Cross-validation of a self-report scale for postoperative pain in school-aged children. Postoperative self-report of pain in children: interscale agreement, response to analgesic, and preference for a faces scale and a visual analogue scale. Validity of Simplified Versus Standard Self-Report Measures of Pain Intensity in Preschool-Aged Children Undergoing Venipuncture. The faces pain scale for the self-assessment of the severity of pain experienced by children: Development, initial validation, and preliminary investigation for ratio scale properties Validation of Self-Report Pain Scales in Children A new analogue scale for assessing children's pain: an initial validation study A comparison of pain-assessment tools for use with elderly long-term-care residents. A comparison of faces scales for the measurement of pediatric pain: children's and parents’ ratings Development and validation of the Nursing Profession Self-Efficacy Scale. Pain assessment in cognitively impaired and unimpaired older adults: a comparison of four scales Validation of 2 pain scales for use in the pediatric emergency department. Pain in 4- to 6-year-old children receiving intramuscular injections: a comparison of the Faces Pain Scale with other self-report and behavioral measures. Validity of four pain intensity rating scales Comparison of four pain scales in children with acute abdominal pain in a pediatric emergency department. Neonatal Facial Coding System for Assessing Postoperative Pain in Infants: Item Reduction is Valid and Feasible An intrusive impact of anchors in children's faces pain scales Reliability of the color analog scale: repeatability of scores in traumatic and nontraumatic injuries. Feasibility and reliability of four pain self-assessment scales and correlation with an observational rating scale in hospitalized elderly demented patients. Children's ratings of the intensity and unpleasantness of post-operative pain using facial expression scales. Developmental data supporting simplification of self-report pain scales for preschool-age children. Validity, reliability, and responsiveness of a digital version of the visual analog scale. Evaluation of toothache severity in children using a visual analogue scale of faces. Facial Expression of Children Receiving Immunizations: A Principal Components Analysis of the Child Facial Coding System
The present study cross-vali date d self-report pain scales : Verbal Rating Scale ( VRS  ) ,  Facial Expression Scale ( FACES  ) ,  Color Analogue Scale ( CAS ) and Poker Chip Tool ( PCT ) in Thai children aged 5 - 12 years . The concordance with observational measure , Children 's Hospital of Eastern Ontario Pain Scale ( CHEOPS ) was also tested . Among 100 students , test-retest reliability of all self-report measures was moderate to good ( K = 0.501 - 0.712 ) and only FACES yielded acceptable face validity(IC > 0.5 ) . Validation in 87 patients , all scales showed construct and concurrent validity . FACES was the most preferred scale . Agreement of self-report measures and CHEOPS was better in the age group 5 - 8 years ( K = 0.417 - 0.826 ) than 9 - 12 years ( K = 0.231 - 0.529 ) . In conclusion , FACES is a valid , reliable and practical tool . Self-report measures are more in concordance with CHEOPS in the younger age group OBJECTIVE To augment available validation data for the Faces Pain Scale - Revised ( FPS-R ) and to assess interscale agreement and preference in comparison with the Coloured Analogue Scale ( CAS ) in pediatric acute pain . METHOD The present prospect i ve , multicentre study included 131 in patients five to 15 years of age ( mean age 8.8 years ; 56 % male ) seen in postoperative recovery . They provided CAS and FPS-R pain scores before and after administration of analgesic medication . Nurses and physicians used the same tools as observational scales . Children and health care providers indicated which scale they preferred . RESULTS  FPS-R scores for the intensity of postoperative pain correlated highly with the corresponding CAS scores in all age groups ( 0.66 < or= r < or= 0.88 ) . There were no significant mean differences in any age group between the scales . Scores on the two scales differed by 210 or less in 81 % to 91 % of children , depending on age . Both scales demonstrated expected changes in postoperative pain following administration of an analgesic . Scores at the upper end point were given by approximately 20 % of children five to six years of age on both scales , compared with 2 % to 9 % in the older age groups . Health care providers ' observational ratings were significantly lower than self-ratings . The FPS-R was preferred over the CAS by most children in all age groups and both sexes . Global satisfaction of the health care providers was similar for both tools . DISCUSSION These results support the use of the FPS-R for most children five years of age or older in the postoperative period . Further research is needed to identify young children , particularly those younger than seven years of age , who have difficulty with self-report tools , and to establish methods for training them in the reliable use of these measures There are inadequate age-specific data to support the use of current self-report pain scales in 3- and 4-year-old children . Most preschool-aged children also lack the necessary