Validity and Reliability of the Verbal Numerical Rating Scale for Children Aged 4 to 17 Years With Acute Pain.

STUDY OBJECTIVE: The Verbal Numerical Rating Scale is the most commonly used self-report measure of pain intensity. It is unclear how the validity and reliability of the scale scores vary across children's ages. We aimed to determine the validity and reliability of the scale for children presenting to the emergency department across a comprehensive spectrum of age. METHODS: This was a cross-sectional study of children aged 4 to 17 years. Children self-reported their pain intensity, using the Verbal Numerical Rating Scale and Faces Pain Scale-Revised at 2 serial assessments. We evaluated convergent validity (strong validity defined as correlation coefficient ≥0.60), agreement (difference between concurrent Verbal Numerical Rating Scale and Faces Pain Scale-Revised scores), known-groups validity (difference in score between children with painful versus nonpainful conditions), responsivity (decrease in score after analgesic administration), and reliability (test-retest at 2 serial assessments) in the total sample and subgroups based on age. RESULTS: We enrolled 760 children; 27 did not understand the Verbal Numerical Rating Scale and were removed. Of the remainder, Pearson correlations were strong to very strong (0.62 to 0.96) in all years of age except 4 and 5 years, and agreement was strong for children aged 8 and older. Known-groups validity and responsivity were strong in all years of age. Reliability was strong in all age subgroups, including each year of age from 4 to 7 years. CONCLUSION: Convergent validity, known-groups validity, responsivity, and reliability of the Verbal Numerical Rating Scale were strong for children aged 6 to 17 years. Convergent validity was not strong for children aged 4 and 5 years. Our findings support the use of the Verbal Numerical Rating Scale for most children aged 6 years and older, but not for those aged 4 and 5 years.

Defining No Pain, Mild, Moderate, and Severe Pain Based on the Faces Pain Scale-Revised and Color Analog Scale in Children With Acute Pain.

OBJECTIVES: The aims of this study were to define the Faces Pain Scale-Revised (FPS-R) and Color Analog Scale (CAS) scores associated with no pain, mild pain, moderate pain, and severe pain in children with acute pain, and to identify differences based on age, sex, and ethnicity. METHODS: We conducted a prospective observational study in 2 pediatric emergency departments of children aged 4 to 17 years with painful and nonpainful conditions. We assessed their pain intensity using the FPS-R, CAS, and qualitative measures. Pain score cut points that best differentiated adjacent categories of pain were identified using a receiver operating characteristic-based method. Cut points were compared within subgroups based on age, sex, and ethnicity. RESULTS: We enrolled 620 patients, of whom 314 had painful conditions. The mean age was 9.2 years; 315 (50.8%) were in the younger age group (aged 4-7 years); 291 (46.8%) were female; and 341 (55%) were Hispanic. The scores best representing categories of pain for the FPS-R were as follows: no pain, 0 and 2; mild pain, 4; moderate pain, 6; and severe pain, 8 and 10. For the CAS, these were 0 to 1, 1.25 to 2.75, 3 to 5.75, and 6 to 10, respectively. Children with no pain frequently reported nonzero pain scores. There was considerable overlap of scores associated with mild and moderate pain. There were no clinically meaningful differences of scores representing each category of pain based on age, ethnicity, and race. CONCLUSIONS: We defined pain scores for the FPS-R and CAS associated with categories of pain intensity in children with acute pain that are generalizable across subgroups based on patient characteristics. There were minor but potentially important differences in pain scores used to delineate categories of pain intensity compared to prior convention.

Children's Forgetting of Pain-Related Memories.

