Amandine Dubois

The perioperative validity of the visual analog anxiety scale in children: a discriminant and useful instrument in routine clinical practice to optimize postoperative pain management.

BACKGROUND:Because children’s anxiety influences pain perception, perioperative anxiety should be evaluated in clinical practice with a unique, useful, and valid tool to optimize pain management. In this study, we evaluated psychometric properties of the visual analog scale (VAS)-anxiety for children and to study its perioperative relevance in clinical practice. METHODS:One hundred children scheduled for elective surgery and general anesthesia were included. VAS-anxiety was measured at four timepoints and compared with both versions of State Spielbergers’ questionnaires (State-Trait Anxiety Inventory for Youth [STAIY] and State-Trait Anxiety Inventory for Children [STAIC]) and the modified Yale Preoperative Anxiety Scale. Children’s pain, parents’ anxiety, and parents’ proxy report of children’s anxiety were evaluated using VAS. RESULTS:The correlation between STAIC and VAS-anxiety was significant on the day of discharge. Moreover, changes over time were not significant with STAIC, whereas VAS-anxiety was significantly sensitive to changes over time in the two groups of age (7–11 yr and 12–16 yr). A receiver operating characteristic curve, using modified Yale Preoperative Anxiety Scale as reference, determined a VAS-anxiety cutoff at 30 to identify high-anxiety groups. Pain levels were significantly higher when children were anxious (VAS ≥30) in the postoperative period. Moreover, children’s anxiety and pain were higher when parents were anxious. CONCLUSION:VAS-anxiety is a useful and valid tool to assess perioperative anxiety in children aged 7–16 yr. The influence of children’s and parents’ anxiety on children’s postoperative pain suggests that VAS-anxiety should be recommended routinely for postoperative clinical practice to optimize anxiety and pain management.

How do children with autism spectrum disorders express pain? A comparison with developmentally delayed and typically developing children.

Summary Parents and clinicians report difficulties in pain assessment in children with autism because of sociocommunicative deficits. This study shows that children with autism spectrum disorders are at least as reactive to pain during venipuncture as developmentally delayed and typically developing children. Abstract There is a lack of knowledge about pain reactions in children with autism spectrum disorders (ASD), who have often been considered as insensitive to pain. The objective of this study was to describe the facial, behavioral and physiological reactions of children with ASD during venipuncture and to compare them to the reactions of children with an intellectual disability and nonimpaired control children. We also examined the relation between developmental age and pain reactions. The sample included 35 children with ASD, 32 children with an intellectual disability, and 36 nonimpaired children. The children were videotaped during venipuncture and their heart rate was recorded. Facial reactions were assessed using the Child Facial Coding System (CFCS) and behavioral reactions were scored using the Noncommunicating Children’s Pain Checklist (NCCPC). A linear mixed‐effects model showed that children’s reactions increased between baseline and venipuncture and decreased between the end of venipuncture and the recovery period. There was no significant difference between groups regarding the amount of facial, behavioral and physiological reactions. However, behavioral reactions seemed to remain high in children with ASD after the end of the venipuncture, in contrast with children in the 2 other groups. Moreover, we observed a significant decrease in pain expression with age in nonimpaired children, but no such effect was found regarding children with ASD. The data reveal that children with ASD displayed a significant pain reaction in this situation and tend to recover more slowly after the painful experience. Improvement in pain assessment and management in this population is necessary.

Pain expression in children with an intellectual disability

Background: Children with an intellectual disability (ID) are sometimes unable to verbalize and describe their painful experience; therefore family members and health carers can assess the intensity of the pain only from the behaviour exhibited by the children.

Autisme et Douleur – Analyse Bibliographique

The purpose of the present article was to assess the available literature concerning pain and autism. First, authors summarized the published articles on pain reactivity in people with autism. Second, the hypotheses envisaged to explain the presence of expressive particularities in people with autism spectrum disorders were reviewed; these included endogenous opioid excess theory, sensorial abnormalities and sociocommunicative deficit. Finally, the present review dealt with the tools available to assess and manage pain in people with autism. In conclusion, the authors revealed the need for more research to obtain more consensual data and provided some recommendations in this domain that were under exploited by the scientific community. From a clinical point of view, more knowledge about pain in people with autism should enable the development of specific assessment tools and, consequently, better pain management in daily care.

Vocal and Verbal Expression of Postoperative Pain in Preschoolers

The purpose of this study was to examine the development and construction of vocal and verbal expression of postoperative pain in young children with limited linguistic abilities. The main objective was to highlight specific pain vocalizations, which may lead to easy and quick detection and assessment of postoperative pain relative to the age of the suffering child. Forty-seven children aged 1 to 6 years were observed during two periods of surgical hospitalization: a preoperative and a postoperative period. The results showed that there was a significant relation between their age and the types of vocalization they expressed during the postoperative period. Regarding the development in relation to certain contexts, a minor modification seems to be concerned not with the type but with the frequency of the items of vocalizations. The study confirms earlier observations and clinical experience that an efficient and reliable assessment of pain in infants and young children necessitates taking several factors into account, such as the developmental age of the children, and especially a consideration of the whole spectrum of pain markers present in the childs behavior and captured by the assessment tools.