cognitive development to use st and ard scales . We aim ed to evaluate the validity and feasibility of 2 novel simplified scales ( Simplified Faces Pain Scale , S-FPS ; Simplified Concrete Ordinal Scale , S-COS ) for preschool-aged children . These simplified scales used a 2-step self-report method : children were first asked whether they have pain ( yes/no ) ; only if yes , then pain intensity was self-reported using a 3-point scale with visual aids signifying mild/moderate/severe . We recruited 180 3- to 6-year-old children undergoing routine blood collection . Each child was r and omly assigned 2 of 3 scales-S-FPS , S-COS , Faces Pain Scale-Revised (FPS-R)-to self-report pain before venipuncture , immediately after , and 5 minutes later , using both scales at each time-point . Pain was also assessed using observation ( Face Legs Activity Cry Consolability ) at each time point . The ability to discriminate pain from no pain was improved with S-FPS and S-COS , compared with the FPS-R , among 4-year-olds , but not 3-year-olds . Correlation with Face Legs Activity Cry Consolability was moderate to strong and cooperation rates were similar for all self-report scales . The simplified scales can improve and simplify pain assessment for 4-year-olds . Quantitative pain rating remains challenging for 3-year-olds . PERSPECTIVE This study evaluated 2 novel simplified pain assessment tools for preschool-aged children undergoing blood sampling . These scales demonstrated good validity and feasibility compared with the FPS-R , suggesting these simplified pain scales may have a role in clinical practice for children as young as 4 years & NA ; Altogether 553 children ( 195 first grade rs , mean age 6.8 years , and 358 third grade rs , mean age 8.7 years ) participated in the development of a self‐report measure to assess the intensity of children 's pain .  The first step was the derivation , from children 's drawings of facial expressions of pain , of 5 sets of 7 schematic faces depicting changes in severity of expressed pain from no pain to the most pain possible . With the set of faces that achieved the highest agreement in pain ordering , additional studies were conducted to determine whether the set had the properties of a scale . In one study , children rank‐ordered the faces on 2 occasions , separated by 1 week . All 7 faces were correctly ranked by 64 % ( retest 1 week later , 61 % ) of grade 1 children and by 86 % ( retest 89 % ) of grade 3 children . In a second study , the faces were presented in all possible paired combinations . All 7 faces were correctly placed by 62 % ( retest 86 % ) of the younger and by 75 % ( retest 71 % ) of the older subjects . A third study asked children to place faces along scale : a procedure allowing a check on the e quality of intervals . The fourth study checked on whether pain was acting as an underlying construct for ordering the faces in memory . We asked whether children perceived the set as a scale by asking if memory for an ordered set of faces was more accurate than for a r and om set . The final study checked , with 6‐year‐old children , the test‐retest reliability of ratings for recalled experiences of pain . Overall , the faces pain scale incorporates conventions used by children , has achieved strong agreement in the rank ordering of pain , has indications that the intervals are close to equal , and is treated by children as a scale . The test‐retest data suggest that it may prove to be a reliable index over time of self‐reported pain BACKGROUND AND OBJECTIVES : The Faces Pain Scale – Revised ( FPS-R ) and Color Analog Scale ( CAS ) are self-report pain scales commonly used in children but insufficiently vali date d in the emergency department setting . Our objectives were to determine the psychometric properties ( convergent validity , discriminative validity , responsivity , and reliability ) of the FPS-R and CAS , and to determine whether degree of validity varied based on age , sex , and ethnicity . METHODS : We conducted a prospect i ve , observational study of English- and Spanish-speaking children ages 4 to 17 years . Children with painful conditions indicated their pain severity on the FPS-R and CAS before and 30 minutes after analgesia . We assessed convergent validity ( Pearson correlations , Bl and -Altman method ) , discriminative validity ( comparing pain scores in children with pain against those without pain ) , responsivity ( comparing pain scores pre- and postanalgesia ) , and reliability ( Pearson correlations , repeatability coefficient ) . RESULTS : Of 620 patients analyzed , mean age was 9.2 ± 3.8 years , 291(46.8 % ) children were girls , 341(55 % ) were Hispanic , and 313(50.5 % ) were in the younger age group ( < 8 years ) . Pearson correlation was 0.85 , with higher correlation in older children and girls . Lower convergent validity was noted in children < 7 years of age . All subgroups based on age , sex , and ethnicity demonstrated discriminative validity and responsivity for both scales . Reliability was acceptable for both the FPS-R and CAS . CONCLUSIONS : The FPS-R and CAS overall demonstrate strong psychometric properties in children ages 4 to 17 years , and between subgroups based on age , sex , and ethnicity . Convergent validity was question able in children < 7 years old & NA ; A new instrument was design ed to provide a practical clinical measure for assessing children 's pain intensity and pain affect .  