Pain Assessment Tools for Infants, Children, and Adolescents With Cancer: A Scoping Review

Pain assessment is essential for effectively managing pain in pediatric oncology. Despite various tools being used globally, few comprehensive studies summarize their features; this complicates the selection of appropriate tools. This scoping review aimed to map the existing literature on pain assessment tools for children with cancer.

On November 20, 2023, we followed the guidelines of the Joanna Briggs Institute Manual for Evidence Synthesis and conducted a comprehensive search of PubMed, Cumulative Index to Nursing and Allied Health Literature, Cochrane Central Register of Controlled Trials, Embase, and Ichushi-Web. Studies describing pain assessment tools for children aged 0-18 years were included. The tools were categorized as self-reporting and proxy reporting. As this study aimed to map, a critical appraisal of study quality was not performed.

We identified 33 pain assessment tools across 48 studies: 18 self-report measures, 10 proxy-rated measures, and five hybrid tools. Commonly identified tools included the visual analog scale (VAS), Numeric Rating Scale (NRS), Wong-Baker FACES Pain Rating Scale, and Face, Legs, Activity, Cry, Consolability (FLACC) Scale. Formats varied from visual scales to digital applications. Several tools used illustrations, making them accessible to children as young as 3-4 years. Most tools were originally developed in English for non-cancer populations, with few validated translations or cultural adaptations.

This review maps available tools for assessing pediatric cancer pain and highlights the need for age-appropriate multidimensional approaches that prioritize self-reporting. Further research should focus on validation and cultural adaptation across diverse groups of children with cancer.