What tool is best for evaluating pain in children who can’t self-report?

Author(s)Marian Freedman, Jon Matthew Farber, MD

Assessing pain in nonverbal patients remains very difficult, including being able to distinguish it from “behavior” (eg, self-stimulation), says Jon Matthew Farber, MD.

The Paediatric Pain Profile (PPP) is the only pain interference tool that a recent report recommends for assessing pain interference in children and adolescents with chronic pain who are unable to self-report. Investigators based this conclusion on a review of 33 studies and abstracts that studied psychometric properties of 10 such tools. Four of the tools were designed for use with children and adolescents, 3 with adults, and 3 could be used in all populations. Only the PPP, which is designed for individuals up to aged 18 years, showed evidence (low quality) of content validity and internal consistency in a population unable to self-report. Studies of the PPP assessed the tool’s psychometric properties, such as internal consistency, test-retest reliability, construct validity, and responsiveness, as well as content validity.

Three other tools for children who are unable to self-report, whether because of communication, motor, or cognitive limitations, show promise but require further investigation. These tools include the Patient-Reported Outcome Measurement Information System Pediatric Proxy Pain Interference Scale, Bath Adolescent Pain Questionnaire for Parents, and the modified Brief Pain Inventory-Proxy.

THOUGHTS FROM DR. FARBER:

Assessing pain in nonverbal patients remains very difficult, including being able to distinguish it from “behavior” (eg, self-stimulation). Questionnaires, while potentially helpful, are still insufficient. Often one must rely on the parents’ and your own “gut feeling.” Speaking of gut, remember that constipation is a common cause of pain in this population.

Reference:

Smith MG, Farrar LC, Gibson RJ, Russo RN, Harvey AR. Chronic pain interference assessment tools for children and adults who are unable to self-report: a systematic review of psychometric properties. Dev Med Child Neurol. 2003;10.1111/dmcn.15535. doi:10.1111/dmcn.15535