OBJECTIVE: Given that forgetting negative experiences can help children cope with these experiences, we examined their ability to forget negative aspects of painful events. METHODS: 86 children aged 7-15 years participated in a retrieval-induced forgetting task whereby they repeatedly retrieved positive details of a physically painful experience, and an experimental pain task (cold-pressor task). RESULTS: Repeatedly retrieving positive details of a prior pain experience produced forgetting of the negative aspects of that experience. Pain-related self-efficacy predicted retrieval-induced forgetting; children with a poorer belief in their ability to cope with pain experienced less forgetting. Children who had a more difficult time forgetting prior negative experiences were more anxious about the pain task and reported higher pain thresholds. CONCLUSIONS: Understanding children's memory for painful experiences may help improve their pain management and coping ability.

A smartphone version of the Faces Pain Scale-Revised and the Color Analog Scale for postoperative pain assessment in children.

BACKGROUND: Effective pain assessment is essential during postoperative recovery. Extensive validation data are published supporting the Faces Pain Scale-Revised (FPS-R) and the Color Analog Scale (CAS) in children. Panda is a smartphone-based application containing electronic versions of these scales. OBJECTIVES: To evaluate agreement between Panda and original paper/plastic versions of the FPS-R and CAS and to determine children's preference for either Panda or original versions of these scales. METHODS: ASA I-III children, 4-18 years, undergoing surgery were assessed using both Panda and original versions of either the FPS-R or CAS. Pain assessments were conducted within 10 min of waking from anesthesia and 30 min later. RESULTS: Sixty-two participants, median (range) age 7.5 (4-12) years, participated in the FPS-R trial; Panda scores correlated strongly with the original scores at both time points (Pearson's r > 0.93) with limits of agreement within clinical significance (80% CI). Sixty-six participants, age 13 (5-18) years, participated in the CAS trial. Panda scores correlated strongly with the original scores at both time points (Pearson's r > 0.87); mean pain scores were higher (up to +0.47 out of 10) with Panda than with the original tool, representing a small systematic bias, but limits of agreement were within clinical significance. Most participants who expressed a preference preferred Panda over the original tool (81% of FPS-R, 76% of CAS participants). CONCLUSION: The Panda smartphone application can be used in lieu of the original FPS-R and CAS for assessment of pain in children. Children's preference for Panda may translate to improved cooperation with self-report of pain.

Psychological interventions for headache in children and adolescents.

Headache in children and adolescents represents a number of complex and multifaceted pain syndromes that can benefit from psychological intervention. There is good evidence for the efficacy of cognitive behavioral therapy, relaxation training, and biofeedback. The choice of intervention is influenced by patients' age, sex, family and cultural background, as well as the nature of stressors and comorbid psychiatric symptoms. Management must always be family-centered. Psychological treatments are essential elements of the multidisciplinary, biopsychosocial management of primary headache disorders, particularly for those with frequent or chronic headache, a high level of headache-related disability, medication overuse, or comorbid psychiatric symptoms. Future studies of efficacy and effectiveness of psychological treatment should use the International Headache Society's definition and classification of headache disorders, and stratify results by headache type, associated conditions, and treatment modality.

The cold pressor task: is it an ethically acceptable pain research method in children?

OBJECTIVES: The cold pressor task (CPT) is an experimental method of inducing pain. Ethical concerns have been raised regarding the nontherapeutic induction of pain in children. The objectives of this study were to describe the ethical challenges and acceptability of the CPT from the perspective of researchers, children and parents. METHODS: Study 1:16 researchers completed a survey regarding their experiences obtaining ethical approval and use of the CPT in pediatric research. Study 2: 175 children and 194 parents answered questions about their experiences participating in studies that used the CPT. RESULTS: Full ethics board review was generally required. Adverse events were rare and transient. The majority of researchers, children, and parents reported positive experiences with the CPT. CONCLUSIONS: The CPT is judged by researchers, children, and parents to be an acceptable research method. The CPT can be used ethically in pediatric research with appropriate study safeguards.

Electronic and paper versions of a faces pain intensity scale: concordance and preference in hospitalized children.

