http://www.immpact.org/static/agendas/IMMPACT-5.pdf

Core outcome domains and measures for pediatric acute and chronic/recurrent pain clinical trials: PedIMMPACT recommendations

Observational (behavioral) scales of pain for children aged 3 to 18 years were systematically reviewed to identify those recommended as outcome measures in clinical trials. This review was commissioned by the Pediatric Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials (www.immpact.org). In an extensive literature search, 20 observational pain scales were identified for review including behavior checklists, behavior rating scales, and global rating scales. These scales varied in their reliance on time sampling and inclusion of physiological items, facial and postural items, as well as their inclusion of multiple dimensions of assessment (e.g., pain and distress). Each measure was evaluated based on its reported psychometric properties and clinical utility. Scales were judged to be indicated for use in specific acute pain contexts rather than for general use. Two scales were recommended for assessing pain intensity associated with medical procedures and other brief painful events. Two scales were recommended for post-operative pain assessment, one for use in hospital and the other at home. Another scale was recommended for use in critical care. Finally, two scales were recommended for assessing pain-related distress or fear. No observational measures were recommended for assessing chronic or recurrent pain because the overt behavioral signs of chronic pain tend to habituate or dissipate as time passes, making them difficult to observe reliably. In conclusion, no single observational measure is broadly recommended for pain assessment across all contexts. Directions for further research and scale development are offered.

http://www.immpact.org/static/publications/von%20Baeyer%20and%20Spagrud,%202007.pdf

Systematic review of observational (behavioral) measures of pain for children and adolescents aged 3 to 18 years.

https://yorkspace.library.yorku.ca/xmlui/bitstream/handle/10315/27969/Taddio_2012.pdf;sequence=1

Survey of the prevalence of immunization non-compliance due to needle fears in children and adults.

Pain assessment in infants and children

Increasing evidence has demonstrated that pain from venipuncture and intravenous cannulation is an important source of pediatric pain and has a lasting impact. Ascending sensory neural pain pathways are functioning in preterm and term infants, yet descending inhibitory pathways seem to mature postnatally. Consequently, infants may experience pain from the same stimulus more intensely than older children. In addition, painful perinatal procedures such as heel lancing or circumcision have been found to correlate with stronger negative responses to venipuncture and intramuscular vaccinations weeks to months later. Similarly, older children have reported greater pain during follow-up cancer-related procedures if the pain of the initial procedure was poorly controlled, despite improved analgesia during the subsequent procedures. Fortunately, both pharmacologic and nonpharmacologic techniques have been found to reduce children's acute pain and distress and subsequent negative behaviors during venipuncture and intravenous catheter insertion. This review summarizes the evidence for the importance of managing pediatric procedural pain and methods for reducing venous access pain.

https://pediatrics.aappublications.org/content/pediatrics/122/Supplement_3/S130.full.pdf

Clinical Implications of Unmanaged Needle-Insertion Pain and Distress in Children

While there is no question that children dislike needles, there are very little data available on the occurrence of high levels of distress experienced by children undergoing routine venipunctures. To provide some insight into this problem, trained observers evaluated distress in 223 different children and adolescents undergoing this procedure. An observational distress scale of 1 to 5 was developed; 1 = calm, 2 = timid/nervous, 3 = serious distress, but still under control, 4 = serious distress with loss of control, and 5 = panic. We observed a strong relation between distress and age but not between distress and gender. During the actual venipuncture, half the subjects (113/223) were scored as having high levels of distress (3 or more). Our subjects were also grouped into three age ranges: toddlers; 2 1/2 to 6 years, N = 70; preadolescents; 7 to 12 years, N = 55; and adolescents; 12 years and older, N = 98. The percent of subjects experiencing high levels of distress for each age group were: 83%, 51%, and 28%, respectively. We conclude that for venipunctures: 1) high levels of distress are common, and 2) age and not gender correlates with distress. Other correlations are discussed. Toddlers and pre-adolescents should be the targets for new interventions to reduce distress.

Cmj Boon

Papers

The occurrence of high levels of acute behavioral distress in children and adolescents undergoing routine venipunctures.