Elena Castarlenas

Evidence for the use of a numerical rating scale to assess the intensity of pediatric pain

The aim of this work was to evaluate the psychometric properties of the Numerical Rating Scale‐11 (NRS‐11) when used to assess pediatric pain intensity. We performed two studies: 175 schoolchildren, aged 8–12, participated in Study 1 and 63 children undergoing surgery and aged 6–16, participated in Study 2. The NRS‐11 showed (a) adequate convergent construct validity when correlated with the Faces Pain Scale – Revised (FPS‐R; r1 = 0.78, r2 = 0.93); (b) adequate discriminant validity in relation to measures of pain‐related affect (z1 = 3.55, z2 = 7.62) and disability (z1 = 7.62, z2 = 6.83); and (c) adequate criterion‐related validity using measures of pain‐related affect (r1 = .58, r2 = .66), disability (r1 = 0.22, r2 = .39), and quality of life (r2 = −.46). Schoolchildren were asked whether they preferred using the NRS‐11 or the FPS‐R when reporting the intensity of their pain. While both sexes and both the younger and older age groups preferred the FPS‐R, this preference was more marked among girls and younger children.

A comparison of four self-report scales of pain intensity in 6- to 8-year-old children.

Summary The study data show that the 4 pain intensity assessment instruments studied measure 1 common factor but that they are not concordant. Abstract There are many different instruments for assessing pain intensity in children, but the agreement between them is unclear. The aims of this study were to determine the 1‐dimensionality of 4 widely used self‐report scales for measuring the intensity of pediatric pain, and the agreement between them. A sample of 126 school children between 6 and 8 years of age (mean = 6.87 years; SD = 0.68 year) were interviewed individually and asked to identify the most frequent pain that they had experienced in the 3 months before the interview, and to report their maximum pain intensity using all 4 scales (Visual Analogue Scale, Coloured Analogue Scale, Faces Pain Scale—Revised and Numerical Rating Scale—11). A factor analysis was conducted to determine the 1‐dimensionality of these 4 scales. Agreement was calculated with the Bland–Altman method with a maximum limit of agreement set at ±20 mm. Our data show the 1‐dimensionality of the scales. The 95% limits of agreement between each pair of measures were as follows: VAS/CAS (−23.8, 23.4); VAS/NRS‐11 (−41, 31.1); VAS/FPS‐R (−38.3, 33.6); CAS/NRS‐11 (−35.6, 26.2); CAS/FPS‐R (−36.4, 32.1), and FPS‐R/NRS‐11 (−36.3, 31). Our data suggest that these 4 instruments measure 1 common factor but that they are not concordant.

Psychometric Properties of the Numerical Rating Scale to Assess Self-reported Pain Intensity in Children and Adolescents: A Systematic Review.

Objectives: The Numerical Rating Scale-11 (NRS-11) is one of the most widely used scales to assess self-reported pain intensity in children, despite the limited information on its psychometric properties for assessing pain in pediatric populations. Recently, there has been an increase in published findings regarding the strengths and weaknesses of the NRS-11 as a measure of pain in youths. The purpose of this study was to review this research and summarize what is known regarding the reliability and validity of the NRS-11 as a self-report measure of pediatric pain intensity. Methods: A literature search was conducted using PubMed, PsycINFO, CINAHL, and the Psychology and Behavioral Sciences Collection from their inception to February 2016. Results: A total of 382 articles were retrieved, 301 were screened for evaluation, and 16 were included in the review. The findings of reviewed studies support the reliability and validity of the NRS-11 when used with children and adolescents. Discussion: Additional research is needed to clarify some unresolved questions and issues, including (1) the minimum age that children should have to offer valid scores of pain intensity and (2) the development of consensus regarding administration instructions, in particular with respect to the descriptors used for the upper anchor. On the basis of available information, the NRS-11 can be considered to be a well-established measure for use with pediatric populations.

The Pittsburgh Sleep Quality Index: Validity and factor structure in young people.

