Systematic Literature Review of Pediatric Pain Measures

Wednesday, 1 August 2012: 11:10 AM

Kuo-Li Chao, RN, BSN
Department of Nursing, Department of Neurology, Yuan's General Hospital/ Fooying University, Lin-ya district, Taiwan
Pei-Hsin Yang, RN, BSN
Neonatal intermediate care unit, Kaohsiung Chang Gung Memorial Hospital , Fooyin University, Kaohsiung City, Taiwan

Learning Objective 1: Systematic review of child behavior check list, the validity and effectiveness of the self reported questionnaire

Learning Objective 2: how the child behavior check list and self reported questionnaire are being utilized.


Articles on pediatric behavioral scales were reviewed to elucidate usage of pain assessment tools in clinical practice. 


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.


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. 


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.