Belinda Goodenough

The Faces Pain Scale – Revised: toward a common metric in pediatric pain measurement ☆

&NA; The Faces Pain Scale (FPS; Bieri et al., Pain 41 (1990) 139) is a self‐report measure used to assess the intensity of childrens pain. Three studies were carried out to revise the original scale and validate the adapted version. In the first phase, the FPS was revised from its original seven faces to six, while maintaining its desirable psychometric properties, in order to make it compatible in scoring with other self‐rating and observational scales which use a common metric (0–5 or 0–10). Using a computer‐animated version of the FPS developed by Champion and colleagues (Sydney Animated Facial Expressions Scale), psychophysical methods were applied to identify four faces representing equal intervals between the scale values representing least pain and most pain. In the second phase, children used the new six‐face Faces Pain Scale – Revised (FPS‐R) to rate the intensity of pain from ear piercing. Its validity is supported by a strong positive correlation (r=0.93, N=76) with a visual analogue scale (VAS) measure in children aged 5–12 years. In the third phase, a clinical sample of pediatric inpatients aged 4–12 years used the FPS‐R and a VAS or the colored analogue scale (CAS) to rate pain during hospitalization for surgical and non‐surgical painful conditions. The validity of the FPS‐R was further supported by strong positive correlations with the VAS (r=0.92, N=45) and the CAS (r=0.84, N=45) in this clinical sample. Most children in all age groups including the youngest were able to use the FPS‐R in a manner that was consistent with the other measures. There were no significant differences between the means on the FPS‐R and either of the analogue scales. The FPS‐R is shown to be appropriate for use in assessment of the intensity of childrens acute pain from age 4 or 5 onward. It has the advantage of being suitable for use with the most widely used metric for scoring (0–10), and conforms closely to a linear interval scale.

Review of Adherence-Related Issues in Adolescents and Young Adults With Cancer

PURPOSE This review aims to provide a broad overview of the issues and clinical challenges of nonadherence in adolescents and young adults (AYAs) with cancer. Nonadherence can reduce treatment efficacy, which places the patient at higher risk of relapse, adverse effects, and poor outcomes. DESIGN A review of the English-speaking literature between 1980 and 2008 was conducted to identify relevant publications, which were supplemented by reference and author searches. RESULTS Definition and measurement of adherence varies. Most studies have not clearly delineated an AYA age group (ie, 15-25 years) and have been dominated by leukemia and lymphoma samples. Estimates for nonadherence in this population range from 27% to 60%, with openness of family relationships and support found to predict adherence. Strategies to avoid, assess, and manage nonadherence are presented. CONCLUSION Overall, the evidence base for adherence and strategies to promote it in AYAs with cancer is woefully lacking. There is a need for high-quality studies that target clinically important questions, randomized controlled trials of theoretically based interventions, and development and evaluation of training programs for oncology staff in the special issues faced by AYAs with cancer.

An investigation of the placebo effect and age-related factors in the report of needle pain from venipuncture in children

Abstract To examine the potential role for a placebo cream in reducing reported needle pain severity in children, and the impact of age‐related factors on pain self‐report, a convenience sample of 117 children scheduled for venipuncture were randomly assigned to one of three treatments: (a) placebo cream with the suggestion that it might help reduce needle pain, (b) placebo cream with no indication as to the creams purpose, and (c) no cream (control group). In allocation to treatment, children were stratified by age group, (3–7, 8–11, 12–17 years). They rated their needle pain severity (both predicted and reported) using the Faces Pain Scale, and rated their anxiety about the procedure using the Childrens Anxiety and Pain Scale. Children in the cream groups were also asked whether they thought the cream had helped. Using video‐tapes, an independent observer, blind to the placebo manipulation, rated each childs reaction to the needle. For the two groups receiving cream, 83% of those children told it might help stated that they believed it did, as compared with only 33% of children who received the cream but were told nothing of its purpose. These beliefs, however, were not reflected in self‐report ratings of pain which showed no statistically significant treatment effect. Similarly, children who gave higher preprocedural anxiety ratings were no more likely to report less pain as a result of receiving the cream. There was, however, a treatment effect on the observers ratings: children receiving cream plus suggestion were assigned significantly lower ratings of pain‐related behaviour than those children who received the cream alone. While venipuncture was associated with only mild levels of pain, younger children, irrespective of treatment group, did report more pain than older children. Hierarchical regression analysis indicated that 60% of the variance in self‐reported pain severity scores could be accounted for by how much the child thought the needle would hurt, how anxious the child was about receiving the needle, gender (higher pain ratings associated with girls), and estimated body surface area (higher pain ratings associated with smaller bodies). We conclude that the efficacy of placebo treatments for needle pain in children may depend on the suggestion of a possible benefit rather than upon treatment application per se.

Cognitive-behavioural predictors of children's tolerance of laboratory-induced pain: implications for clinical assessment and future directions.

This study sought to investigate cognitive-behavioural predictors of childrens tolerance for laboratory-induced cold-pressor pain. It was hypothesised that pain tolerance, as measured by immersion time, would be greater in children who were high in self-efficacy for pain, high in self-reported use of cognitive-coping strategies, and low in emotion-focused coping strategies such as catastrophising. Age and sex differences were also examined in post hoc analyses. Children between the ages of 7 and 14 years (N = 53) participated in the study. Offering partial support for the hypotheses, use of cognitive distraction was found to be associated with greater pain tolerance, while use of internalising/catastrophising was associated with lower pain tolerance. Older boys tended to have greater pain tolerance than younger boys, whereas younger and older girls had intermediate pain tolerance levels. Self-efficacy for pain, in general, was found to be positively correlated with age. The results support efforts to identify children who, because they have lower confidence or lower skills in coping with distress, may need extra support and preparation for painful procedures. Further research is needed to investigate these findings within a clinical pain context.

