Pain assessment tools

• Multi-dimensional tools can provide useful information intensity, location, qualities (e.g., throbbing, aching), emotion, frequency and pain interference or impact. They can also make the young person feel heard (and understood) and also result in better pain management
• Various quality of life questionnaires such as the Paediatric Pain Questionnaire focus on the impact of pain, rather than identifying the type and intensity.
• A body map is used to draw/write pain locations and descriptions. Younger children may need help identifying left and right sides of the body.
• Pain diaries (ages 6+yrs) are available in paper and electronic form and can be useful if pain is unexplained or recurring. An electronic example: https://www.icpcn.org/icpcn-pain-assessment-tool-for-children/
• Drawings of pain by the child/young person can be useful to start the conversation, and can provide insight into the intensity and type of pain experienced.
• There are basic uni-dimensional tools that are useful to start a conversation about pain; e.g., the visual analogue scale (aged 7 and above) or a faces pain scale (aged 4 and above). Self-report tools: from about 3-4 years children can reliably use self-report pain tools, which improves accuracy of assessment and should be used in preference when possible.

More information about self-reporting and the developmental age-related choice of tools is available. 

https://starship.org.nz/guidelines/paediatric-pain-assessment/

Faces pain scale (4 years and above) https://www.iasp-pain.org/resources/faces-pain-scale-revised/

Visual Analogue Scales (7 years and above) https://www.aboutkidshealth.ca/Article?contentid=2994&language=English

Numerical Rating scale https://starship.org.nz/guidelines/paediatric-pain-assessment/

Behavioural assessment tools: children who are either too young or unable to communicate cannot self-report their pain. In this case, assessing behaviour in combination with discussion with the parent/caregiver is the next best option. These scales work best when pain is present at the time of observation.

 https://starship.org.nz/guidelines/paediatric-pain-assessment/

https://www.connectedcare.sickkids.ca/quick-hits/2019/8/29/volume6-efnk4-nyn48-max8h-45bm7

Tips for using pain scales

• It may be easier to present a body image or mannikin if pain is in more than one area. Younger children may need assistance to identifying left and right sides of the body.
• Look out for both paper-based and electronic versions of tools; use them regularly with patients who will get used to seeing and rating their pain on the same tools.
• Use consistent time-frames for referencing pain e.g., if you ask a young person about their pain in the past few weeks, use this reference point at each visit.
• Use short time-frames. The shorter the time period, the better, such as last week or last few days.
• Use consistent anchor points for pain assessments and try to avoid phrases like ‘worst imaginable pain’ which can be interpreted very differently between children and young people. Anchors such as ‘a lot of pain’ or ‘severe pain’ are better.
• Ask the young person to keep some reports about how their pain is at home e.g., in a diary. If they do not have any pain, reporting that they had ‘pain free days’ can be very helpful.
• Sometimes the clinical environment or the young person’s perceptions about the person asking about pain (e.g., talking to a clinician with the expectation of a painful procedure such as blood taking to follow).