The Pittsburgh Sleep Quality Index (PSQI) is a widely used measure of sleep quality in adolescents, but information regarding its psychometric strengths and weaknesses in this population is limited. In particular, questions remain regarding whether it measures one or two sleep quality domains. The aims of the present study were to (a) adapt the PSQI for use in adolescents and young adults, and (b) evaluate the psychometric properties of the adapted measure in this population. The PSQI was slightly modified to make it more appropriate for use in youth populations and was translated into Spanish for administration to the sample population available to the study investigators. It was then administered with validity criterion measures to a community-based sample of Spanish adolescents and young adults (AYA) between 14 and 24 years old (N = 216). The results indicated that the questionnaire (AYA-PSQI-S) assesses a single factor. The total score evidenced good convergent and divergent validity and moderate reliability (Cronbachs alpha = .72). The AYA-PSQI-S demonstrates adequate psychometric properties for use in clinical trials involving adolescents and young adults. Additional research to further evaluate the reliability and validity of the measure for use in clinical settings is warranted.

Validity of three rating scales for measuring pain intensity in youths with physical disabilities.

There is growing evidence confirming that youths with physical disabilities are at risk for chronic pain. Although many scales for assessing pain intensity exist, it is unclear whether they are all equally suitable for youths. The aim of this study was to address this knowledge gap by comparing the validity of the Numerical Rating Scale (NRS‐11), the Wong Baker FACES Pain Rating Scale (FACES), and a 6‐point categorical Verbal Rating Scale (VRS‐6) for assessing pain intensity among youths (aged 8–20) with physical disabilities.

Sex differences in psychological response to pain in patients with fibromyalgia syndrome.

Objectives:To examine whether men and women with fibromyalgia syndrome (FMS) differ with respect to pain severity and functioning, pain-related beliefs, or pain-related coping. We hypothesized no significant sex differences in measures of pain and functioning, but that we would observe differences between men and women in how they view and how they cope with FMS-related pain. Methods:A total of 747 women and 48 men with FMS who attended a multidisciplinary treatment program completed the study measures. Analyses of covariance were used to examine sex differences in the study measures, with a P-value of ⩽0.01 and at least a moderate effect size (Cohen d≥0.5) required for a difference to be deemed statistically significant. Results:Men and women did not differ on demographic measures except for their age, with the men in our sample being significantly younger than the women. Consistent with the study hypothesis, the results revealed no sex differences in the measures of pain and functioning. For pain-related beliefs, men were more likely to view pain as reflecting harm, and they were also more likely than women to use activity avoidance as a pain-coping strategy. Discussion:The study findings suggest that women and men with FMS may think about and cope with pain somewhat differently, and may therefore benefit from different types of psychosocial pain intervention.

Assessment of Pain Intensity in Clinical Trials: Individual Ratings vs Composite Scores

OBJECTIVES To evaluate the reliability of findings suggesting that composite scores made up of just two ratings of recalled pain may be adequately reliable and valid for assessing outcome in pain clinical trials. DESIGN Secondary analyses of data from a study where the responsivity of the outcome measures was a critical concern; that is, a study with few subjects testing the effects of a treatment that had only modest effects. Ten adults with spinal cord injury rated four domains of pain intensity (current pain and 24-hour recalled worst, least, and average pain) on four occasions before and after 12 sessions of neurofeedback treatment. We evaluated the reliability and validity of four single ratings and 16 different composite scores. RESULTS None of the single-item scales performed adequately. However, composite scores made up of two items or more yielded consistent effect size estimates. CONCLUSIONS The findings provide additional evidence that two-item composite scores may be adequate for assessing the primary outcome of pain intensity in chronic pain clinical trials. Additional research is needed to further establish the generalizability of these findings.

Agreement between verbal and electronic versions of the numerical rating scale (NRS-11) when used to assess pain intensity in adolescents.