BACKGROUND: Assessment of pain in children is an important aspect of pain management and can be performed by observational methods or by self-assessment. The Faces Pain Scale-Revised (FPS-R) is a self-report tool which has strong positive correlations with other well established self-report pain intensity measures. It has been recommended for measuring pain intensity in school-aged children (4 years and older). The objective of this study is to compare the concordance and the preference for two versions, electronic and paper, of the FPS-R, and to determine whether an electronic version of the FPS-R can be used by children aged 4 and older. METHODS: The study is an observational, multicenter, randomized, cross-over, controlled, open trial. Medical and surgical patients in two pediatric hospitals (N=202, age 4-12 years, mean age 8.3 years, 58% male) provided self-reports of their present pain using the FPS-R on a personal digital assistant (PDA) and on a paper version. Paper and electronic versions of the FPS-R were administered by a nurse in a randomized order: half the patients were given the PDA version first and the other half the paper version first. The time between the administrations was planned to be less than 30 minutes but not simultaneous. Two hundred and thirty-seven patients were enrolled; 35 were excluded from analysis because of misunderstanding of instructions or abnormal time between the two assessments. RESULTS: Final population for analysis comprised 202 children. The overall weighted Kappa was 0.846 (95%CI: 0.795; 0.896) and the Spearman correlation between scores on the two versions was rs=0.911 (p<0.0001). The mean difference of pain scores was less than 0.1 out of 10, which was neither statistically nor clinically significant; 83.2% of children chose the same face on both versions of the FPS-R. Preference was not modified by order, sex, age, hospitalization unit (medical or surgical units), or previous analgesics. The PDA was preferred by 87.4% of the children who expressed a preference. CONCLUSION: The electronic version of the FPS-R can be recommended for use with children aged 4 to 12, either in clinical trials or in hospitals to monitor pain intensity.

An integration of vibration and cold relieves venipuncture pain in a pediatric emergency department.

OBJECTIVE: A randomized controlled trial compared a reusable device combining cold and vibration to standard care for pediatric venous access pain relief. METHODS: Pediatric emergency department patients received either the cold vibration device placed 5 to 10 cm proximally throughout venipuncture or standard care control (primarily vapocoolant spray). Block randomization of patients with or without lidocaine cream already in place ensured equal allocation in both intervention groups. Pain was measured via self- and parent-report using the 0- to 10-point Faces Pain Scale-Revised and with coded videotaped observed behaviors. Venipuncture success, use of distraction, and access times were also assessed. RESULTS: Eighty-one 4- to 18-year-olds were randomized to the device (n = 41) or standard care (n = 40) (median age, 10.09 years; 95% confidence interval [95% CI], 8.91-10.89). Median patient-reported pain scores with the device were lower than with standard care (-2; 95% CI, -4 to 0), as were parent-assessed pain scores (-2; 95% CI, -4 to -2). Observed distress behaviors were more common with standard care (2; 95% CI, 1-3) than with the device (1; 95% CI, 0-2). Venipuncture success was more likely with the device (odds ratio, 3.05; 95% CI, 1.03-9.02). There were no device refusals. CONCLUSIONS: The combination of cold and vibration decreased venipuncture pain significantly more than standard care without compromising procedural success. A device incorporating these elements could overcome the common barriers to needle procedure pain control.

Ability of 3- to 5-year-old children to use simplified self-report measures of pain intensity.

Little is known about self-report pain intensity scales best suited for young children. We tested the ability of preschool children to use two simplified scales (concrete ordinal and faces). Three- to 5-year-olds (n = 123) were asked to make binary discriminations ('less' vs 'more' pain) between response options using the Simplified Faces Pain Scale and Simplified Concrete Ordinal Scale and to complete a seriation task. Eighty participants were also asked to use the Simplified Concrete Ordinal Scale, with modified verbal anchors, to rate the loudness of tones and to assess practice effects. Binary discrimination accuracy and seriation ability improved with age. When using the Simplified Concrete Ordinal Scale to rate the loudness of tones, even the 3-year-olds performed significantly better than chance, and performance was better in 4- and 5-year-olds. Little evidence supported the ability of 3-year-olds to use either of the simplified tools in the pain context. The 4-year-olds demonstrated greater accuracy in using the Simplified Concrete Ordinal Scale than the Simplified Faces Pain Scale, suggesting that the Simplified Concrete Ordinal Scale may be more appropriate for this age group.