The pocket size measure includes a Coloured Analogue Scale ( CAS ) to assess intensity and a facial affective scale to assess the aversive component of pain . Both scales have numerical ratings on the back , so that the person administering it can quickly note the numbers that represent a child 's pain . This study was conducted to determine : the validity of the new instrument by evaluating the psychophysical properties of the intensity scale and by evaluating the discriminant validity of the intensity and affective scales . Since visual analogue scales ( VAS ) are valid and reliable measures for assessing children 's pain , children 's ability to use the new analog scale was compared with their performance on a VAS . Children 's ability to rate pain affect using an affective scale , in which the 9 faces on a Facial Affective Scale ( FAS ) are presented in an ordered sequence from least to most distressed , was compared to their performance on the original FAS , in which the same faces were presented in a r and om order . Using a parallel groups design , 104 children ( 5–16 years ; 60 female , 44 male ; 51 healthy and 53 with recurrent headaches ) were r and omized into two groups : CAS or VAS . Children used the assigned scale to complete a calibration task , in which they rated the sizes of 7 circles varying in area ( 491 , 804 , 1385 , 2923 , 3848 , 5675 and 7854 mm2 ) . The psychophysical function relating perceived circle size to actual physical size was determined for the CAS and VAS . Children 's  CAS and VAS  responses on the calibration task yielded similar mathematical relationships ; & PHgr;cas = 0.035I0.87 , & PHgr;vas = 0.027I0.89 , where & PHgr ; = perceived magnitude and I = stimulus intensity . The R2 values were 0.921 and 0.922 for the CAS and VAS groups , respectively . Analyses of covariance revealed no significant differences in the characteristics of these relationships , i.e. , R2 , slope , or y intercept , by scale type . Children used the same scale to complete the Children 's Pain Inventory ( CPI ) , in which they rated the intensity and affect of 16 painful events ( varying in nature and extent of tissue damage ) . Children 's  CAS and VAS  responses on the CPI were similar . Analyses of covariance indicated that there were no differences in either intensity or affective ratings by scale type . However , the mean number of painful events experienced by children increased significantly with age ( P = 0.0001 ) . Intensity ratings decreased significantly with age ( P = 0.002 ) , but affective ratings did not vary with age . The new instrument has equivalent psychometric properties to a 165 mm VAS . However , the CAS was rated as easier to administer and score than the VAS , so it may be more practical for routine clinical use . Since the CAS has fulfilled the first two criteria for a pain measure ( psychophysical properties and discriminant validity ) , it is ethical to proceed with the formal definitive test for construct validity , in which children from various clinical population s use the CAS scale to assess their own pain The purpose of this study was to examine the psychometric properties ( test-retest and interrater reliability , criterion concurrent validity ) of 3 verbal pain- assessment tools ( Faces Pain Scale , Numerical Rating Scale , Present Pain Intensity Scale )  and a behavioural pain- assessment scale for use with an elderly population . The study used a repeated- measures design to examine the reliability and validity of the tools across 4 groups of participants with varying levels of cognitive impairment using a non-r and om stratified sample of 130 elderly long-term-care residents . The findings support the test-retest and interrater reliability of the  behavioural pain- assessment tool  across all levels of cognitive impairment , whereas the same measures of reliability for the verbal-report tools decreased with increasing cognitive impairment ; however , the majority of elderly with mild to moderate cognitive impairment were able to complete at least 1 of these tools . The findings are discussed in relation to their clinical and research implication Faces scales have become the most popular approach to eliciting children 's self-reports of pain , although different formats are available . The present study examined : ( a ) the potential for bias in children 's self-reported ratings of clinical pain when using scales with smiling rather than neutral ' no pain ' faces ; ( b ) levels of agreement between child and parent reports of pain using different faces scales ; and ( c ) preferences for scales by children and parents . Participants were 75 children between the ages of 5 and 12 years undergoing venepuncture , and their parents . Following venepuncture , children and parents independently rated the child 's pain using five different r and omly presented faces scales and indicated which of the scales they preferred and why . Children 's ratings across scales were very highly correlated ; however , they rated significantly more pain when using scales with a smiling rather than a neutral ' no pain ' face . Girls reported significantly greater levels of pain than boys , regardless of