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1.  A Quantitative Examination of Extreme Facial Pain Expression in Neonates: The Primal Face of Pain across Time 
Pain Research and Treatment  2012;2012:251625.
Many pain assessment tools for preschool and school-aged children are based on facial expressions of pain. Despite broad use, their metrics are not rooted in the anatomic display of the facial pain expression. We aim to describe quantitatively the patterns of initiation and maintenance of the infant pain expression across an expressive cycle. We evaluated the trajectory of the pain expression of three newborns with the most intense facial display among 63 infants receiving a painful stimulus. A modified “point-pair” system was used to measure movement in key areas across the face by analyzing still pictures from video recording the procedure. Point-pairs were combined into “upper face” and “lower face” variables; duration and intensity of expression were standardized. Intensity and duration of expression varied among infants. Upper and lower face movement rose and overlapped in intensity about 30% into the expression. The expression reached plateau without major change for the duration of the expressive cycle. We conclude that there appears to be a shared pattern in the dynamic trajectory of the pain display among infants expressing extreme intensity. We speculate that these patterns are important in the communication of pain, and their incorporation in facial pain scales may improve current metrics.
PMCID: PMC3356985  PMID: 22645679
2.  Anxiety influences children’s memory for procedural pain 
To examine the effects of temperament and trait anxiety on memory for pain.
Three dimensions of temperament, as well as trait anxiety, were assessed in 36 children (five to 12 years of age) undergoing dental procedures; after the procedure, the children provided pain ratings. Following a six- to eight-week delay, the children reported how much pain they remembered.
Most children (85%) accurately recalled their pain. Temperament had no significant effect, but trait-anxious children showed a greater likelihood of recalling more pain than they initially reported, suggesting that they may negatively distort recollections of painful experiences.
When treating children, in particular trait-anxious children, clinicians should consider what children remember as part of pain management intervention.
PMCID: PMC2706554  PMID: 19547763
Anxiety; Children; Memory; Procedural pain; Temperament
3.  Children’s self-report of pain intensity: What we know, where we are headed 
The present paper provides a short, practical introduction to children’s self-report measures of pain intensity, followed by an overview of principles and issues. Details on individual self-report scales were previously reported in a landmark systematic review in 2006 and will not be repeated here. Broader measurement issues discussed here include interpretation of pain scores over time, across individuals and in relation to contextual factors; special considerations affecting children younger than six years of age; social communicative functions of pain reports; cognitive developmental factors in understanding pain scales and their anchors; screening for the ability to use self-report scales and training for children who do not have this skill; level of measurement (interval versus ordinal); estimating clinically significant change for groups and individuals; and measurement of aspects of pain other than intensity. Also highlighted are areas in which there has been progress and a lack of progress since the last time this topic was featured at the International Forum on Pediatric Pain in 1996. The present article closes with an outline of key areas for further research on children’s self-report of pain and a brief summary of recommendations for clinicians.
PMCID: PMC2706563  PMID: 19262915
Child; Faces scales; Measurement; Numerical rating scale; Pain intensity; Pain scale; Self-report
4.  Understanding and managing children’s recurrent pain in primary care: A biopsychosocial perspective 
Paediatrics & Child Health  2007;12(2):121-125.
Recurrent pains in childhood are those that occur at least three times within three months and interfere with daily activities. The most common reasons for pain are headaches and abdominal pain, and the great majority of these have no serious or treatable physical cause. Instead, a functional analysis of the antecedents and consequences of the pain for the child is needed. This requires time, trust, rapport and acceptance, as well as the development of a shared biopsychosocial understanding of the pain. Some interview questions are suggested for this purpose. These include questions about the physical and social triggers of pain episodes, such as stress at school or at home, and modelling of pain behaviour by family members. Also included are questions about the adverse consequences of pain, such as sleep problems, difficulty in concentration, avoidance of responsibility and of feared situations, and inadvertent reinforcement of pain behaviour by solicitous behaviour on the part of parents. Among the numerous interventions for recurrent pain, those that promote learning of relaxation skills are the best established. A cognitive-behavioural, biopsychosocial approach to treating recurrent pain is well supported by research evidence. Primary care physicians and paediatric consultants can help to prevent and relieve children’s recurrent pain.
PMCID: PMC2528902  PMID: 19030351
Abdominal pain; Biopsychosocial; Evidence-based; Headache; Management; Primary care; Recurrent pain; Treatment
5.  Children’s self-reports of pain intensity: Scale selection, limitations and interpretation 
Most children aged five years and older can provide meaningful self-reports of pain intensity if they are provided with age-appropriate tools and training. Self-reports of pain intensity are an oversimplification of the complexity of the experience of pain, but one that is necessary to evaluate and titrate pain-relieving treatments. There are many sources of bias and error in self-reports of pain, so ratings need to be interpreted in light of information from other sources such as direct observation of behaviour, knowledge of the circumstances of the pain and parents’ reports. The pain intensity scales most commonly used with children – faces scales, numerical rating scales, visual analogue scales and others – are briefly introduced. The selection, limitations and interpretation of self-report scales are discussed.
PMCID: PMC2539005  PMID: 16960632
Child; Measurement; Pain intensity; Pain scale; Self-report

Results 1-5 (5)