This study describes the relationship between different indicators of pain, including self-reports, behavioral observations, and physiological measures, in children with cancer undergoing invasive procedures. Forty-five children between the ages of 4 and 10 years were evaluated while undergoing Port-a-Cath access. The study was conducted in the outpatient clinics of the Children’s Cancer Center in Beirut, Lebanon. Children used 2 self-report measures of pain (the Wong-Baker FACES Pain Rating Scale and an adaptation of the FACES, the DOLLS). Parents and nurses assessed the child’s pain on the FACES and the child’s distress on the Observational Scale of Behavioral Distress-Revised. Nurses recoded behavioral observations as well as physiological responses to pain. There was a high degree of consistency between the self-reports and moderate to high correlations between self-reports, behavioral parameters, and physiological parameters, suggesting that accurate pain assessments can be made by both nurses and parents. The results also demonstrate adequate validity and reliability of the DOLLS scale in a Lebanese population, in addition to being the preferred assessment tool for all the children in the study.
Abu-Saad, H. (1984). Cultural components of pain: The Arab-American child. Issues in Comprehensive Pediatric Nursing, 7, 91-99.
2.
Barrier, G., Attia, J., Mayer, M. N., Amiel-Tison, C. I., & Shnider, S. M. (1989). Measurement of post-operative pain and narcotic administration in infants using a new clinical scoring system. Intensive Care Medicine, 15(Suppl. 1), 37-39.
3.
Beyer, J. (1998). Key issues surrounding the assessment of pain in children. Pediatric and Perinatal Drug Therapy, 2, 3-13.
4.
Beyer, J., & Knott, C. (1998). Construct validity estimation for the African-American and Hispanic versions of the Oucher Scale. Journal of Pediatric Nursing, 13, 20-31.
5.
Bieri, D., Reeve, R. A, Champion, G. D., Addicoat, L., & Ziegler, J. B. (1990). 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. Pain, 4, 139-150.
6.
Blount, R. L., Piira, T., Cohen, L. L., & Cheng, P. S. (2006). Blount pediatric procedural pain. Behavior Modification, 30(1), 24-49.
7.
Bournaki, M. C. (1997). Correlates of pain-related responses to venipunctures in school-age children. Nursing Research, 46(3), 147-154.
8.
Broome, M. E., Rehwaldt, M., & Fogg, L. (1998). Relationships between cognitive behavioral techniques, temperament, observed distress, and pain reports in children and adolescents during lumbar puncture. Journal of Pediatric Nursing, 13(1), 48-54.
9.
Chambers, C. T., Hardial, J., Craig, K. D., Court, C., & Montgomery, C. (2005). Faces scales for the measurement of postoperative pain intensity in children following minor surgery. Clinical Journal of Pain, 21(3), 277-285.
10.
Chambers, C. T., Reid, G. J., Craig, K. D., McGrath, P. J., & Finley, G. A. (1998). Agreement between child and parent reports of pain. Clinical Journal of Pain, 14(4), 336-342.
11.
Cheng, S. F., Foster, R. L., & Hester, N. O. (2003). A review of factors predicting children’s pain experiences. Issues in Comprehensive Pediatric Nursing, 26(4), 203-216.
12.
Drendel, A. L., Brousseau, D. C., & Gorelick, M. H. (2006). Pain assessment for pediatric patients in the emergency department. Pediatrics, 117(5), 1511-1518.
13.
Eland, J. M., & Coy, J. A. (1990). Assessing pain in the critically ill child. Focus on Critical Care, 17(6), 469-475.
14.
Elusiyan, J. B., & Senbanjo, I. O. (2005). Management of pain in children: A review of the literature. Nigerian Journal of Medicine, 14(4), 363-367.
15.
Finley, G., & McGrath, P. (1996). Postoperative pain in children. Canadian Journal of Anaesthesia, 43(4), 418-419.
16.
Gharaibeh, M., & Abu-Saad, H. (2002). Cultural validation of pediatric pain assessment tools: Jordanian perspective. Journal of Transcultural Nursing, 13(1), 12-18.
17.
