Related Experiment Video
Updated: May 8, 2026
Quantifying Pain Location and Intensity with Multimodal Pain Body Diagrams
Published on: July 7, 2023
Validation of self-report pain scales in children
Daniel S Tsze1, Carl L von Baeyer, Blake Bulloch
1Division of Pediatric Emergency Medicine, 622 W 168th St, PH 137, New York, NY, 10032. dst2141@columbia.edu.
Insights
The Faces Pain Scale-Revised (FPS-R) and Color Analog Scale (CAS) are reliable pain scales for children aged 4-17. While generally valid, convergent validity was lower in children under 7 years old.
Area of Science:
- Pediatric Emergency Medicine
- Pain Assessment
- Psychometrics
Background:
- The Faces Pain Scale-Revised (FPS-R) and Color Analog Scale (CAS) are widely used for pediatric pain assessment.
- Validation of these scales in the emergency department (ED) setting is limited.
- Understanding their psychometric properties across diverse pediatric populations is crucial.
Purpose of the Study:
- To evaluate the psychometric properties of the FPS-R and CAS in children aged 4-17 years in the ED.
- To assess convergent validity, discriminative validity, responsivity, and reliability of both scales.
- To determine if psychometric properties vary by age, sex, or ethnicity.
Main Methods:
- Prospective, observational study of 620 English- and Spanish-speaking children (ages 4-17).
- Pain severity assessed using FPS-R and CAS before and after analgesia.
- Psychometric properties evaluated including convergent validity, discriminative validity, responsivity, and reliability.
Main Results:
- Overall, strong psychometric properties were observed for both FPS-R and CAS.
- Convergent validity (Pearson correlation = 0.85) was higher in older children and girls.
- Discriminative validity and responsivity were demonstrated across all age, sex, and ethnicity subgroups. Reliability was acceptable.
Conclusions:
- The FPS-R and CAS exhibit robust psychometric properties in children aged 4-17 years.
- These scales are valid and reliable for pain assessment in diverse pediatric populations within the ED.
- Convergent validity may be less reliable in children younger than 7 years.
Background And Objectives:
The Faces Pain Scale-Revised (FPS-R) and Color Analog Scale (CAS) are self-report pain scales commonly used in children but insufficiently validated in the emergency department setting. Our objectives were to determine the psychometric properties (convergent validity, discriminative validity, responsivity, and reliability) of the FPS-R and CAS, and to determine whether degree of validity varied based on age, sex, and ethnicity.
Methods:
We conducted a prospective, observational study of English- and Spanish-speaking children ages 4 to 17 years. Children with painful conditions indicated their pain severity on the FPS-R and CAS before and 30 minutes after analgesia. We assessed convergent validity (Pearson correlations, Bland-Altman method), discriminative validity (comparing pain scores in children with pain against those without pain), responsivity (comparing pain scores pre- and postanalgesia), and reliability (Pearson correlations, repeatability coefficient).
Results:
Of 620 patients analyzed, mean age was 9.2 ± 3.8 years, 291(46.8%) children were girls, 341(55%) were Hispanic, and 313(50.5%) were in the younger age group (<8 years). Pearson correlation was 0.85, with higher correlation in older children and girls. Lower convergent validity was noted in children <7 years of age. All subgroups based on age, sex, and ethnicity demonstrated discriminative validity and responsivity for both scales. Reliability was acceptable for both the FPS-R and CAS.
Conclusions:
The FPS-R and CAS overall demonstrate strong psychometric properties in children ages 4 to 17 years, and between subgroups based on age, sex, and ethnicity. Convergent validity was questionable in children <7 years old.
