patient satisfaction and facilitate recognition of institutional obstacles to optimal pain treatment, but it is not a panacea for undertreated pain. By making the magnitude of the problem apparent and committing the institution to change, pain treatment QI programs can provide a foundation for a multifaceted approach that includes education of clinicians and patients, design of informational tools to minimize errors in prescribing, and improved coordination of the process of assessing and treating pain.(JAMA. 1995;274:1874-1880)
This study examined concurrent self-reports of pain intensity and behavioral responses in 25 children aged 3–7 yr. Behavioral (Children's Hospital of Eastern Ontario Pain Scale, cheops) and self-report (the Oucher and Analogue Chromatic Continuous Scale) measures of pain were obtained following major surgery. The two self-report measures were strongly and significantly correlated, and the pattern of scores over the 36-hr observation period was as expected. There was little relationship between the scores for the self-report and the behavioral measures. Many children who reported severe pain manifested few of the bihavioral indicators of distress used in the cheops. This behavioral response pattern may occur commonly in children experiencing pain after surgery and may limit the applicability of current behavioral scales as sole measures of pain intensity in younger children.
The purpose of this study was to determine the factors that are associated with child, parent, and nurse ratings of acute pediatric pain and distress during venipuncture. The behavior of eighty-five pediatric cancer patients during venipuncture was recorded by trained raters, and their observations were compared with ratings of pain and distress obtained from parents, pediatric patients, and pediatric nurses. Regression analyses indicated that ratings made by the child, parent, and nurse reflect different perspectives. Nurses' ratings were based upon overt distress, parents' ratings reflected their subjective perception of the child's pain, and the child's self-report was associated with the child's chronologic age.
Thesis (M.S.)--MGH Institute of Health Professions, December 1993. Includes bibliographical references (p. 116-121). Photocopy.
This is the first article written by this group of authors/researchers who are collaborating on the development of the Oucher, an assessment tool to assist 3- to 12-year-olds describe the intensity of pain. The background and conceptual framework for its development, the research supporting the validation of the original Oucher, the research to create new ethnic versions, and the basic instructions for clinical use are described. In addition, several issues regarding the continued development and use of the Oucher are identified, including those relative to poster size and the gender and ethnicity of the photographed child. This article illustrates the precision and care needed to create clinically useful tools for obtaining information directly from young children.
The purpose was to examine nurses' use of pediatric pain scales and to compare their estimate of the child's pain intensity and affect with the child's self-report. The Analog Chromatic Continuous Scale (ACCS) was used for pain intensity and the McGrath Affective Faces Scale (MAFS) for pain affect. Self-report of pain was obtained from 124 hospitalized postoperative children aged 5 to 17 years and compared with estimates of 44 pediatric nurses randomly assigned to either an experimental or control group. Experimental nurses used the ACCS and MAFS to obtain pain ratings whereas control nurses made estimates according to their customary method of assessment. Findings revealed that only 36% of the nurses had at any time used a pediatric pain scale. Correlations between the experimental nurses' ratings and the child's self-report were significantly higher than the control nurses' estimates and the child's self-report. The correlation between the child's self-report of pain intensity on the ACCS and of affect on the MAFS was r = .612, suggesting that nurses' use of both an intensity and affect pediatric pain scale would more accurately reflect the child's pain experience.
Reliability and validity of the Faces and Word Descriptor Scales to measure pain in verbal children undergoing painful procedures were assessed. Test-retest reliability and construct and discriminant validity were supported for both instruments among a sample of 118 children in three age groups (3-7, 8-12, 13-18). Construct validity was determined by comparisons with a visual analogue scale and a numerical scale with known validity. A majority of the children preferred to use the Faces scale when providing self-report of pain regardless of age. The Faces and Word Descriptor Scales are valid and reliable instruments to measure procedural pain intensity.