Goodenough, T. B., Perrott, D. A., Champion, G. D., & Thomas, W. (2000). Painful pricks and prickle pains: Is there a relation between children’s ratings of venipuncture pain and parental assessments of usual reaction to other pains?Clinical Journal of Pain, 16(2), 135-143.
18.
Harrison, A. (1993). Comparing nurses’ and patients’ pain evaluations: A study of hospitalized patients in Kuwait. Social Science & Medicine, 36(5), 683-692.
19.
Helgadottir, H. L., & Wilson, M. E. (2004). Temperament and pain in 3 to 7-year-old children undergoing tonsillectomy. Journal of Pediatric Nursing, 19(3), 204-213.
20.
Hester, N., & Barcus, C. (1986). Assessment and management of pain in children. Pediatrics: Nursing Update, 1(14), 2-2.
21.
Hinojosa, R. J. (1997). Comparisons of pain ratings from postoperative children, their mothers, and their nurses: A research critique. Plastic Surgical Nursing, 17(1), 33-36.
22.
Jacob, E., & Puntillo, K. A. (1999). Pain in hospitalized children: Pediatric nurses’ beliefs and practices. Journal of Pediatric Nursing, 14(6), 379-391.
23.
Jay, S., & Elliott, C. (1986). Observation scale of behavior distress revised. Los Angeles: Children’s Hospital of Los Angeles; 1986.
24.
Jay, S. M., Elliott, C. H., Ozolins, M., Olson, R. A., & Pruitt, S. D. (1985). Behavioral management of children’s distress during painful medical procedures. Behaviour Research and Therapy, 23(5), 513-520.
25.
Johnston, C. C. (1998). Psychometric issues in the measurement of pain. In G. A Finley & P. J. McGrath (Eds.), Measurements of pain in infants and children (pp. 5-20). Seattle, WA: IASP Press.
26.
Jordan-Marsh, M., Yoder, L., Hall, D., & Watson, R. (1994). Alternate Oucher form testing: Gender, ethnicity, and age variations. Research in Nursing & Health, 17(2), 111-118.
27.
Kankkunen, P. M., Vehvilainen-Julkunen, K. M., Pietila, A. M., & Halonen, P. M. (2003). Parents’ perceptions of their 1-6-year-old children’s pain. European Journal of Pain, 7(3), 203-211.
28.
Keck, J., Gerkensmeyer, J., Joyce, B., & Schade, J. (1996). Reliability and validity of the Faces and Word Descriptor Scales to measure procedural pain. Journal of Pediatric Nursing, 11, 368-374.
29.
Kelly, A. M., Powell, C. V., & Williams, A. (2002). Parent visual analogue scale ratings of children’s pain do not reliably reflect pain reported by child. Pediatric Emergency Care, 18(3), 159-162.
30.
Kleiber, C., & Harper, D. C. (1999). Effects of distraction on children’s pain and distress during medical procedures: A meta-analysis. Nursing Research, 48(1), 44-49.
31.
Krechel, S., & Bildner, J. (1995). CRIES: A new postoperative pain measurement score. Initial testing of validity and reliability. Pediatrics Anesthesia, 5, 53-61.
32.
McCarthy, P., Chammas, G., Wilimas, J., Alaoui, F. M., & Harif, M. (2004). Managing children’s cancer pain in Morocco. Journal of Nursing Scholarship, 36(1), 11-15.
33.
McGrath, P. J. (1998). Behavioral measures of pain. In G. A. Finley & P. J. McGrath (Eds.), Measurements of pain in infants and children (pp. 83-102). Seattle, WA: International Association for the Study of Pain.
34.
McGrath, P. J., & Dick, B. (2003). Measuring pain in children: Developmental and instrumental issues. In N. L. Schechter, C. B. Berde, & M. Yaster (Eds.), Pain in infants, children, and adolescents (2nd ed., pp. 128-141). Baltimore: Williams & Wilkins.
35.
McGrath, P. J., & Unruh, A. M. (2002). The social context of neonatal pain. Clinics in Perinatology, 29, 555-572.
36.
Merkel, S., Voepel-Lewis, T., & Malviya, S. (2002). Pain assessment in infants and young children: The FLACC scale. American Journal of Nursing, 102(10), 55-58.
37.
Miller, D. (1996). Comparisons of pain ratings from postoperative children, their mothers, and their nurses. Pediatric Nursing, 22, 145-149.
