There is more to pain measurement in children than ''ouch''

Pain measurement in children has made important advances in the past decade. There are now excellent self report measures of pain for children over the age of about five years of age. In addition, there are both broad band and fine grained behavioral measures that have been extensively studied. Among the fine grained measures, facial action scales appear to be most sensitive. At this time, cry measures are not developed to the point of being able to distinguish a pain cry. Broad band behavioral measures have been shown to be valid and sensitive for short, sharp pain and for pain in the recovery room in infants and children. There is evidence that these measures habituate when a child is in pain for several hours. Moreover, some measures are not specific to pain and may also reflect anxiety and depression. Although the progress has been impressive, there are significant deficiencies in the measurement of longer term pain when self report measures cannot be used. The major technical problems are that both biological and behavioral measures tend to habituate over time and that measures may not be specific to pain. Development of new measures will require different approaches than those currently in use. There are significant economic and political barriers to adequate pain measurement that are as important as our current technical problems. The low priority that pain has in hospitals and the lack of education about pain in medical and nursing schools combine with highly prevalent myths about pain to prevent adequate assessment and management of pain. Children in hospitals deserve adequate pain control and the implementation of pain measurement is a critical step in this process.