Postoperative self-report of pain in children: interscale agreement, response to analgesic, and preference for a faces scale and a visual analogue scale.

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

Children's self-report of pain intensity: what we know, where we are headed.

The present paper provides a short, practical introduction to children's self-report measures of pain intensity, followed by an overview of principles and issues. Details on individual self-report scales were previously reported in a landmark systematic review in 2006 and will not be repeated here. Broader measurement issues discussed here include interpretation of pain scores over time, across individuals and in relation to contextual factors; special considerations affecting children younger than six years of age; social communicative functions of pain reports; cognitive developmental factors in understanding pain scales and their anchors; screening for the ability to use self-report scales and training for children who do not have this skill; level of measurement (interval versus ordinal); estimating clinically significant change for groups and individuals; and measurement of aspects of pain other than intensity. Also highlighted are areas in which there has been progress and a lack of progress since the last time this topic was featured at the International Forum on Pediatric Pain in 1996. The present article closes with an outline of key areas for further research on children's self-report of pain and a brief summary of recommendations for clinicians.

Anxiety influences children's memory for procedural pain.

OBJECTIVE: To examine the effects of temperament and trait anxiety on memory for pain. METHODS: Three dimensions of temperament, as well as trait anxiety, were assessed in 36 children (five to 12 years of age) undergoing dental procedures; after the procedure, the children provided pain ratings. Following a six- to eight-week delay, the children reported how much pain they remembered. RESULTS: Most children (85%) accurately recalled their pain. Temperament had no significant effect, but trait-anxious children showed a greater likelihood of recalling more pain than they initially reported, suggesting that they may negatively distort recollections of painful experiences. CONCLUSIONS: When treating children, in particular trait-anxious children, clinicians should consider what children remember as part of pain management intervention.

Changes in Pain Score Associated With Clinically Meaningful Outcomes in Children With Acute Pain.

BACKGROUND: Identifying changes in pain score associated with clinically meaningful outcomes is necessary when using self-report measures to assess pain in children. We aimed to determine the changes in pain score associated with a minimum clinically significant difference (MCSD), ideal clinically significant difference (ICSD), and patient-perceived adequate analgesia (PPAA) and to evaluate for differences based on initial pain intensity and patient characteristics. METHODS: This was a cross-sectional study of children 6 to 17 and 4 to 17 years old who were assessed using the Verbal Numerical Rating Scale (VNRS) and Faces Pain Scale-Revised (FPS-R), respectively. Children qualitatively described any endorsed change in pain score; those who received an analgesic were asked if they wanted additional analgesics to decrease their pain intensity. We used a receiver operating characteristic curve-based methodology to identify changes in pain score associated with "a little less" and "much less" pain (MCSD and ICSD, respectively) and patients declining additional analgesics because of adequate analgesia (PPAA). RESULTS: We enrolled 431 children with painful conditions. For the VNRS, raw change and percent reductions in pain scores associated with MCSD, ICSD, and PPAA were 2/10 and 20%, 3/10 and 44%, and 2/10 and 29%, respectively, and for the FPS-R, 2/10 and 33%, 4/10 and 60%, and 4/10 and 40%, respectively. Raw change in pain scores increased with increasing initial pain intensity, but percent reductions remained stable. There were no significant differences based on patient characteristics such as age, sex, and race/ethnicity. CONCLUSION: Our findings provide patient-centered outcomes in children that are suitable for designing trials and are generalizable across patient characteristics.

Pain in Child Health from 2002 to 2015: The early years of an international research training initiative.

