Evidence supporting the use of the 11-point numeric rating scale (NRS-11), the Faces Pain Scale Revise (FPS-R), and the Color Analogue Scale (CAS) for the self-assessment of acute pain in children aged 3 to 18 is strong, according to a review published in Pain. However, the review authors could not issue strong recommendations for the use for these or other self-report measures for the evaluation of postsurgical or chronic pain in pediatric populations.

A search of studies evaluating the use of self-report measures in children or adolescents yielded 21,448 abstracts for possible inclusion. Of these, 80 articles examining the use of 8 self-reported measures of pain intensity met Cohen’s “well-established assessment” criteria, and were included for review. 

These self-report measures for pain assessment were: CAS, the Oucher Photographic and Numeric scales, the Visual Analogue Scale (VAS), the Wong-Baker FACES Pain Rating Scale (FACES), NRS-11, the FPS-R, and the Pieces of Hurt/Poker Chip Tool. Investigators conducted database searches for data from 2005 to 2017, and a research assistant screened for inclusion eligibility. A second author reviewed a randomly selected 15% of all selected studies, and a 2-author team examined the selected studies for inclusion. A third author mediated disagreements regarding inclusion or exclusion of studies.

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The reviewers assessed the quality (rated as poor, fair, good, or excellent) of each individual measure using COSMIN quality and sufficiency ratings, which included reliability, content validity, hypothesis testing, a cross-cultural measure, criterion validity, and responsiveness.

“The availability of eight ‘well-established’ self-report pain intensity measures with at least some supportive measurement property evidence for children 6 years and older directs selection of one of these over other less rigorously tested measures. Evidence of variable quality was shown across types of pain and from early childhood to late adolescence. Overall, we strongly emphasize the value of self-report of pain given the subjectivity of pain experience, and lack of regular pain assessment and documentation in clinical care. There is a need [for] continued efforts focused on self-report of pain in young children.”

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Birnie KA, Hundert A, Lalloo C, Nguyen C, Stinson JN. Recommendations for selection of self-report pain intensity measures in children and adolescents: a systematic review and quality assessment of measurement properties [published online August 22, 2018]. Pain. doi: 10.1097/j.pain.0000000000001377.