Measurement of Pain

Pain is measured by self-report, observational, and/ or physiological measures. When possible, pain is best assessed by asking the child in pain about the location, quality, duration, frequency, and intensity of the pain. Some children, however, do not have the cognitive capacity to engage in such an assessment. In such cases, clinicians or parents can have difficulty differentiating between distress related to pain and distress related to fear or some other discomfort. Some children become adept at using distraction or withdrawal/dissociation to cope with pain and therefore might appear comfortable when they truly are not comfortable. This can present a confusing picture for clinicians who might see a child exhibiting extreme pain behaviors alternating with normal play, television viewing, or sleep. Finally, some individuals may be reluctant to report pain due to anxiety related to talking to doctors, getting an injection of pain medication, being viewed as weak or demanding, distressing others, becoming addicted to pain medication, not being able to stay awake or think clearly, or finding out they are sick or in need of going to the hospital.

Structured pain assessment tools have been developed for use with children and adolescents (see reviews by Cohen et al. 2008; Stinson et al. 2006; von Baeyer and Spagrud 2007). Table 9-2 lists examples of commonly used pain assessment tools that have good to excellent psychometric properties. The clinician should use measures that are developmentally appropriate and rate pain prospectively (in the moment) whenever possible. Because asking children or adolescents to focus on pain can exacerbate the pain, the clinician should ask them to rate pain only when necessary. For hospitalized chronic pain patients, it is acceptable to the Joint Commission on Accreditation of Health Care Organizations to refrain from pain assessment as the fifth vital sign if this instruction is incorporated into the treatment plan.

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