scale type . There were no age differences in children 's pain reports . Parents ' ratings across scales were also highly correlated ; however , parents also had higher pain ratings using scales with smiling ' no pain ' faces . The level of agreement between child and parent reports of pain was low and did not vary as a function of the scale type used ; parents overestimated their children 's pain using all five scales . Children and parents preferred scales that they perceived to be happy and cartoon-like . The results of this study indicate that subtle variations in the format of faces scales do influence children 's and parents ' ratings of pain in clinical setting AIM This study describes the development and validation of the  Nursing Profession Self-Efficacy Scale . BACKGROUND Self-efficacy can be useful in predicting performance , job satisfaction or well-being . In the nursing field , there is a shortage of studies on self-efficacy with regard to nurses ' global confidence in coping ability across a range of everyday , challenging work situations . METHODS To define the theoretical framework of nursing professional self-efficacy , two focus groups and a literature review were performed . An empirical study was then conducted to test validity and reliability . Face and content validity , construct validity , concurrent validity , internal consistency and test-retest reliability were examined . The content validity index was evaluated by 12 experts who suggested deleting 11 redundant items . The final developed tool was tested for construct analysis using a cross-validation approach , r and omly splitting the overall sample of 917 nurses in two sub-groups . FINDINGS The construct validity indicated two dimensions . The face and content validity were adequate . Test-retest reliability displayed a good stability , and internal consistency ( Cronbach 's α ) was acceptable . Moreover , concurrent validity using the Generalized Self-Efficacy Scale was in line with the theoretical framework . CONCLUSION The scale showed evidence of validity and reliability . The major limitation is the strong influence of the Italian context in the tool development . IMPLICATION S FOR NURSING AND HEALTH POLICY The Nursing Profession Self-Efficacy Scale could be a fruitful tool that facilitates the application of theories ( i.e. social-cognitive theory ) in the nursing field and even development of interventions . Furthermore , a measurement of self-efficacy could be used to predict nursing clinical performance & NA ; The purpose of the study was to compare the psychometric properties of four established pain scales in a population of hospitalized older adults ( mean age , 76 years ) with varying levels of cognitive impairment . Patients made ratings of current pain three times/day for 7 days . They also made retrospective daily , weekly , and bi‐weekly ratings of usual , worst , and least pain levels over a 14‐day period . Ratings were made on four different scales , varying in numeric and verbal dem and s : a five‐point verbal rating scale , a seven‐point faces pain scale , a horizontal 21‐point ( 0–100 ) box scale , and two vertical 21‐point ( 0–20 ) box scales ( measuring pain intensity and pain unpleasantness ) . The accuracy , reliability , construct validity , postdictive validity , and bias susceptibility of each scale were evaluated . The horizontal 21‐point box scale emerged as the best scale with respect to both psychometrics and validity , regardless of mental status . Pain intensity did not vary as a function of mental status . Retrospective estimates of pain varied by mental status : a combination of usual/worst pain was best for cognitively impaired patients , while a combination of usual/least pain was best for unimpaired patients . These findings support the use of the 21‐point box scale for pain assessment in older patients , including those with mild‐to‐moderate cognitive impairment . They also support the ability of older , cognitively impaired patients to rate pain reliably and validly OBJECTIVE To determine the construct , content , and convergent validity of 2 self-report pain scales for use in the untrained child in the emergency department ( ED ) . METHODS A prospect i ve study was conducted of all children who presented to an urban ED between 5 and 16 years of age inclusive after written informed consent was obtained . Children were excluded if they were intoxicated , had altered sensorium , were clinical ly unstable , did not speak English , or had developmental delays . Children marked their current pain severity on a st and ardized Color Analog Scale ( CAS ) and a 7-point Faces Pain Scale ( FPS ) . They were then asked whether their pain was mild , moderate , or severe . Children were then administered an analgesic at the discretion of the attending physician and asked to repeat these measurements . For assessing content validity , the scales were also administered to age- and gender-matched children in the ED for nonpainful conditions . Convergent validity was assessed by determining the Spearman correlation coefficient between the 2 pain scales . RESULTS A total of 60 children were enrolled , 30 with pain and 30 without , with a mean age of 9.3 + /- 3.3 years . Boys accounted for 38 of the enrollees ( 63.3 % ) . The median score before analgesic