Hidden financial costs in treatment for childhood cancer: An Australian study of lifestyle implications for families absorbing out-of-pocket expenses

Purpose The impact of out-of-pocket expenses on five domains of family lifestyle were explored: social, assets, credit, utilities, and charity. Methods Using a cross-sectional survey, 100 parents of pediatric cancer patients reported on the types of out-of-pocket expenses incurred and the perceived lifestyle impact of meeting those expenses. Results Eighty percent of the sample reported a minimum of five different out-of-pocket expenses (total mean value = AUS

Children’s ratings of the intensity and unpleasantness of post-operative pain using facial expression scales

19,064; approximately US

The Sydney Multisite Intervention of LaughterBosses and ElderClowns (SMILE) study: cluster randomised trial of humour therapy in nursing homes

9,723). The majority reflected travel, accommodation, and communication costs, use of work-related entitlements, and changes in paid employment. In lifestyle terms, the area of greatest impact was found for the social domain, such as cancelling vacations and giving up recreational pleasures and social expenditure. Those families living furthest from the major cancer treatment center reported the greatest range of out-of-pocket expenses and subsequent lifestyle impact. While there were few differences as a function of cancer type, results suggested that families most vulnerable to financial distress tended to be those whose child had spent relatively longer on treatment. Conclusions In meeting out-of-pocket expenses, parents primarily seek ways to “trim the fat” off existing family expenditure. While all families may incur extra expenses, parents of patients located a significant distance from the cancer treatment center remain especially vulnerable (despite increased government allowances). Creative solutions for addressing some expenses may include applications of telemedicine to augment outreach services.

Needle pain severity in children: Does the relationship between self-report and observed behaviour vary as a function of age?

This study explored whether global unidimensional self‐report pain scales based on facial expression help children separately estimate the sensory and affective magnitude of post‐operative pain. Ninety paediatric elective surgery patients (in two age groups: 5–9 and 10–15 years) used each of four scales to estimate pain intensity and pain affect during the first 2 days after surgery. The four scales were: Faces Pain Scale (FPS), Facial Affective Scale (FAS), and the Coloured Analogue Scale (CAS) (one for intensity and one for unpleasantness). As hypothesised, ratings on the FPS correlated more highly with analogue scale ratings for intensity than for unpleasantness, whereas ratings on the FAS correlated more highly with those on the analogue scale for unpleasantness than for intensity. Factor analysis indicated that although all measures loaded on a single dimension of distress, there was an additional weaker factor corresponding to a unique contribution of the FAS. No systematic age effects were observed. It was concluded that the FPS and the FAS may partly measure different aspects of the postoperative pain experience in children, although shared instrument variance may obscure true estimates of covariation in ratings of intensity and affective magnitude. The clinical relevance of the present results remains to be determined.

A comparison of the Faces Pain Scale and the Facial Affective Scale for children's estimates of the intensity and unpleasantness of needle pain during blood sampling.

Objectives To determine whether humour therapy reduces depression (primary outcome), agitation and behavioural disturbances and improves social engagement and quality-of-life in nursing home residents. Design The Sydney Multisite Intervention of LaughterBosses and ElderClowns study was a single-blind cluster randomised controlled trial of humour therapy. Setting 35 Sydney nursing homes. Participants All eligible residents within geographically defined areas within each nursing home were invited to participate. Intervention Professional ‘ElderClowns’ provided 9–12 weekly humour therapy sessions, augmented by resident engagement by trained staff ‘LaughterBosses’. Controls received usual care. Measurements Depression scores on the Cornell Scale for Depression in Dementia, agitation scores on the Cohen-Mansfield Agitation Inventory, behavioural disturbance scores on the Neuropsychiatric Inventory, social engagement scores on the withdrawal subscale of Multidimensional Observation Scale for Elderly Subjects, and self-rated and proxy-rated quality-of-life scores on a health-related quality-of-life tool for dementia, the DEMQOL. All outcomes were measured at the participant level by researchers blind to group assignment. Randomisation Sites were stratified by size and level of care then assigned to group using a random number generator. Results Seventeen nursing homes (189 residents) received the intervention and 18 homes (209 residents) received usual care. Groups did not differ significantly over time on the primary outcome of depression, or on behavioural disturbances other than agitation, social engagement and quality of life. The secondary outcome of agitation was significantly reduced in the intervention group compared with controls over 26 weeks (time by group interaction adjusted for covariates: p=0.011). The mean difference in change from baseline to 26 weeks in Blom-transformed agitation scores after adjustment for covariates was 0.17 (95% CI 0.004 to 0.34, p=0.045). Conclusions Humour therapy did not significantly reduce depression but significantly reduced agitation. Trial registration Australian New Zealand Clinical Trials Registry -ACTRN12611000462987.

The relationship between the quality of the built environment and the quality of life of people with dementia in residential care

Reactions to needle pain were observed in children aged 3 to 17 years undergoing venipuncture. The primary aim was to determine whether agreement between observer ratings and childrens self-report of pain varied as a function of the age of the child. A second aim was to explore which factors predicted whether a child spontaneously chose to watch the needle, and whether looking behaviour was related to pain ratings. Results showed that correlations between behavioural and self-report measures were strongest for the 3- to 7-year-olds and weakest for the 12- to 17-year-olds. While the best predictor of self-report ratings was facial reaction for both the 8- to 11- and 12- to 17-year-olds, vocal and verbal reactions were also significant predictor variables for the 3- to 7-year-olds. The profile of a “non-looker” was a child who was older and had experienced few needles, who expected pain and was anxious about the procedure.