Background: The 2018 Global Year for Excellence in Pain Education, an initiative of the International Association for the Study of Pain, brought worldwide attention to the need for education that crosses narrow disciplinary boundaries, addresses up-to-date research methods and findings, and encourages teamwork among trainees and mentors at different levels of training and with different perspectives. Aims: This commentary describes the development of Pain in Child Health (PICH), an interdisciplinary training program for researchers in pediatric pain at the undergraduate, graduate, and postdoctoral levels of training. Methods: Based on documentation of the structure, training processes, leadership, and membership of PICH, we outline its organization and its challenges and accomplishments over the first 12 years of its growth into a well-known international program. Results and Conclusions: Pain in Child Health began as a Strategic Training Initiative of the Canadian Institutes of Health Research in 2002 and developed into an international research training consortium featuring cross-site and cross-discipline mentorship and collaboration. PICH trainees and alumni have contributed extensively to the current scientific literature on children's pain. PICH could serve as a possible model for training and mentorship in other specialized health research domains within and outside thestudy of pain.

Contexte: En 2018, l'Année internationale pour l'excellence en éducation sur la douleur, une initiative de l'Association internationale pour l'étude de la douleur, a attiré l'attention partout dans le monde sur l'importance d'une éducation qui transcende les frontières étroites entre les disciplines, qui aborde les méthodes et les résultats de la recherche les plus actuels et qui encourage le travail d'équipe parmi les apprenants et les mentors à différents niveaux de formation et à partir de différentes perspectives.But: Ce commentaire décrit l'évolution de Pain in Child Heath (PICH), un programme de formation interdisciplinaire destiné aux chercheurs en douleur pédiatrique à tous les niveaux de formation : premier cycle, cycles supérieurs et postdoctoral.Méthodes: À partir de la documentation portant sur la structure, les processus de formation, le leadership et les caractéristiques des membres du PICH, nous décrivons son organisation, ses difficultés et ses accomplissements au cours de ses premiers douze ans, jusqu'à ce qu'il devienne un programme international de renom.Résultats et conclusions: À ses débuts, Pain in Child Health était une initiative de formation stratégique des Instituts de recherche en santé du Canada en 2002. Il s'est par la suite transformé en consortium international de formation à la recherche axé sur le mentorat et la collaboration entre différents sites et différentes disciplines. Les étudiants et les anciens du PICH ont largement contribué à la littérature scientifique sur la douleur pédiatrique. Le PICH pourrait possiblement servir de modèle en matière de formation et de mentorat dans d'autres domaines de recherche spécialisée en santé, que ce soit dans le contexte de l'étude de la douleur ou dans un autre contexte.

Boo-boos as the building blocks of pain expression: An observational examination of parental responses to everyday pain in toddlers.

BACKGROUND: Everyday pain experiences (minor bumps/scrapes) are common in early childhood and create frequent opportunities for socialization of pain behaviors. Nevertheless, everyday pain during the formative toddler period has been largely overlooked. AIMS: The aim of the current study was to describe the frequency and nature of toddlers' everyday pain experiences, child and parent responses, and the relationship between child characteristics (age, sex, temperament) and responses. METHODS: Fifty-two children aged 12-32 months and their parents were observed at an indoor play facility. Using an observational checklist, trained observers recorded children's everyday pain incidents and associated child and parent responses. RESULTS: Overall, 101 pain incidents were observed, the majority of which evoked low levels of pain and distress, which resolved after 1 min. Pain incidents occurred at a rate of 1.02 incidents/child/hour, with 81% of children experiencing at least one incident, which is higher than previous research with preschoolers and daycare staff. Common parent responses included a range of verbal (reassurance) and nonverbal (staying closer, hugging/kissing child) behaviors. Boys were more likely to not exhibit any protective behaviors. Parents were more likely to pick up older toddlers. CONCLUSIONS: Future research should examine the link between self-reported and observed parent responses to child pain in everyday and clinical contexts.