administration was 6.0 cm ( interquartile range [ IQR ] : 4.0 - 8.0 ) on the CAS and 3.0 faces ( IQR : 2.0 - 5.0 ) on the FPS ; after analgesic administration , the median scores decreased to 3.1 cm ( IQR : 1.1 - 4.3 ) and 2.0 faces ( IQR : 1.0 - 3.0 ) , respectively . As the reported pain intensity increased , so did the scores on the 2 pain scales . The 30 children with no pain had a median score on the CAS of 0.0 ( IQR : 0.0 - 1.0 ) and on the FPS of 0.0 ( IQR : 0.0 - 1.0 ) , whereas the 13 children with severe pain had a median CAS of 7.0 ( IQR : 6.0 - 8.0 ) and a median FPS of 5.0 ( IQR : 4.0 - 6.0 ) . The Spearman correlation coefficient between the CAS and the FPS was positive and strong ( r = 0.894 ) . CONCLUSION The CAS and the FPS exhibit construct , content , and convergent validity in the measurement of acute pain in children in the ED OBJECTIVE The main objective was to compare the utility of the Faces Pain Scale  ( Bieri et al. , 1990 ) with three alternative self-report measures of pain intensity in children , as well as with pain ratings based on observations of the child 's behavior . DESIGN Fifty children used 4 self-report scales to rate the severity of needle pain from routine immunization . Using videotapes , the child 's pain-related behavior was coded in detailed fashion , and a subset of the sample were also rated globally by 60 registered pediatric nurses . MAIN OUTCOME MEASURES  Faces Pain Scale ; Poker Chip Tool ; Visual Analogue Toy ; Verbal Rating Scale ;  behavioral checklist ( scoring observable facial , motor , verbal and vocal reactions ) . RESULTS AND CONCLUSIONS The  Faces Pain Scale  was simple to use , readily understood by the children , and showed a realistic distribution of scores with respect to the type of pain being measured . With the exception of verbal reactions ( which were not meaningfully related to self-report ) , observer ratings based on detailed coding of the child 's behavior correlated only poorly to moderately well with self-report scores ( r = .39 to r = .58 ) . Similarly , although confident in their judgments , the nurses ' ratings showed only moderate agreement with those of the children . In estimating the child 's pain , all observers appeared to appropriately weigh changes in the child 's facial behavior , which showed evidence of being the most sensitive behavioral index to the intensity of short sharp ( needle ) pain in 4 to 6 years olds Summary The validity of 4 common pain intensity measures is supported , although the 0–10 Numerical Rating Scale and Visual Analogue Scale evidence d the most responsivity . Abstract The  Visual Analogue Scale ( VAS ) , Numerical Rating Scale ( NRS ) , Verbal Rating Scale ( VRS ) , and the Faces Pain Scale‐Revised ( FPS‐R )  are among the most commonly used measures of pain intensity in clinical and research setting s. Although evidence supports their validity as measures of pain intensity , few studies have compared them with respect to the critical validity criteria of responsivity , and no experiment has directly compared all 4 measures in the same study . The current study compared the relative validity of  VAS , NRS , VRS , and FPS‐R  for detecting differences in painful stimulus intensity and differences between men and women in response to experimentally induced pain . One hundred twenty‐seven subjects underwent four 20‐second cold pressor trials with temperature order counterbalanced across 1 ° C , 3 ° C , 5 ° C , and 7 ° C and rated pain intensity using all 4 scales . Results showed statistically significant differences in pain intensity between temperatures for each scale , with lower temperatures result ing in higher pain intensity . The order of responsivity was as follows : NRS , VAS , VRS , and FPS‐R. However , there were relatively small differences in the responsivity between scales . A statistically significant sex main effect was also found for the NRS , VRS , and FPS‐R. The findings are consistent with previous studies supporting the validity of each scale . The most support emerged for the NRS as being both ( 1 ) most responsive and ( 2 ) able to detect sex differences in pain intensity . The results also provide support for the validity of the scales for use in Portuguese sample STUDY OBJECTIVE In children , the agreement between the many scales used to document the intensity of pain is not well known . Thus , to determine the agreement , we evaluate the visual analog scale , the st and ardized color analog scale , the Wong-Baker FACES Pain Rating Scale , and a verbal numeric scale in children with acute abdominal pain suggestive of appendicitis in a pediatric emergency department ( ED ) . METHODS Participants were children who were aged 8 to 18 years , presented to a pediatric ED with abdominal pain suggestive of appendicitis , and were recruited to participate in a r and omized controlled trial evaluating the efficacy of morphine . Patients were initially asked to grade their pain on a plasticized color analog scale , a paper visual analog scale , a paper Wong-Baker FACES Pain Rating Scale , and then with a verbal numeric scale . Thirty minutes after morphine or placebo administration , the assessment was repeated . All scores were then converted to a value of 0 to 100 . Agreements between scores were evaluated with the Bl and -Altman