Related Experiment Video
Updated: Apr 15, 2026
A Quantitative Sensory Testing Paradigm to Obtain Measures of Pain Processing in Patients Undergoing Breast Cancer Surgery
Published on: January 18, 2018
HEDEN Pain Scale: A Shortened Behavioral Scale for Assessment of Prolonged Cancer or Postsurgical Pain in Children
Perrine Marec-Berard1, Frédéric Gomez, Sylvie Combet
1Leon Berard Cancer Centre, Pediatric Oncology Unit , Lyon , France.
Insights
The new Hétero Evaluation Douleur Enfant (HEDEN) scale accurately assesses prolonged pain in young cancer patients. It is a faster, validated alternative to the Douleur Enfant Gustave Roussy (DEGR) scale for pediatric oncology pain management.
Area of Science:
- Pediatric Oncology
- Pain Management
- Psychometrics
Background:
- Assessing chronic pain in children with cancer is challenging due to diminishing behavioral cues.
- The existing Douleur Enfant Gustave Roussy (DEGR) scale is validated but time-consuming for clinical use.
- A need exists for a more efficient, reliable pain assessment tool for young cancer patients.
Purpose of the Study:
- To develop and validate the Hétero Evaluation Douleur Enfant (HEDEN) scale.
- To create a shorter, clinically practical observational scale for prolonged pain in children with cancer.
- To compare the HEDEN scale's performance against the established DEGR scale.
Main Methods:
- The HEDEN scale was derived from the DEGR scale using expert consensus, selecting 5 items with three rating levels.
- Concurrent validity was assessed by correlating HEDEN and DEGR scores in a cohort of 59 children.
- The HEDEN scale was further validated in a second cohort of 48 children, evaluating reliability and interrater agreement.
Main Results:
- The HEDEN scale demonstrated acceptable correlation (r=0.5) and good reliability (α=0.61) in the initial cohort.
- Validation in the second cohort showed a significant correlation (r=0.6) with good reliability (α=0.75) and excellent interrater agreement (r=0.67).
- HEDEN scale assessments averaged 4.42 minutes, significantly faster than the DEGR scale's 23 minutes.
Conclusions:
- The HEDEN scale is a reliable and valid tool for assessing prolonged pain in young children with cancer.
- HEDEN offers a significant time-saving advantage over the DEGR scale for daily clinical practice.
- This validated scale facilitates accurate and efficient pain management in pediatric oncology settings.
Abstract:
Few observational scales are available for assessing chronic or recurrent pain in children with cancer because overt behavioral signs of chronic pain dissipate as time passes, making them difficult to detect reliably. The Douleur Enfant Gustave Roussy (DEGR) scale developed by Gauvain-Piquard to monitor prolonged pain in children with cancer aged 2-6 years is currently the only validated tool available for this purpose, but is time consuming and difficult to use in daily clinical practice. To shorten composite measurement scales, we developed the Hétero Evaluation Douleur Enfant (HEDEN) scale from the DEGR scale. We present here the process and validation of this scale. Expert consensus was used for the elaboration of HEDEN: 5/10 DEGR items were chosen with three rating levels. Concurrent validity was tested in a first cohort with correlation analysis between HEDEN and DEGR. The HEDEN scale was then validated in a second cohort. In the first step, the study (59 children) showed acceptable correlation between DEGR and HEDEN (r = 0.5), with good reliability (α = 0.61), and interrater agreement (r = 0.62). Subsequent validation in 48 children showed a significant correlation between DEGR and HEDEN (r = 0.6). Reliability was good (α = 0.75), with excellent interrater agreement [r = 0.67 (95% CI: 0.48-0.79)]. On average, the evaluation took 23 minutes (SD = 10.4) for DEGR versus 4.42 minutes (SD = 5.9) for HEDEN. This study shows a good correlation between HEDEN and DEGR scales. HEDEN allows accurate assessment of prolonged pain in young children with cancer.
