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 .
Multicentre randomised controlled trial of nasal diamorphine for analgesia in children and teenagers with clinical fractures
Abstract Objective : To compare the effectiveness of nasal diamorphine spray with intramuscular morphine for analgesia in children and teenagers with acute pain due to a clinical fracture , and to describe the safety profile of the spray . Design : Multicentre r and omised controlled trial . Setting : Emergency departments in eight UK hospitals . Participants : Patients aged between 3 and 16 years presenting with a clinical fracture of an upper or lower limb . Main outcome measures : Patients ' reported pain using the Wong Baker face pain scale , ratings of reaction to treatment of the patients and acceptability of treatment by staff and parents , and adverse events . Results : 404 eligible patients completed the trial ( 204 patients given nasal diamorphine spray and 200 given intramuscular morphine ) . Onset of pain relief was faster in the spray group than in the intramuscular group , with lower pain scores in the spray group at 5 , 10 , and 20 minutes after treatment but no difference between the groups after 30 minutes . 80 % of patients given the spray showed no obvious discomfort compared with 9 % given intramuscular morphine ( difference 71 % , 95 % confidence interval 65 % to 78 % ) . Treatment administration was judged acceptable by staff and parents , respectively , for 98 % ( 199 of 203 ) and 97 % ( 186 of 192 ) of patients in the spray group compared with 32 % ( 64 of 199 ) and 72 % ( 142 of 197 ) in the intramuscular group . No serious adverse events occurred in the spray group , and the frequencies of all adverse events were similar in both groups ( spray 24.1 % v intramuscular morphine 18.5 % ; difference 5.6 % , -2.3 % to 13.6 % ) . Conclusion : Nasal diamorphine spray should be the preferred method of pain relief in children and teenagers presenting to emergency departments in acute pain with clinical fractures . The diamorphine spray should be used in place of intramuscular morphine
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 .