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Clinically significant differences in acute pain measured on self-report pain scales in children
Daniel S Tsze1, Gerrit Hirschfeld, Carl L von Baeyer
1Department of Pediatrics, Columbia University College of Physicians and Surgeons, New York, NY.
Insights
The minimum clinically significant difference (MCSD) for pain scales in children is stable across moderate to severe pain, regardless of demographics. Ideal clinically significant difference (ICSD) estimates varied, limiting generalizability.
Area of Science:
- Pediatric Emergency Medicine
- Pain Management
- Clinical Significance
Background:
- Accurate assessment of pain intensity in children is crucial for effective management.
- The Faces Pain Scale-Revised (FPS-R) and Color Analog Scale (CAS) are commonly used pediatric pain assessment tools.
- Establishing clinically significant differences (CSDs) helps interpret pain score changes.
Purpose of the Study:
- To determine the minimum and ideal clinically significant differences (MCSD, ICSD) for the FPS-R and CAS in children.
- To investigate if these CSD estimates vary based on patient characteristics.
Main Methods:
- Prospective study of 314 children (4-17 years) with acute pain in pediatric emergency departments.
- Pain intensity assessed using FPS-R and CAS, with qualitative descriptions of pain change.
- Receiver operating characteristic-based method used to identify MCSD ("a little less" pain) and ICSD ("much less" pain).
Main Results:
- MCSD estimates for FPS-R: 2/10 raw score, 25% reduction; for CAS: 1/10 raw score, 15% reduction.
- ICSD estimates for FPS-R: 3/10 raw score, 60% reduction; for CAS: 2.75/10 raw score, 52% reduction.
- MCSD estimates were stable for moderate to severe pain and across demographics (age, sex, ethnicity). ICSD estimates were not stable across pain intensities.
Conclusions:
- MCSD estimates for FPS-R and CAS are reliable for moderate to severe pain in children, independent of demographic factors.
- ICSD estimates demonstrated variability across pain intensity levels, limiting their broad applicability.
- These findings aid in interpreting pain changes using FPS-R and CAS in pediatric emergency settings.
Objectives:
The objective was to determine the minimum and ideal clinically significant differences (MCSD, ICSD) in pain intensity in children for the Faces Pain Scale-Revised (FPS-R) and the Color Analog Scale (CAS) and to identify any differences in these estimates based on patient characteristics.
Methods:
This was a prospective study of children aged 4 to 17 years with acute pain presenting to two urban pediatric emergency departments. Participants self-reported their pain intensity using the FPS-R and CAS and qualitatively described their changes in pain. Changes in pain score reported using the FPS-R and CAS that were associated with "a little less" and "much less" pain (MCSD and ICSD, respectively) were identified using a receiver operating characteristic-based method and expressed as raw change score and percent reductions. Estimates of MCSD and ICSD were determined for each category of initial pain intensity (mild, moderate, and severe) and patient characteristics (age, sex, and ethnicity). Post hoc exploratory analyses evaluated categories of race, primary language, and etiology of pain.
Results:
A total of 314 children with acute pain were enrolled; mean (±SD) age was 9.8 (±3.8) years. The FPS-R raw change score and percent reduction MCSD estimates were 2/10 and 25%, with ICSD estimates of 3/10 and 60%. For the CAS, raw change score and percent reduction MCSD estimates were 1/10 and 15%, with ICSD estimates of 2.75/10 and 52%. For both scales, raw change score and percent reduction estimates of the MCSD remained unchanged in children with either moderate or severe pain. For both scales, estimates of ICSD were not stable across categories of initial pain intensity. There was no difference in MCSD or ICSD based on age, sex, ethnicity, race, primary language, or etiology of pain.
Conclusions:
The MCSD estimates can be expressed as raw change score and percent reductions for the FPS-R and CAS. These estimates appear stable for children with moderate to severe pain, irrespective of age, sex, and ethnicity. Estimates of ICSD were not stable across different categories of initial pain intensity, therefore limiting their potential generalizability.