Objectives:Electronic pain measures are becoming common tools in the assessment of pediatric pain intensity. The aims of this study were (1) to examine the agreement between the verbal and the electronic versions of the 11-point Numerical Rating Scale (NRS-11) (vNRS-11 and eNRS-11, respectively) when used to assess pain intensity in adolescents; and (2) to report participants’ preferences for each of the 2 alternatives. Materials and Methods:A total of 191 school children enrolled in grades 7 to 11 (mean age, 14.61; range, 12 to 18) participated. They were asked to report the highest intensity of the most frequent pain that they had experienced during the last 3 months using both the vNRS-11 and the eNRS-11. Agreement analyses were carried out using: (1) the Bland-Altman method, with confidence intervals (CI) of both 95% and 80%, and a maximum limit of agreement of ±1; and (2) weighted intrarater &kgr;-coefficients between the ratings for each participant on the vNRS-11 and eNRS-11. Results:The limits of agreement at 95% fell outside the limit established a priori (scores ranged from −1.42 to 1.69), except for participants in grade 11 (−0.80, 0.88). Meanwhile, the limits of agreement at 80% CI fell inside the maximum limit established a priori (scores ranged from −0.88 to 0.94), except for participants in grade 8 (Supplemental Digital Content 2, http://links.lww.com/CJP/A97) (−0.88, 1.16). The &kgr;-coefficients ranged from 0.786 to 0.912, indicating “almost perfect” agreement. A total of 83% of participants preferred the eNRS-11. Discussion:Pain intensity ratings on the vNRS-11 and eNRS-11 seem to be comparable, at least for the 80% CI.

Cognitive Fusion and Pain Experience in Young People

Objectives:Acceptance and Commitment Therapy (ACT) has been shown to be an effective treatment for chronic pain in young people. Cognitive fusion is a key concept of ACT that is hypothesized to contribute to distress and suffering. In this study, we sought to: (1) test hypothesized associations between cognitive fusion and pain intensity, disability, and catastrophizing; and (2) examine the function of cognitive fusion as a possible mediator between catastrophizing and disability. Methods:A community sample of 281 young people (11 to 20 y) completed measures assessing cognitive fusion, pain intensity, disability, and pain catastrophizing. Results:Cognitive fusion was positively related to pain intensity (r=0.24, P<0.01), disability (r=0.32, P<0.001), and pain catastrophizing (r=0.47, P<0.001). Moreover, cognitive fusion was found to mediate the association between pain catastrophizing and disability (&bgr;=0.01, 95% confidence interval=0.002-0.024, 5000 bootstrap resamples). Discussion:The findings indicate that cognitive fusion is moderately to strongly associated with pain-related outcomes, which support the need for further research to (1) better understand the relationship between cognitive fusion and adjustment to chronic pain, and (2) determine whether the benefits of treatments such as ACT are mediated, at least in part, by reductions in cognitive fusion.

A Catalan adaptation and validation of the Pain Catastrophizing Scale for Children.

Pain catastrophizing is a key factor in modern conceptualizations of pain. The development of the Pain Catastrophizing Scale for Children (PCS-C) has greatly contributed to the interest shown by pediatric pain specialists. The purpose of this work was to study the factor structure of the Pain Catastrophizing Scale and analyze its reliability and convergent, discriminant, and criteria related validity. Three hundred sixteen adolescents (12-19 years) completed the Catalan version of the PCS-C and provided information about pain intensity. A subgroup of 136 participants also completed measures of disability, anxiety sensitivity and pain coping strategies. The results confirmed the 3-factor model solution for the PCS-C, and demonstrated good internal consistency for the total Catastrophizing Scale (0.89) and for the Rumination (0.80) and Helplessness (0.82) PCS-C subscales. Internal consistency for the Magnification subscale, however, was not quite as good (0.63). This 3-factor model could be improved by removing Item 8 and developing additional items for the Rumination PCS-C subscale. The results also provide evidence of the convergent, discriminant and criterion-related validity of the PCS-C scores when used with Catalan-speaking adolescents. Our data demonstrate that the Catalan version of the PCS-C is a psychometrically sound questionnaire that provides valid and reliable scores when used to assess pain catastrophizing in adolescents. (PsycINFO Database Record