A descriptive study was undertaken to determine if children located at the descriptive words ("little pain", "medium pain," and "large pain") found on the Word-Graphic Rating Scale (WGRS) as they are placed on the original scale. The convenience sample consisted of 34 hospitalized children ages 8-15 years. There were 16 males and 18 females. Children did not place word descriptors equidistant on a 100 mm line. "Little pain" was placed closer to "no pain," while "medium pain" and "large pain" placement showed no statistical difference in simultaneous placement as compared to the WGRS.
The purpose of this study was to investigate the influence of psychosocial variables in the prediction of children's pain intensity following surgery. Forty-two children, ages 7 to 17 years (M = 12.26, SD = 3.06), completed an interview 1 week prior to surgery assessing anticipatory distress related to their forthcoming surgery and history of coping strategy use. Following surgery, children reported the intensity of their pain using visual analog scales. Findings demonstrated that the majority of children experienced moderate to severe postoperative pain. Hierarchical multiple regression analyses revealed that psychosocial variables added to the prediction of children's postoperative pain after controlling for the influence of surgery-related and demographic variables. These findings lend initial support for the inclusion of psychosocial assessment measures (e.g., anticipatory surgery distress) in the preoperative assessment of pediatric patients who may be at risk for excessive postsurgical pain.
Parents are often the primary source of information regarding their children's pain in both research and clinical practice. However, parent-child agreement on pain ratings has not been well established. The objective of the present study was to examine agreement between child- and parent-rated pain following minor surgery.
Tertiary care children's hospital.
A total of 110 children (56.4% male) aged 7-12 years undergoing surgery and their parents.
Parents and children independently rated pain intensity by using a 7-point Faces Pain Scale on the day of the child's surgery and the following 2 days.
Correlations (both Pearson's and intraclass correlation coefficients) indicated a highly significant relationship between child and parent ratings. However, kappa statistics indicated only poor to fair agreement beyond chance. Parents tended to underestimate their children's pain on the day of surgery and the following day, but not on the second day following surgery. When children's and parents' pain ratings for each of the 3 days were collapsed into a no-pain/low-pain group or a clinically significant pain group, kappa statistics indicated fair to good agreement. Parents demonstrated low levels of sensitivity in identifying when their children were experiencing clinically significant pain.
Correlations between parent and child pain reports do not accurately represent the relationship between these ratings and in fact overestimate the strength of the relationship. Parents' underestimation of their child's pain may contribute to inadequate pain control.
The Pre-Verbal, Early Verbal Pediatric Pain Scale (PEPPS) is conceptualized to measure the established pain response in toddlers, a pediatric group void of pain assessment scales. It consists of seven categories, each with weighted indicators. Scores can range from 0 to 26. Using a blinded, cross-sectional design, 40 children, aged 12 to 24 months, were videotaped throughout their postoperative stay in the postanesthesia care unit. Vignettes were randomly selected and viewed by four experienced pediatric nurses. Results indicated that the PEPPS was easy to use and demonstrated acceptable inter-rater and intrarater reliability. Early evidence of construct validity was established by statistically significant differences in premedication and postmedication pain scores.
This study examined children's and adolescents' perceptions of the descriptors hurt, ache, and pain. Nonhospitalized subjects (N = 198) between 8 and 19 years of age from three schools rated the levels of intensity associated with each of the descriptors on a word-graphic rating scale and matched each to one of three drawings depicting painful experiences. Subjects ranked pain highest; hurt middle; and ache lowest intensity. Significant preferences for matching descriptors to painful experiences was not demonstrated except for the word ache. These findings indicate that children and adolescents associate similar levels of intensity with pain, hurt, and ache but associate different experiences with each.