method , and the 95 % lower and upper limits were reported . We defined a priori the maximum limit of agreement at + /-20 mm . RESULTS A total of 87 children were included in the study , 58 of them with confirmed appendicitis . The 95 % limits of agreement for each pair of scales were visual analog scale/color analog scale -18.6 , 14.4 ; visual analog scale/Wong-Baker FACES Pain Rating Scale -20.1 , 33.7 ; visual analog scale/verbal numeric scale -30.2 , 20.7 ; color analog scale/Wong-Baker FACES Pain Rating Scale -18.5 , 36.3 ; color analog scale/verbal numeric scale -26.9 , 22.1 ; and Wong-Baker FACES Pain Rating Scale/verbal numeric scale -38.7 , 15.7 . CONCLUSION Our study suggests that only the visual analog scale and the color analog scale have acceptable agreement in children with moderate to severe acute abdominal pain . In particular , the verbal numeric scale is not in agreement with the other evaluated scales Objective The objectives of this study were to : ( 1 ) evaluate the validity of the Neonatal Facial Coding System ( NFCS ) for assessment of postoperative pain and ( 2 ) explore whether the number of NFCS facial actions could be reduced for assessing postoperative pain . Design Prospect i ve , observational study . Patients Thirty-seven children ( 0–18 months old ) undergoing major abdominal or thoracic surgery .  Outcome Measures The outcome measures were the NFCS , COMFORT “ behavior ” scale , and a Visual Analog Scale ( VAS ) , as well as heart rate , blood pressure , and catecholamine and morphine plasma concentrations . At 3-hour intervals during the first 24 hours after surgery , nurses recorded the children 's heart rates and blood pressures and assigned COMFORT “ behavior ” and VAS scores . Simultaneously we videotaped the children 's faces for NFCS coding .  Plasma concentrations of catecholamine , morphine , and its metabolite M6 G were determined just after surgery , and at 6 , 12 , and 24 hours postoperatively . Results All 10 NFCS items were combined into a single index of pain . This index was significantly associated with COMFORT “ behavior ” and VAS scores , and with heart rate and blood pressure , but not with catecholamine , morphine , or M6 G plasma concentrations . Multidimensional scaling revealed that brow bulge , eye squeeze , nasolabial furrow , horizontal mouth stretch , and taut tongue could be combined into a reduced measure of pain . The remaining items were not interrelated . This reduced NFCS measure was also significantly associated with COMFORT “ behavior ” and VAS scores , and with heart rate and blood pressure , but not with the catecholamine , morphine , or M6 G plasma concentrations . Conclusion This study demonstrates that the NFCS is a reliable , feasible , and valid tool for assessing postoperative pain . The reduction of the NFCS to 5 items increases the specificity for pain assessment without reducing the sensitivity and validity for detecting changes in pain & NA ; The numerous pain rating scales using faces depicting varying degrees of distress to elicit reports of pain from children fall into two categories ; those with a neutral face as the ‘ no pain ’ anchor , and those with a smiling face as the ‘ no pain ’ anchor . This study examined the potentially biasing impact of these anchor types on children 's self‐reports  of pain  in response to a series of vignettes . Participants were 100 children stratified by age ( 5–6 years , 7–8 years , 9–12 years ) and r and omly assigned to one of three groups : ( 1 ) neutral scale/sensory instructions ; ( 2 ) smiling scale/sensory instructions ; ( 3 ) smiling scale/affective instructions . Children completed a  faces scale , a VAS , and emotions ratings  in response to four scenarios depicting : ( 1 ) no pain/negative emotions ; ( 2 ) pain/negative emotions ; ( 3 ) no pain/positive emotions ; ( 4 ) pain/positive emotions . Results showed that children who used the smiling scale had significantly higher pain scores for no pain and pain/negative emotions vignettes and significantly lower faces scale scores for pain/positive vignettes than children who used the neutral faces scale . Instructions varying in focus on sensory or affective qualities of pain had no effect on children 's pain ratings . Group differences in children 's ratings with the VAS and emotions measure suggested that rating pain with a smiling faces scale may alter a child 's concept of pain . Age differences indicated the younger children rated the negative emotion vignettes as more painful than the older children . These findings suggest that children 's pain ratings vary depending on the types of faces scale used , and that faces scales with smiling anchors may confound affective states with pain ratings OBJECTIVES The objective was to assess in a pediatric emergency department ( ED ) the reliability of the color analog scale ( CAS ) for acute pain assessment , overall and between traumatic and nontraumatic pain etiology . METHODS This was a prospect i ve study of children aged 5 to 16 years in the ED of a children 's hospital who had a complaint of pain . The CAS was administered to the patient at admission and at 30 minutes . To evaluate repeatability , a second measurement was obtained 1 minute following each assessment . This assumed there would be no substantial change in pain intensity