Contexte: Les expériences douloureuses quotidiennes (bosses et éraflures mineures), courantes chez les jeunes enfants, créent des occasions fréquentes de socialisation des comportements liés à la douleur. Néanmoins, la douleur de tous les jours pendant la période formative des tout-petits a été largement néligée.Buts: Le but de cette étude était de décrire la fréquence et la nature des expériences douloureuses de tous les jours chez les tout-petits, les réponses des enfants et des parents à ces expériences, ainsi que le lien entre les caractéristiques de l'enfant (âge, sexe, tempérament) et ces réponses.Méthodes: Cinquante-deux enfants âgés de 12 à 32 mois et leurs parents ont été observés dans un espace de jeu intérieur. À l'aide d'une grille d'observation, des observateurs dûment formés ont noté les incidents douloureux de tous les jours vécus par les enfants ainsi que les réponses des enfants et des parents à ces incidents.Résultats: Dans l'ensemble, 101 incidents douloureux ont été observés, dont la majorité a suscité des niveaux de douleur et de détresse faibles, résolus après une minute. Les incidents douloureux sont survenus à un rythme de 1,02 incident/enfant/heure et 81 % des enfants ont vécu au moins un incident, ce qui est plus élevé que les études antérieures portant sur des enfants d'âge préscolaire et le personnel de services de garde. Les réponses les plus courantes des parents comprenaient toute une gamme de comportements verbaux (rassurer) et non-verbaux (rester plus proche, étreindre ou embrasser l'enfant). Les garçons étaient plus suceptibles de ne pas démontrer de comportements de protection. Les parents étaient plus susceptibles de prendre les tout-petits plus âgés dans leurs bras.Conclusions: D'autres études devraient se pencher sur le lien entre les réponses auto-déclarées et les réponses observées des parents à la douleur de tous les jours chez les enfants ainsi qu'à la douleur dans un contaxte clinique.

Effects of preparatory information and distraction on children's cold-pressor pain outcomes: a randomized controlled trial.

This experimental study investigated whether preparatory sensory information was more effective in managing children's pain when coupled with a distraction technique. Seventy-eight children aged 7-12 years were randomly allocated to 1 of 4 experimental conditions. They were given either a detailed sensory description of an imminent painful event (cold-pressor arm immersion in 10 degrees C water) or control instructions lacking sensory information. During the cold-pressor task, half the sample received an imagery-based distraction intervention. Pain measures included immersion tolerance, self-reported pain intensity, and facial pain responses. Self-reported coping style was assessed using the Pain Coping Questionnaire [Reid, G. J., Gilbert, C. A., & McGrath, P. J. (1998). The pain coping questionnaire: Preliminary validation. Pain, 76, 83-96]. The effects of information provision interacted with distraction for pain intensity but not pain tolerance. Children given sensory preparation reported less intense pain when this was coupled with distraction than when it was not. Children with a distraction-based coping style showed greater tolerance when assigned to a condition congruent with their coping style. These findings suggest ways to better prepare children for painful medical procedures.

Understanding and managing children's recurrent pain in primary care: A biopsychosocial perspective.

Recurrent pains in childhood are those that occur at least three times within three months and interfere with daily activities. The most common reasons for pain are headaches and abdominal pain, and the great majority of these have no serious or treatable physical cause. Instead, a functional analysis of the antecedents and consequences of the pain for the child is needed. This requires time, trust, rapport and acceptance, as well as the development of a shared biopsychosocial understanding of the pain. Some interview questions are suggested for this purpose. These include questions about the physical and social triggers of pain episodes, such as stress at school or at home, and modelling of pain behaviour by family members. Also included are questions about the adverse consequences of pain, such as sleep problems, difficulty in concentration, avoidance of responsibility and of feared situations, and inadvertent reinforcement of pain behaviour by solicitous behaviour on the part of parents. Among the numerous interventions for recurrent pain, those that promote learning of relaxation skills are the best established. A cognitive-behavioural, biopsychosocial approach to treating recurrent pain is well supported by research evidence. Primary care physicians and paediatric consultants can help to prevent and relieve children's recurrent pain.