38.
Miller, D., Pfefferbaum, B., Adams, J., & Aceves, J. (1990). The influence of culture on pain of Anglo and Hispanic children with cancer. Journal of the American Academy of Child and Adolescent Psychiatry, 29, 642-647.
39.
Schneider, E. M., & LoBiondo-Wood, G. (1992). Perceptions of procedural pain: Parents, nurses, and children. Children’s Health Care, 21(3), 157-162.
40.
Simons, J. M., & Macdonald, L. M. (2004). Pain assessment tools: Children’s nurses’ views. Journal of Child Health Care, 8(4), 264-278.
41.
Spence, K., Gillies, D., Harrison, D., Johnston, L., & Nagy, S. (2005). A reliable pain assessment tool for clinical assessment in the neonatal intensive care unit. Journal of Obstetric, Gynecologic, and Neonatal Nursing, 34(1), 80-86.
42.
Stanford, E. A., Chambers, C. T., & Craig, K. D. (2006). The role of developmental factors in predicting young children’s use of a self-report scale for pain. Pain, 120, 16-23.
43.
Stevens, B., & Grunau, R. E. (2002). Pain in vulnerable infants: Introduction. Clinics in Perinatology, 29(3), 25-27.
44.
Stevens, B., Johnston, C., Petryshen, P., & Taddio, A. (1996). Premature Infant Pain Profile: Development and initial validation. Clinical Journal of Pain, 12(1), 13-22.
45.
Streiner, D., & Norman, G. (1995). Health measurement scales: A practical guide to their development and use (2nd ed.). Oxford, UK: Oxford University Press.
46.
Stuber, M. L., Christakis, D. A., Houskamp, B., Kazak, A. F. (1996). Posttrauma symptoms in childhood leukemia survivors and their parents. Psychosomatics, 37, 254-261.
47.
Tesler, M. D., Savedra, M. C., Holzemer, W. L., Wilkie, D. J., Ward, J. A., & Paul, S. M. (1991). The Word-Graphic Rating Scale as a measure of children’s and adolescents’ pain intensity. Research in Nursing & Health, 14(5), 361-371.
48.
Van Hulle, V. C. (2005). Nurses’ knowledge, attitudes, and practices: Regarding children’s pain. MCN: The American Journal of Maternal Child Nursing, 30(3), 177-183.
49.
Vetter, T., & Heiner, E. (1996). Discordance between patient self-reported visual analog scale pain scores and observed pain-related behavior in older children after surgery. Journal of Clinical Anesthesia, 8(5), 371-375.
50.
Villarruel, A., & Denyes, M. (1991). Pain assessment in children: Theoretical and empirical validity. Advances in Nursing Science, 14(2), 32-41.
51.
Voepel-Lewis, T., Malviya, S., & Tait, A. R. (2005). Validity of parent ratings as proxy measures of pain in children with cognitive impairment. Pain Management Nursing, 6(4), 168-174.
52.
Walco, G. A. (2004). Toward an integrated model of pain over the life course. Pain, 108, 207-208.
53.
Walco, G. A., Conte, P. M., Labay, L. E., Engel, R., & Zeltzer, L. K. (2005). Procedural distress in children with cancer: Self-report, behavioral observations, and physiological parameters. Clinical Journal of Pain, 21(6), 484-490.
54.
Weisenberg, M., & Caspi, Z. (1989). Cultural and educational influences on pain of childbirth. Journal of Pain and Symptom Management, 4(1), 13-19.
55.
Willis, M. H., Merkel, S. I., Voepel-Lewis, T., & Malviya, S. (2003). The FLACC behavioral pain assessment scale: A comparison with the child’s self-report. Pediatric Nursing, 29(3), 195-198.
56.
Wong, D., & Baker, C. (1988). Pain in children: Comparison of assessment scales. Pediatric Nursing, 14(1), 9-17.
57.
World Health Organization. (1998). Cancer pain relief and palliative care in children. Geneva, Switzerland: Author.
58.
Zahr, L., & Hattar-Pollara, M. (1998). Nursing care of Arab children: Consideration of cultural factors. Journal of Pediatric Nursing, 13, 349-355.
