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The majority of previous research that has examined the validity of pain intensity rating scales has been conducted in western and developed countries. Research to evaluate the generalizability of previous findings in non-developed countries is necessary for identifying the scales that are most appropriate for use in international research. The aims of the current study were to (1) evaluate the validity and utility of four commonly used measures of pain intensity in a sample of patients with chronic pain from Thailand and (2) compare findings in the current sample with published findings from research conducted in other countries, in order to identify the measure or measures which might be most appropriate for cross-country research. Three hundred and sixty patients with chronic pain seen in a hospital in Bangkok, Thailand, were asked to rate their current pain and average, worst, and least pain intensity in the past week using the Visual Analogue Scale (VAS), 6-point Verbal Rating Scale (VRS-6), 0-10 Numerical Rating Scale (NRS-11), and Faces Pain Scale-Revised (FPS-R). We evaluated the utility and validity of each measure by examining the (1) rates of correct responding and (2) association of each measure with a factor score representing the variance shared across measures, respectively. We also evaluated the associations between incorrect response rates and both age and education level, and then compared the findings from this sample with the findings from research conducted in other countries. The results indicated support for the validity of all measures among participants who were able to use these measures. However, there was variability in the incorrect response rates, with the VAS having the highest (45%) and the NRS-11 having the lowest (15%) incorrect response rates. The VAS was also the least preferred (9%) and the NRS-11 the most preferred (52%) scale. Education and age were significantly associated with incorrect response rates, and education level with scale preference. The findings indicate that the NRS-11 has the most utility in our sample of Thai individuals with chronic pain. However, when considered in light of the findings from other countries, the results of this study suggest that the FPS-R may have the most utility for use in cross-cultural and international research. Research in additional samples in developing countries is needed to evaluate the generalizability of the current findings.

Background: Topical anesthetics have an intrinsic part to reduce pricking pain sensation due to needle stick before injection in children. Aim: The present study aimed to determine the effectiveness of a novel herbal anesthetic gel used as a topical anesthetic before an inferior alveolar nerve block. SettingsandDesign: This was a bilateral split-mouth, single blind, crossoverin vivo study. Methods: Atotal number of 30 children were selected for this study design. After the application of the topical anesthesia, a 26-gauge needle was inserted in the mucobuccal fold and local anesthetic solution was deposited. Assessment of pain perception was done before the procedure and at the time of needle penetration using hemodynamic parameters such as blood pressure and heart rate. The objective and subjective pain assessment was recoded through sound eye motor scale and Faces Pain Scale-Revised (FPS-R). StatisticalAnalysis: As the data followed a normal distribution, parametric tests were used to analyze these data. The independent sample t-test and paired sample t-test were used to check the mean differences. Results: The data showed no statistically significant differences in the objective and subjective pain assessment values of the novel herbal anesthetic gel compared to the 2% lignocaine gel. However, the intragroup comparisons of the before and during treatment results showed statistically significant results (P < 0.05). Conclusion: The novel herbal anesthetic gel was effective and safe in reducing the pain from needle insertion. Thus, setting up scientific evidence for the therapeutic usage of herbal products can, therefore, assist to develop a more efficient and alternative topical anesthetic.

The Faces Pain Scale-Revised (FPS-R) is widely used to assess pain intensity in young people. The aims of this research were to study the convergent and discriminant validity and reliability properties of a culturally adapted version of the FPS-R for its use with Arabic-speaking individuals. The sample consisted of 292 students living in Lebanon. They were interviewed online, asked to imagine themselves in one of two given situations based on their age (8–12 and 13–18 years old), and then asked rate the intensity of pain they would experience using the FPS-R-Arabic and a Numerical Rating Scale (NRS-11-Arabic). They were also asked to respond to the Pain Catastrophizing Scale (PCS-C-Arabic). Two weeks later, participants were asked to repeat the same procedure. The data showed strong associations between the scores of the FPS-R-Arabic and NRS-11-Arabic (r = 0.72; p < 0.001), which were higher than the associations of the scores of the FPS-Arabic with the PCS-C-Arabic scores (z = 7.36, p < 0.001). The associations between the FPS-R-Arabic scores on the two measurements were also strong (r = 0.76; p < 0.001). The findings support the convergent and discriminant validity and reliability of the FPS-R-Arabic scores when used to measure pain intensity in young people aged 8 to 18 years old.

