Pain Scale/Year |
Population Tested and Dimensions |
Validity/Reliability |
Clinical Utility/Feasibility |
Pain Rating Scale (PRS)[25] 1994 |
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Discriminant validity (t-test = 11.52, P < 0.0001)
Interrater reliability (pilot data = 80.99%); (r = 0.65 to 0.84, P < 0.0001)
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Riley Infant Pain Scale (RIPS)[26] 1996 Revision of PRS |
391 postoperative infants and children
6 categories of behavior (facial, body movement, sleep, verbal/vocal, consolability, response to movement/touch)
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Discriminant validity (t-tests = 8.4 and 9.7, P < 0.001)
Interrater reliability (ICCs = 0.39-0.87)
Internal consistency (Cronbach's alpha from 0.87 to 0.93)
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Neonatal Facial Coding System (NFCS)[27] 1987 |
140 well newborns
Brow bulge, eye squeeze, nasolabial furrow, open lips, vertical mouth stretch, horizontal mouth stretch, lip purse, taut tongue, chin quiver, (tongue protrusion added in 199028)
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Face/content validity
Construct validity (10 actions scored but only 7 in analysis; n = 27; [F1, 25] = 12.01, P < 0.002)[29]; (n = 75 infants; r = 0.79, P < 0.001)[30]
Interrater reliability (reliability coefficient = 0.88)
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Maximally Discriminative Facial Movement Coding System (MAX)[32] 1979 Original copyright 1995 Revised version[32] |
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The Children's Hospital of Eastern Ontario Pain Scale[33] 1985 |
26 children aged 1 to 5 years and 30 children aged 1 to 7 postoperatively
6 categories of behavior (cry, facial, child verbal, torso, touch, legs)
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No objective
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Infant Body Coding System (IBCS)[4,34] 1993 (Portion of original infant pain behavior rating scale)[34] |
56 preterm and full-term newborns
Hand/foot movements, arm movements, leg movements, head movements, and torso movements
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Échelle Douleur Inconfort Nouveau-Né (EDIN) = Neonatal Pain and Discomfort Scale[35] 2001 |
76 preterm infants; mean gestational age 31.5 weeks
5 behavioral indicators of prolonged pain: facial activity, body movements, quality of sleep, quality of contact with nurses, and consolability
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Construct validity (mean total scores lower after analgesia, 4.7 vs. 9.2, P < 0.0001, paired t-test)
Interrater reliability (weighted κ coefficient = 0.59-0.74)
Internal consistency (Cronbach's alpha coefficients = 0.86-0.94)
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Clinical Scoring System (CSS)[36,37,38] 1987 Also referenced as the Postoperative Pain Score (POPS)[25,26] |
23 infants from 1 to 7 months requiring surgery
Sleep during preceding hour, facial expression of pain, quality of cry, spontaneous motor activity, spontaneous excitability, flexion of fingers/toes, sucking, global evaluation of tone, consolability, sociability. Tool later revised by removing 3 indicators (sleep, sociability, and sucking)[26]
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Modified Postoperative Comfort Score (PCS) 1998 Revision of CSS/POPS[39] |
22 mechanically ventilated preterm infants
Sleep, facial expression, sucking, hyperreactivity, agitation, hypertonicity, toes and fingers, consolability (removed quality of cry and sociability and double-scored 2 other variables)
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Discriminant validity (in both placebo and fentanyl groups) (comfort scores from bedside assessment increased significantly after 'analgesia' period, P < 0.00001; video assessment of comfort scores increased in the fentanyl group vs placebo, P < 0.05)
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Behavioral Pain Score[40] 1994 Modified from other tools[27,33] |
84 mechanically ventilated preterm infants
Facial expression, movements, response to handling, consolability, rigidity of the limbs and body
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Behavioral Pain Score (BPS)[41] 1991 Adapted from CHEOPS[33] |
41 chronically ill infants and toddlers between 3 and 36 months of age
Facial expression, cry, movements added for total potential score of 8 signifying increased pain
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Modified Behavioral Pain Scale (MBPS)[42] 1995 |
96 healthy infants aged 4 to 6 months
Facial expression, cry, gross body movement with score of 0 to 10
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Concurrent validity (correlation coefficient between MBPS and visual analogue scores was 0.68, P < 0.001; and 0.74, P < 0.001)
Construct validity (post-vaccination scores significantly lower for EMLA group compared to placebo group, P < 0.01)
Interrater reliability (ICC = 0.95, P < 0.001)
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Liverpool Infant Distress Scale (LIDS)[43] 1996 |
16 newborn infants post-operatively
Spontaneous movement, spontaneous excitability, flexion of fingers/toes, tone, facial expression, quantity of crying, quality of crying, sleep pattern and amount
|
Face/content validity
Construct validity (scores higher in group undergoing major surgery but reporting of statistics limited)
Interrater reliability (Pearson's Correlation Coefficient, 0.74 to 0.88)
Test-retest reliability (Pearson's Correlation Coefficient, 0.81 to 0.96)
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Facial Action Coding System (FACS)[44] 1978 |
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Baby Facial Action Coding System (Baby FACS)[45] 1988 |
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Children's and Infants' Postoperative Pain Scale (CHIPPS)[46] 2000 |
584 newborns, infants, and young children
5 behavioral indicator scale (cry, facial expression, posture of trunk, posture of legs, and motor restlessness)
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Concurrent validity (compared with Toddler-Preschooler Postoperative Pain Scale, identified pain-free or analgesic demand in 87.4%).
Interrater reliability (reliability coefficient = 0.93)
Internal consistency (Cronbach's alpha = 0.92 for toddlers, and 0.96 for infants)
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Douleur Aigue du Nouveau-né (DAN) Acute Pain Rating Scale for Neonates[47,48] 1997 |
42 newborns born between 25 and 41 weeks gestational age
Facial expression, limb movements, and vocal expression with scores ranging from 0 to 10
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Unpublished Unidimensional Pain Assessment Tools |
Mills Infant/Toddler Pain Index (Creator ~ Mills) Based on observed pain behaviors[11] |
Limb movement, trunk and general body responses, communication, facial expressions, interactions, self-consolation, activities of daily living |
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