Specific Pain Measures for Adolescents

Pain is a complex, subjective sensation that is influenced by many factors. Pain intensity has long been measured using the Visual Analogue Scale (50). This gives a subjective measure of the pain intensity according to the adolescent and/or that pain perceived by their carer. This is a 10-cm horizontal line anchored by "no pain" at the far left and "worst pain" at the right hand end. The young person marks where he or she feels the level of their pain is. While these are useful measures prospectively they give no indication of the impact of pain on the young person's life. For example, one adolescent with a pain score of 7 on the visual analogue scale (VAS) may difficult.

Social Life

I don't see friends anymore. I can't keep up and t don't understa

Education

I use to love school but have missed 80% in the last year.

Family

Mum worries about me. She's had to give up work.

Education

I use to love school but have missed 80% in the last year.

Family

Mum worries about me. She's had to give up work.

Sleep

I go to bed at 11 but don't fall asleep until 3. I keep waking up.

Fitness

I used to run track for the school. Now I can't even walk without pain and tiredness.

Sleep

I go to bed at 11 but don't fall asleep until 3. I keep waking up.

Independence I even need my mum to help me go to the toilet. It's not fair - I'm 16.

Fitness

I used to run track for the school. Now I can't even walk without pain and tiredness.

Appetite/eating I feel too sick for breakfast. I just eat junk in the day.

Moods

I get angry and frustrated. I just go my room, I don't want to talk to anyone.

Figure 2 The pain spider.

still get to school where another adolescent with the same score may not be getting out of bed.

Multidimensional Pain Measures

The most frequently used multidimensional pain measure in pediatric rheumatology is the Varni/Thompson Pediatric Pain Questionnaire (51).

Recently, however, the Bath Adolescent Pain Questionnaire has been developed (52). This is a validated multidimensional measure that evaluates the impact of pain on a young person's life. It includes anxiety, disability, mood/ depression, somatomization, and sleep disorder. From this measure it is possible to specifically direct rehabilitation and prospectively monitor progress.

Physiological Measures of Pain

There is very little data on the role of physiological measures in assessing pain in adolescents. The role of thermography in CRPS has been studied (53), really evaluating its use in the early and late stages of this pain condition. Bone scintigraphy has also been looked at, the interest here is that in many adolescents with CRPS there is reduced uptake compared to the increased uptake that is seen in adult CRPS (54). Opinion is divided in the usefulness of both these measures in this condition.

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