Optimizing Numeric Pain Rating Scale administration for children: The effects of verbal anchor phrases.

Background: The 0-10 Verbal Numeric Rating Scale (VNRS) is commonly used to obtain self-reports of pain intensity in school-age children, but there is no standard verbal descriptor to define the most severe pain. Aims: The aim of this study was to determine how verbal anchor phrases defining 10/10 on the VNRS are associated with children's reports of pain. Methods and Results: Study 1. Children (N = 131, age 6-11) rated hypothetical pain vignettes using six anchor phrases; scores were compared with criterion ratings. Though expected effects of age and vignette were found, no effects were found for variations in anchors. Study 2. Pediatric nurses (N = 102) were asked how they would instruct a child to use the VNRS. Common themes of "the worst hurt you could ever imagine" and "the worst hurt you have ever had" to define 10/10 were identified. Study 3. Children's hospital patients (N = 27, age 8-14) rated pain from a routine injection using four versions of the VNRS. Differences in ratings ranging from one to seven points on the scale occurred in the scores of 70% of children when the top anchor phrase was changed. Common themes in children's descriptions of 10/10 pain intensity were "hurts really bad" and "hurts very much." Discussion: This research supports attention to the details of instructions that health care professionals use when administering the VNRS. Use of the anchor phrase "the worst hurt you could ever imagine" is recommended for English-speaking, school-age children. Details of administration of the VNRS should be standardized and documented in research reports and in clinical use.

Contexte: L'échelle numérique verbale (ENV) de 0 à 10 est fréquemment utilisée pour l'auto-évaluation de l'intensité de la douleur chez les enfants d'âge scolaire, mais il n'existe pas de descripteur verbal pour définir la douleur la plus aiguë.But: Déterminer de quelle manière les énoncés définissant 10/10 sur l'ENV sont associés à la douleur rapportée par les enfants.Méthodes et résultats: Étude 1. Des enfants (N = 131, âgés de 6 à 11 ans) ont évalué des vignettes représentant une douleur hypothétique à l'aide de six énoncés; les scores obtenus ont été comparés aux évaluations de référence. Bien que les effets attendus en ce qui concerne l'âge et la vignette aient été observés, aucun effet n'a été observé pour les variations dans les énoncés. Étude 2. On a demandé à des infirmières pédiatriques (N = 102) de quelle manière elles enseigneraient à un enfant à utiliser l'ENV. Les thèmes communs de « la pire douleur que tu puisses imaginer ¼ et « la pire douleur que tu aies ressentie ¼ pour définir 10/10 ont été identifiés. Étude 3. Les patients d'un hôpital pour enfants (N = 27, âgés de 8 à 14 ans) ont évalué la douleur d'une injection de routine à l'aide de quatre versions de l'ENV. Des différences dans l'évaluation allant d'un à sept points sur l'échelle sont apparues dans les scores de 70 % des enfants lorsque l'énoncé relatif à la douleur la plus élevée a été modifié. Les thèmes communs dans les descriptions des enfants en ce qui concerne l'intensité de douleur 10/10 étaient « hurts really bad ¼ (fait vraiment mal) and « hurts very much ¼ (fait très mal).Discussion: Cette étude démontre l'importance de porter attention aux détails dans les instructions que les professionnels de la santé utilisent lorsqu'ils ont recours à l'ENV. L'utilisation de l'énoncé « the worst hurt you could ever imagine ¼ (la pire douleur que tu puisses imaginer) est recommandée pour les enfants d'âge scolaire anglophones. Les détails concernant l'utilisation de l'ENV devraient être uniformisés et documentés dans les rapports de recherche ainsi que dans le cadre de leur usage clinique.