within 1 minute . The authors used the intraclass correlation coefficient ( ICC ) to evaluate the repeatability of 1-minute interval measurements . RESULTS A total of 170 patients were enrolled . The origin of pain was traumatic in 81 cases ( 48 % ) . Regardless of pain etiology , the  CAS scores were highly repeatable ( r = 0.97 , 95 % confidence interval [ CI ] = 0.95 to 0.98 ) . CONCLUSIONS The color analog scale is both a valid and a reliable self-reporting tool in the assessment of acute pain in children BACKGROUND Acute and chronic pain is common in hospitalized demented elderly people , yet there are limited data about the performance of pain assessment tools in this population . The aim of this study was to evaluate the feasibility and reliability of four  pain self- assessment scales  in this population and compare their performance to an observational pain rating scale . METHODS Our prospect i ve clinical study was conducted in an acute-care and intermediate-care geriatric hospital on 160 consecutive inpatient referrals to the dementia consultation who met Diagnostic and Statistical Manual of Mental Disorders-IV criteria for dementia . Exclusion criteria were delirium , terminal care , and severe sensory impairment .  Four unidimensional self- assessment tools -- the verbal , horizontal visual , vertical visual , and faces pain scales -- were administered in r and omized order to mild , moderate , and severely demented patients . An observational pain rating scale was independently completed by the nursing team . RESULTS Only 12 % of the 160 patients ( mean age 85 years , 71 % women ) understood no scale . Respectively , 97 % , 90 % , and 40 % of patients with mild , moderate , and severe dementia understood at least one scale ( p < .05 ) . There was a nonsignificant trend toward poorer comprehension of the faces scale . Test-retest reliability was high for all four self- assessment scales , and the correlation between these scales was very strong ( Spearman 's r(s ) = 0.81 - 0.95 ; p < .001 ) . Observational rating correlated moderately with self- assessment and tended to underestimate pain intensity ( r(s ) = 0.31 - 0.40 ; p < .05 ) . CONCLUSIONS Self- assessment pain scales  can be used reliably in the vast majority of older hospitalized patients with mild to moderate dementia and in nearly half of those with severe dementia . Observational pain rating scales correlate only moderately with self- assessment and should be reserved for those few patients who have demonstrated that they can not complete a self- assessment This study explored whether global unidimensional self-report pain scales based on facial expression help children separately estimate the sensory and affective magnitude of post-operative pain . Ninety paediatric elective surgery patients ( in two age groups : 5 - 9 and 10 - 15 years ) used each of four scales to estimate pain intensity and pain affect during the first 2 days after surgery . The four scales were :  Faces Pain Scale ( FPS ) , Facial Affective Scale ( FAS ) , and the Coloured Analogue Scale ( CAS )  ( one for intensity and one for unpleasantness ) . As hypothesised , ratings on the FPS correlated more highly with analogue scale ratings for intensity than for unpleasantness , whereas ratings on the FAS correlated more highly with those on the analogue scale for unpleasantness than for intensity . Factor analysis indicated that although all measures loaded on a single dimension of distress , there was an additional weaker factor corresponding to a unique contribution of the FAS . No systematic age effects were observed . It was concluded that the FPS and the FAS may partly measure different aspects of the postoperative pain experience in children , although shared instrument variance may obscure true estimates of covariation in ratings of intensity and affective magnitude . The clinical relevance of the present results remains to be determined UNLABELLED Cl aims regarding the ability of preschool-age children to provide accurate self-reports using st and ard pain scales are not well supported by age-specific evidence . Responses of children younger than 5 years are often idiosyncratic and subject to biases . Simplifying the task of self-report of pain would make it more developmentally appropriate for 3- to 5-year-olds . A binary question is asked : " Does it hurt ? " or an equivalent . If yes , a simplified scale is presented , comprising 3 categories representing low , medium , and high pain severity . Children aged 3 to 5 years ( N = 184 ) were recruited from preschools and day care centers . Following parental consent and child assent , children were r and omly assigned to use either the  Faces Pain Scale-Revised or a 3-face scale preceded by a yes-no question to rate pain in 9 picture stories from the Charleston Pediatric Pain Pictures portraying no pain , moderate pain , and severe pain . The  simplified pain rating task  made no difference for 5-year-olds , whose mean scores were nearly identical using the 2 approaches . However , discrimination of the 3 levels of Charleston Pediatric Pain Pictures items was significantly better in 3- and 4-year-olds with the simplified task than with the  Faces Pain Scale-Revised .  