Systematic Literature Review of Pediatric Pain Measures

Abstract

Abstract: Articles on pediatric behavioral scales were reviewed to elucidate usage of pain assessment tools in clinical practice. Methods: A literature search was performed in the MEDLINE, PubMed, Cochrane Library, CINAHL, SODL, CEPS and master thesis databases for systematic reviews published from 2000 to 2011 using the following search terms: pain, child, children, childhood, systematic review, and instrument. A total of 112 articles were identified. 7 articles on child pain assessment instrument met the inclusion criteria. Results: Pediatric pain assessment scales can be either observational scales or self-reported measure. 20 articles on observational scales were identified. CHEOPS, FLACC, PPPM, COMFORT, POCIS scales were suggested to be used in hospitalized, post-operative, critical care, and burn patients. A total of 34 single-item self-report measures were found. The most often used scale for research purposes were Pieces of hurt tool, FPS, Oucher, Wong-Baker FACES pain score, and VAS. The scales mentioned above were reliable, effective, and can be utilized in different types of diseases. Conclusion: Pain is subjective. In order to accurately assess pain in pediatric population, behavioral scales, self-report measure, and physiologic indicators should be incorporated. In pediatric population pain could not be well expressed due to immature cognition. Self-report measure is not a reliable tool when used in patients less than 6-year-old. Pain will be assessed more accurately when self-report measure is utilized in combination with a reliable and effective behavioral observation scale. In the future, research should be directed to comparison of the physiologic indicators with observational scales vs self-report measure to validate the effectiveness of different scales.