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Updated: Aug 15, 2026
An Experimental Paradigm for the Prediction of Post-Operative Pain (PPOP)
Published on: January 27, 2010
The FLACC: a behavioral scale for scoring postoperative pain in young children
S I Merkel1, T Voepel-Lewis, J R Shayevitz
1Department of Anesthesiology, University of Michigan Medical School and Health Systems, Ann Arbor, USA.
Insights
The FLACC Pain Assessment Tool demonstrates high reliability and validity in assessing pain in young children. This tool effectively quantifies pain behaviors, aiding clinicians in pain management for non-verbal patients.
Area of Science:
- Pediatric Anesthesiology
- Pain Management
- Clinical Assessment Tools
Background:
- Accurate pain assessment in children, especially those unable to verbalize pain, is crucial for effective management.
- The FLACC (Face, Legs, Activity, Cry, Consolability) Pain Assessment Tool offers a behavioral framework for pain evaluation.
Purpose of the Study:
- To evaluate the reliability and validity of the FLACC Pain Assessment Tool in pediatric surgical patients.
- To determine if the FLACC tool can accurately quantify pain behaviors in children aged 2 months to 7 years.
Main Methods:
- Eighty-nine children undergoing surgical procedures were observed in the Post Anesthesia Care Unit (PACU).
- Interrater reliability was measured, and validity was tested by observing FLACC score changes after analgesic administration.
- FLACC scores were compared with the Objective Pain Scale (OPS) and nurses' global pain ratings.
Main Results:
- The FLACC tool exhibited high interrater reliability among observers.
- A significant decrease in FLACC scores following analgesic administration provided preliminary evidence of validity.
- FLACC scores correlated well with the OPS and nurses' global pain ratings, further supporting its validity.
Conclusions:
- The FLACC tool provides a simple, reliable, and valid method for quantifying pain behaviors in non-verbal children.
- Preliminary data supports the FLACC as a valuable instrument for pain assessment in pediatric patients post-surgery.
Purpose:
To evaluate the reliability and validity of the FLACC Pain Assessment Tool which incorporates five categories of pain behaviors: facial expression; leg movement; activity; cry; and consolability.
Method:
Eighty-nine children aged 2 months to 7 years, (3.0 +/- 2.0 yrs.) who had undergone a variety of surgical procedures, were observed in the Post Anesthesia Care Unit (PACU). The study consisted of: 1) measuring interrater reliability; 2) testing validity by measuring changes in FLACC scores in response to administration of analgesics; and 3) comparing FLACC scores to other pain ratings.
Findings:
The FLACC tool was found to have high interrater reliability. Preliminary evidence of validity was provided by the significant decrease in FLACC scores related to administration of analgesics. Validity was also supported by the correlation with scores assigned by the Objective Pain Scale (OPS) and nurses' global ratings of pain.
Conclusions:
The FLACC provides a simple framework for quantifying pain behaviors in children who may not be able to verbalize the presence or severity of pain. Our preliminary data indicates the FLACC pain assessment tool is valid and reliable.