Purpose: To evaluate the reliability and validity of the Faces Pain Scale Revised (FPS‐R), the Numeric Rating Scale (NRS), and the Iowa Pain Thermometer (IPT) for pain assessment in Chinese elders who have had surgery. Design: A descriptive correlational design with repeated measures was used. A convenience sample of 180 Chinese elders (age range 65 to 95 years) undergoing scheduled surgery at a university‐affiliated hospital was recruited. Methods: On the day before surgery, recalled pain and anticipated postoperative pain intensity were rated by patients with three scales presented in randomized order, and then cognitive function was measured. On the first 3 postoperative days, participants completed the three scales in random order to assess current, worst, and least pain on each day. On the 3rd postoperative day, single retrospective ratings on worst, least, and average pain over the 3 days for each scale were also obtained and scale preferences were investigated. Findings: The failure rates for all three scales were extremely low. The intraclass correlation coefficients across current, worst, and least pain on each postoperative day were consistently high (0.949 to 0.965), and all scales at each rating were strongly correlated (r=.833 to .962). Pain scores significantly decreased during the 3 postoperative days and all three scales were found to be sensitive in evaluating patient‐controlled analgesia (PCA) efficacy. The scale mostly preferred was the IPT (54.7%), followed by the FPS‐R (28.5%) and the NRS (15.6%). No significant differences were noted in participant preference by age and cognitive status, but preference for the IPT and the FPS‐R were significantly related to gender and education level. Conclusions: Although all three scales show good reliability, validity, and sensitivity for assessing postoperative pain intensity in Chinese elders, the IPT appears to be a better choice based on patient preference. Clinical Relevance: The FPS‐R, the NRS, and the IPT can be used confidently to assess postoperative pain in Chinese surgical elders.

OBJECTIVE: To augment available validation data for the Faces Pain Scale – Revised (FPS‐R) and to assess interscale agreement and preference in comparison with the Coloured Analogue Scale (CAS) in pediatric acute pain. METHOD: The present prospective, multicentre study included 131 inpatients five to 15 years of age (mean age 8.8 years; 56% male) seen in postoperative recovery. They provided CAS and FPS‐R pain scores before and after administration of analgesic medication. Nurses and physicians used the same tools as observational scales. Children and health care providers indicated which scale they preferred. RESULTS: FPS‐R scores for the intensity of postoperative pain correlated highly with the corresponding CAS scores in all age groups (0.66 ≤ r ≤ 0.88). There were no significant mean differences in any age group between the scales. Scores on the two scales differed by 2/10 or less in 81% to 91% of children, depending on age. Both scales demonstrated expected changes in postoperative pain following administration of an analgesic. Scores at the upper end point were given by approximately 20% of children five to six years of age on both scales, compared with 2% to 9% in the older age groups. Health care providers’ observational ratings were significantly lower than self‐ratings. The FPS‐R was preferred over the CAS by most children in all age groups and both sexes. Global satisfaction of the health care providers was similar for both tools. DISCUSSION: These results support the use of the FPS‐R for most children five years of age or older in the postoperative period. Further research is needed to identify young children, particularly those younger than seven years of age, who have difficulty with self‐report tools, and to establish methods for training them in the reliable use of these measures.

Three commonly used pain scales, the visual analogue scale, the Wong-Baker Faces Pain Scale, and the Faces Pain Scale Revised were administered to 122 Thai children, of whom half were HIV infected, in order to assess their validity. These scales presented moderate to good correlation and moderate agreement, sufficient for valid use in Thai children.

This chapter contains sections titled: Nurses' Role in Pain Assessment Pain Measurement and Pain Assessment Self‐Report Tools Behavioural Tools Physiological Indicators Pain Assessment Tools for Neonates Pain Assessment in Cognitively Impaired Children Choosing the Right Pain Assessment Measure How Often Should Pain Be Assessed? Summary References