Simplifying the task improved preschool-age children 's ability to estimate pain intensity . PERSPECTIVE St and ard self-report pain scales with 6 faces are confusing for many 3- and 4-year-olds . In basic preparatory research for future development of a preschool self-report pain scale , we simplified the task . This simplification made no difference for 5-year-olds but improved the performance of 3- and 4-year-olds UNLABELLED The design used in this study was a prospect i ve cohort . Pain intensity levels recorded by the digital version of the visual analog scale ( VAS-D ) are easy to both score and share with other health care professionals . The purpose of the study was to examine the test-retest reliability , concurrent validity , and responsiveness of the VAS-D.  Thirty-three people with upper extremity injuries reported pain intensity levels before and after performing four maximal grip contractions ( pre- and postgripping ) . Our version of the VAS-D had high test-retest reliability ( r=0.96 ) and good concurrent validity ( r=0.84 - 0.97 ) with both the paper version of the VAS ( VAS-P ) and the verbal numerical rating scale ( NRS-V ) . Responsiveness of the VAS-D was indicated by a significant increase in pain levels from pre- to postgripping . Similar responsiveness to that of the VAS-P and NRS-V was indicated by similar effect size coefficients and analysis of variance of pain change scores . In conclusion , the VAS-D is a reliable , valid , and responsive measure of pain intensity for people with upper extremity injuries . However , differences in accuracy ( resolution ) among the VAS-D , VAS-P , or NRS-V may render the three pain scales not fully compatible . LEVEL OF EVIDENCE Not applicable PURPOSE Pain is a frequent symptom of oral disease . It is difficult to measure , however , due to its subjectivity , especially among children . The purpose of this study was to verify the utility and applicability of a  visual analogue scale of faces ( VASOF ) , adapted for 8- to 9-year-olds , to measure the severity of toothaches . METHODS A cross-sectional study was undertaken , which included 601 boys and girls r and omly selected from state and private schools in the city of Belo Horizonte , Minas Gerais , Brazil . They were interviewed and clinical ly examined , and a VASOF was applied . RESULTS The VASOF 's application revealed a high percentage of intense/very intense pain in the sample ( 39 % ) . The presence of this pain intensity was accompanied by a high incidence of children who cried , were awakened by the pain , and were unable to carry out habitual tasks . Furthermore , this severe pain was strongly associated with less-privileged economic groups and the presence of oral pathology ( P < or = .05 ) . The scale was well understood by children , independent of gender or economic group . CONCLUSIONS A VASOF was found to be capable of measuring toothache severity experienced by school-age children Objective To identify the structure of facial reaction to procedural pain and to determine the subset of facial actions that best describe the response . Design Observational . Setting Five rural and five urban physicians ' offices . Patients One hundred twenty-three children aged 4 to 5 years undergoing routine diphtheria , pertussis , tetanus , and polio immunization .  Outcome Measures The Child Facial Coding System , comprising 13 discrete facial actions , was used to code each second of five 10-second phases from videotape : baseline , preneedle , needle , postneedle , and posth and ling . Parents and a technician provided visual analog scale ratings of children 's pain . Children provided a self-report using a  Faces Pain Scale  , and parents and nurses rated the children 's pain and anxiety using visual analog scales . Results A “ pain face ” similar to that reported in adults emerged with the onset of pain . Principal component analyses revealed the frequency and intensity of facial action during the needle phase could be represented by components reflecting pain sensation , a “ brave face , ” and the children 's expectations for pain . Children 's Faces Pain Scale and adult visual analog scale ratings were best predicted by components reflecting pain sensation and expectations of high pain . Conclusions These results provide a preliminary indication that the Child Facial Coding System can be reduced to components that reflect several aspects of children 's acute pain experience and predict self-reports and observer reports of children 's pain
All 4 faces pain scales were found to be adequately supported by psychometric data .
When given a choice between faces scales , children preferred the WBFPRS .
Confounding of pain intensity with affect caused by use of smiling and crying anchor faces is a disadvantage of the WBFPRS .
: For clinical use , we found no grounds to switch from 1 faces scale to another when 1 of the scales is in use .
CONTEXT : Numerous faces scales have been developed for the measurement of  pain intensity in children .
It remains unclear whether any one of the faces scales is better for a particular purpose with regard to validity , reliability , feasibility , and preference .
OBJECTIVES : To summarize and systematic ally review faces pain scales most commonly used to obtain self-report of pain intensity in children for evaluation of reliability and validity and to compare the scales for preference and utility .