» Measuring the Pain Experience in Children After Surgery
Measuring the Pain Experience in Children After Surgery

Pain is a subjective symptom, meaning you can't see it or take a picture of it. Describing pain becomes something we trust that the person who is telling us about their pain is accurate. Measuring pain in adults is difficult enough. Imagine getting a similar report from children who may not even have the words to describe what they are feeling.

But that's what this report is all about -- a new tool to use when evaluating pain in children and teens. It's called the Child Pain Anxiety Symptoms Scale or CPASS. It is a way to gauge how much pain, anxiety, and pain-anxiety children have and how sensitive they are to anxiety (referred to as anxiety-sensitivity).

According to the authors who wrote this report, anxiety sensitivity is the extent to which anxiety-related symptoms can predict a poor outcome. In other words, the presence of anxiety symptoms such as increased heart rate and feeling nauseated is linked with physical ailments, psychologic disturbances, and the development of chronic (long-lasting) pain.

Assessing children for pain anxiety in the early stages of pain might help us identify who is at risk for poor outcomes related to pain. Then we could potentially do something about it as soon as possible. The CPASS has already been tested and validated in one group of children. This study takes a look at the reliability of the CPASS when used with children after surgery.

All children in the study were between the ages of eight and 18. They were all having some type of orthopedic surgery (e.g., spinal fusion for scoliosis, repair broken bone) or general surgery.

Each child/teen completed the CPASS along with six other standardized tests measuring anxiety, pain, depression, function and disability. The children were tested 48 to 72 hours after surgery and again two weeks later.

They rated statements like "It scares me when I throw up" or "I feel helpless about my pain" on a scale from "not at all" to” a lot". Activities and function ("I can walk to the bathroom by myself" or "I can eat regular meals") were measured on a five-point scale from zero (no trouble with the task) to five (impossible).

They found that after orthopedic or general surgery girls have more general anxiety and anxiety sensitivity than boys. Girls were more likely to experience pain right after surgery as more unpleasant (but not more intense) than boys. Two weeks later (after discharge from the hospital), they scored their pain the same as boys.

Analysis of the test and test scores showed that the CPASS measured responses equally between boys and girls. In other words, the differences reported weren't because of the test but a true measure. The test was able to measure the changes experienced by the children from the early hours after surgery to the two-week post-operative time period.

Overall, the CPASS is a reliable and sensitive measure of how much children misinterpret pain and anxiety symptoms as harmful. It is a good way to predict pain intensity and unpleasantness after surgery. The authors make note that the results of this study are preliminary.

Further research is needed to find a cutoff point in the scoring. Children with a high enough score would be at risk for chronic pain and disability. But what is that 'high enough score' has yet to be determined. And because the CPASS was originally designed for adults and then modified for children, it's possible that there are other dimensions of the pain experience (besides anxiety) that are important but remain unknown at this time.

Reference: M. Gabrielle Pagé, et al. Reliability and Validity of the Child Pain Anxiety Symptom Scale (CPASS) in a Clinical Sample of Children and Adolescents with Acute Postsurgical Pain. In PAIN. September 2011. Vol. 152. No. 9. Pp. 1958-1965.