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Postsurgical pain assessment in children and adolescents with cerebral palsy: A scoping review
Débora Sierra-Núñez1, Esperanza Zuriguel-Pérez2,3, Alejandro Bosch-Alcaraz4
1Paediatric Surgery Unit, Vall d'Hebron University Hospital, Barcelona, Spain.
Insights
Assessing postoperative pain in children with cerebral palsy (CP) is complex. The revised Face, Legs, Activity, Cry and Consolability (FLACC) scale is recommended, but more research is needed.
Area of Science:
- Pediatric Pain Management
- Cerebral Palsy Research
- Clinical Assessment Tools
Background:
- Postoperative pain assessment in children with cerebral palsy (CP) presents unique challenges.
- Understanding factors influencing pain assessment is crucial for effective management.
- Existing literature lacks comprehensive reviews on available pain assessment tools for this population.
Purpose of the Study:
- To identify factors influencing postoperative pain assessment in pediatric patients with CP.
- To review and evaluate instruments used for determining pain intensity in these patients.
- To provide evidence-based recommendations for pain assessment in postsurgical CP patients.
Main Methods:
- Systematic literature search conducted in January 2022 across six databases.
- Inclusion criteria focused on pediatric patients with CP and postsurgical pain assessment instruments published within the last 11 years.
- Analysis of 8 selected studies out of 441 identified articles.
Main Results:
- Seven distinct pain assessment instruments were identified, including the revised Face, Legs, Activity, Cry and Consolability (FLACC) pain scale.
- The revised FLACC scale is noted for its ease of use and independence from parental input, making it suitable for postsurgical settings.
- Observed differences in pain expression between males and females, highlighting the potential role of family input.
Conclusions:
- The revised FLACC pain scale is a practical tool for postsurgical pain assessment in children with CP.
- Further research is required to validate the clinical utility of identified pain scales in postsurgical units.
- Emphasizing family collaboration in pain assessment is recommended, alongside further investigation into influencing factors.
Aim:
To investigate factors that influence the assessment of postoperative pain in children and adolescents with cerebral palsy (CP) and the tools available to determine pain intensity.
Method:
The search was performed in January 2022 using six databases. Articles focused on paediatric patients with CP; we included instruments for postsurgical pain assessment in this population published in the last 11 years.
Results:
Eight of 441 studies were included. Males and females behave differently; their families can be called on to describe their pain responses. Seven instruments for pain assessment were identified: the Non-Communicating Children's Pain Checklist and its Postoperative Version; the Paediatric Pain Profile; the revised Face, Legs, Activity, Cry and Consolability (FLACC) pain scale; the Douleur Enfant San Salvador scale; the Pain Indicator for Communicatively Impaired Children; the University of Wisconsin Children's Hospital Pain Scale; and the Individualized Numeric Rating Scale.
Interpretation:
The revised FLACC pain scale is suited to postsurgical units because of its ease of use and the fact that parental collaboration is not required. More studies are needed to demonstrate the clinical utility of these scales in postsurgical units and the factors that influence pain assessment.
What This Paper Adds:
Families should be asked to collaborate when assessing pain in children and adolescents whenever possible. Larger studies that focus on the factors influencing pain assessment in this population are required.
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