Faces scales have become the most popular approach to eliciting children's self-reports of pain, although different formats are available. The present study examined: (a) the potential for bias in children's self-reported ratings of clinical pain when using scales with smiling rather than neutral 'no pain' faces; (b) levels of agreement between child and parent reports of pain using different faces scales; and (c) preferences for scales by children and parents. Participants were 75 children between the ages of 5 and 12 years undergoing venepuncture, and their parents. Following venepuncture, children and parents independently rated the child's pain using five different randomly presented faces scales and indicated which of the scales they preferred and why. Children's ratings across scales were very highly correlated; however, they rated significantly more pain when using scales with a smiling rather than a neutral 'no pain' face. Girls reported significantly greater levels of pain than boys, regardless of scale type. There were no age differences in children's pain reports. Parents' ratings across scales were also highly correlated; however, parents also had higher pain ratings using scales with smiling 'no pain' faces. The level of agreement between child and parent reports of pain was low and did not vary as a function of the scale type used; parents overestimated their children's pain using all five scales. Children and parents preferred scales that they perceived to be happy and cartoon-like. The results of this study indicate that subtle variations in the format of faces scales do influence children's and parents' ratings of pain in clinical settings.
Ethical aspects of pain management in the peri-anesthesia practice setting revolve around issues of competence. Nurses must have knowledge relevant to the current scope of nursing practice, changing issues and concerns, and ethical concepts and principles. Nurses and other health care providers must engage in ongoing discussion and deliberation about ethics and culturally sensitive care. Additionally, to ensure optimal outcomes, the care provided must address those aspects that are age specific. It is important not only to develop competence as related to tasks and skills, but also to develop critical thinking and decision making. All nurses need to be able to articulate a personal philosophy. They need to understand their own values and be able to anticipate the impact that ethical choice will have on their professional practice.
Pain management: Problems and progress, dictors of children's postoperative pain
- Mccaffery
McCaffery M: Pain management: Problems and progress, dictors of children's postoperative pain. Clinical Nursing Re-in McCaffery M, Pasero C (eds): Pain: Clinical Manual. St search 7:275-291, 1998
Psychosocial pre-Measurement of pain by self-report
- Palermo Tm
- Drotar
- Dd
- Lambert
Palermo TM, Drotar DD, Lambert S: Psychosocial pre-Measurement of pain by self-report, in Finley GA, McGrath PJ AND MALVIYA (eds): Measurement of Pain in Infants and Children, Progress in Pain Research and Management, vol 10. Seattle, WA, IASP Press, 1998, p 123
Behavioral measures of pain Measurement of Pain in Infants and Chil-dren
- Finley
- Ga
Finley GA: Behavioral measures of pain, in Finley GA, McGrath PJ (eds): Measurement of Pain in Infants and Chil-dren, Progress in Pain Research and Management, vol 10. Seattle, WA, IASP Press, 1998, p 83
Acute pain management Orthopedic Knowledge Update: Pediatrics. Res-onant, IL, American Academy of Orthopedic Surgeons
- S Malviya
Malviya S, Merkel S: Acute pain management, in Rich-ards BS (ed): Orthopedic Knowledge Update: Pediatrics. Res-onant, IL, American Academy of Orthopedic Surgeons, 1996, p 47
Pain in infants Pain: Clinical Manual
- Stevens
Stevens B: Pain in infants, in McCaffery M, Pasero C (eds): Pain: Clinical Manual. St Louis, MO, Mosby, 1999, p 626
Decision-making and paedi-attic pain: A review Schroeter K: Pain management: Ethical issues for the perianesthesia nurse
- Abu-Saad Hh
- Jp
Abu-Saad HH, Hamers JP: Decision-making and paedi-attic pain: A review. J Adv Nurs 26:946-952, 1997 27. Schroeter K: Pain management: Ethical issues for the perianesthesia nurse. J PeriAnesth Nurs 14:393-397, 1999
Whaley and Wong's Nursing Care of Infants and Children
- Wong
Wong DL, Hockenberry-Eaton M, Wilson D, et al: Whaley and Wong's Nursing Care of Infants and Children (ed 6). St. Louis, MO, Mosby, 1999, p 1153
Pain management: Problems and progress
- McCaffery
Pain assessment and management standards
- Joint Commission on Accreditation of Healthcare Organizations JCAHO
Putting pain measurement into clinical practice
- Hester
Behavioral measures of pain
- Finley