Assessment and Questionnaires for Children with Pain

Original Editor - Robin Tacchetti based on the course by Tracy Prowse
Top Contributors - Robin Tacchetti, Jess Bell, Naomi O'Reilly, Kim Jackson, Ewa Jaraczewska and Tarina van der Stockt

Chronic Pain[edit | edit source]

Pain that occurs for longer than three months is considered chronic. The pediatric population coping with chronic pain may have disruptions in social, recreational and school activities causing functional and emotional distress. In response to chronic pain, children may develop changes in sleep, mood and anxiety. [1]

Factors Affecting Pain[edit | edit source]

The most reliable and accurate measure of pain in children is self-reporting, however, that is not without its challenges. Pain is shaped by developmental factors and the sociocultural, psychological and biological attributes of the child need to be understood. Utilising this biopsychosocial model helps to appreciate the child’s understanding of pain, how they describe it and how they manage their pain. These attributes are always changing and are not static as the child grows and develops.[2]

When assessing a child’s report on their pain, Freud et al. (2019)[2] listed four factors to take into account:

  1. Level of cognitive development: depending on the age of the child determines how they perceive the cause and effect of pain. Very young infants do not understand pain, but can experience it and remember it. As they age, their understanding of pain matures.
  2. Fear and prior painful experiences: Previous pain experiences can influence future or potentially painful incidents. Increased levels of fear in children correspond with higher levels of reported pain, the persistence of pain, anxiety, avoidance behaviours and disability
  3. Societal expectations, stereotypical assumptions, and familial cultural norms: children learn how to experience, manage and describe pain by observing their parents’ response. Parental and caregiver responses are guided by societal stereotypes and expectations
  4. Anchor effects: this refers to extremes of a scale such as:
    1. no pain vs pain
    2. Smiley face vs sad face
    3. High number vs low number
    4. One colour that depicts pain vs another colour depicting no pain[2]

The issue with anchor effects is that children can not readily understand these abstract scales leaving them to choose based on previous experiences. If they feel happy, they still could be in pain and vice versa, if they are sad, they might not be in pain. This could cause false-positive or false-negative depending on their bias towards colour or number. [2]

Assessment[edit | edit source]

Pain questionnaires can be used to get a holistic view of the child and to gain an understanding of what they are experiencing. Ideally, getting a history from the child and parent will create a more in-depth picture of the child's life experiences.[2] Effective assessment tools are necessary to help guide successful treatment.

Pain Questionnaires[edit | edit source]

FOPQ-C and FOPQ-P: Fear of Pain Questionnaire Child and Parent: Fear of pain increases pain perception and decreases functionality. Alternatively, the absence of pain-related fear lends the child to continue with routine daily activities and decreases the likelihood of emotional side effects. This specific tool allows the clinician to identify symptoms that may be related to avoidance and fear of pain.[1]

PSQI: Pittsburgh Sleep Quality Index: This self-measured tool looks at the overall sleep quality. The use of open-ended questions serves to identify the possible causes of sleep issues and to guide treatment.[3]

CSI: Central Sensitivity Inventory https: This tool is used to determine how sensitive the nervous system is. When the central nervous system is on high alert, it can increase the child's sensitivity to various things in their everyday routine like bright lights or strong smells. This questionnaire aims to find areas where the child might be sensitive that they may not have related to their pain.[4]

HADS: Hospital Anxiety and Depression Scale: Depression often follows anxiety. This questionnaire measures depression and anxiety and is a fast, simple and easy to use the tool. [5]

RCADS: Revised Child and Anxiety Scale: This self-reported questionnaire is another tool to measure depression and anxiety in children and adolescents

Adverse Childhood questionnaire: This is a freely available tool that identifies if there has been any trauma or traumatic experiences influencing their pain.[4]

Resilience questionnaire: Resilience describes the ability to cope with adversity.[6] This questionnaire looks at resilience in the face of stressors in various arenas including self, peer, school, family and community.[7]

Highly sensitive child questionnaire: When the nervous system is over-protective it can be overly sensitive. This quality can be a positive as it tunes the child into the world around them, however, it just needs to stay in check so that it is not making them hypersensitive to the environment. This questionnaire asks questions to help the child identify if they are innately a highly sensitive person. [4]

Physical Assessment[edit | edit source]

After reviewing the questionnaire and the past medical history, a physical assessment including range of motion, strength, sensation and functional mobility are performed. When limitations are noted, it is important to find out what the child would like to return to and what skills or activities they would like to do. Using the child’s value system in goal and treatment planning helps increase success during their rehabilitation. [4]

Resources[edit | edit source]

References[edit | edit source]

  1. ↑ 1.0 1.1 Romariz JA, Nonnemacher C, Abreu M, Segabinazi JD, Bandeira JS, Beltran G, Souza A, Torres IL, Caumo W. The Fear of Pain Questionnaire: psychometric properties of a Brazilian version for adolescents and its relationship with brain-derived neurotrophic factor (BDNF). Journal of pain research. 2019;12:2487.
  2. ↑ 2.0 2.1 2.2 2.3 2.4 Freund D, Bolick BN. CE: Assessing a child's pain. AJN The American Journal of Nursing. 2019 May 1;119(5):34-41.
  3. ↑ Faulkner S, Sidey-Gibbons C. Use of the Pittsburgh Sleep Quality Index in people with schizophrenia spectrum disorders: a mixed methods study. Frontiers in psychiatry. 2019 May 9;10:284.
  4. ↑ 4.0 4.1 4.2 4.3 Prowse, T. Assessment and Questionnaire Course. Physioplus. 2022
  5. ↑ Stern AF. The hospital anxiety and depression scale. Occupational medicine. 2014 Jul 1;64(5):393-4.
  6. ↑ del Carmen Pérez-Fuentes M, Jurado MD, Martín AB, Rubio IM, Linares JJ. Validation of the Resilience Scale for Adolescents in High School in a Spanish Population. Sustainability. 2020;12(7):1-1.
  7. ↑ Gartland D, Bond L, Olsson CA, Buzwell S, Sawyer SM. Development of a multi-dimensional measure of resilience in adolescents: the Adolescent Resilience Questionnaire. BMC medical research methodology. 2011 Dec;11(1):1-0.
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