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Choosing a faces pain scale



Choosing a pain rating scale for children

Margo McCaffery is a consultant in the nursing care of patients with pain, Los Angeles, Calif.

QUESTION: In my pediatric unit, we currently use the Wong-Baker FACES Pain Rating Scale to assess children's pain. I've heard that a new faces pain scale has been published. Which one's better?

ANSWER: Used correctly, either of these tools can help measure a child's pain intensity, so consider the pros and cons of each before making a choice.

Besides being graded to capture changes in pain intensity, a good pain assessment tool must be easy to understand, easy to score, and liked by both patients and staff. And consistency counts: The patient and caregiver should use the same tool each time to minimize misunderstandings and to track trends accurately.

With these points in mind, let's compare the Wong-Baker FACES Pain Rating Scale with the new Faces Pain Scale-Revised (FPS-R). Keep in mind that both are easy to photocopy.

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Wong-Baker FACES Pain Rating Scale

The Wong-Baker FACES Pain Rating Scale has been widely used to obtain a self-report of pain from children as young as 3 years old. The scale consists of six faces assigned a rating from 0 to 5, with 0 equaling no pain and 5 the most intense pain. Each face is labeled with short verbal descriptions ranging from “no hurt” to “hurts worst.”

Figure. Face

Figure. Face

Although the scale can be renumbered as 0, 2, 4, 6, 8, 10 under the six faces, these numbers may not correlate well with the 0-to-10 numeric scale. For example, a 4 on the faces scale may not equal a 4 on the 0-to-10 numeric scale.



A potential drawback to this scale is that the “no hurt” and the “hurts little bit” faces are smiling, which may cause a child to feel he must choose the “hurts little more” face, if he's experiencing mild pain. Additionally, the “hurts worst” face is tearful. A child may think he can't choose the “hurts worst” face unless he's crying. Emphasize to the patient that he should pick the face that shows how much he hurts, not how his own face looks.

One advantage of the Wong-Baker scale is that it's been translated into several languages.

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Faces Pain Scale-Revised

In a study published last year, Carrie Hicks and her colleagues introduced a different faces scale called theFaces Pain Scale-Revised(FPS-R). Although the FPS-R has six faces, it's numbered 0, 2, 4, 6, 8, 10. A strong positive correlation was found between the FPS-R and the numeric 0-to-10 scale used with adults.

For example, a 2 on this faces scale corresponds to a 2 on the numeric scale. If desired, this faces scale can be numbered 0 to 5.

A recent survey indicated that many practitioners feel that a 0-to-10 scale “makes more sense” as a numeric standard, so they may be more comfortable using it.

An advantage of this scale is that the faces don't depict smiles or tears, which reduces the potential for confusion based on facial expression.

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Bieri, D., et al.: “Support for a Common Metric for Pediatric Pain Intensity Scales,” Pain Research and Management. 5(2):157–160, Summer 2000.
Hicks, C., et al.: “The Faces Pain Scale-Revised: Toward a Common Metric Pediatric Pain Measurement,” Pain. 93(2):173–183, August 2001.
McCaffery, M., and Pasero, C.: Pain: Clinical Manual, 2nd edition. St. Louis, Mo., Mosby, Inc., 1999.
    von Baeyer, C., et al.: “Validation of the Faces Pain Scale-Revised (FPS-R): Pain Intensity in Clinical and Non-clinical Samples. Poster presented to Canadian Pain Society, Montreal, May 2001.
      © 2002 Lippincott Williams & Wilkins, Inc.