TABLE 4

Pain-Assessment Tools for Nonverbal Children With Neurologic Impairment

r-FLACC18
 • Revised from the FLACC to include pain behaviors specific to children with cognitive impairment
 • Like the FLACC, a 5-item pain assessment tool with a score ranging from 0 to 10
 • Allows parents to individualize by adding behaviors specific to their child
 • Option of indicating individualized behaviors can be beneficial for children with atypical pain behaviors and lack of other typical features, which may result in a false low score on other tools
INRS19
 • A personalized pain-assessment tool for nonverbal children with intellectual disability, based on the parent’s knowledge of the child, developed for use in the hospital
 • Parents and caregivers identify behaviors that indicate no pain to the worst possible pain on a scale ranging from 0 to 10
 • Moderate to strong correlation between INRS ratings and NCCPC-PV (see below) total scores
 • Option of indicating individualized behaviors can be beneficial for children with atypical pain behaviors and lack of other typical features, which may result in a false low score on other tools
NCCPC-PV20
 • 27-item pain-assessment tool for children with severe cognitive impairment
 • Moderate to severe pain determined at a cutoff of ≥11 of 81
 • In Breau et al,20 this cutoff provided a sensitivity of 0.88 and specificity of 0.81
 • Available for download for clinical use or use in research funded by not-for-profit agencies at http://pediatric-pain.ca/resources/our-measures/
NCCPC-R21
 • 30-item pain-assessment tool designed for nonverbal children ages 3–18 y with severe cognitive impairment
 • Moderate to severe pain determined at a cutoff of ≥7 of 90
 • In Breau et al,21 this cutoff provided a sensitivity of 0.84 and specificity of 0.77
 • Revised from the NCCPC-PV (postoperative version)
 • Available for download for clinical use or use in research funded by not-for-profit agencies at http://pediatric-pain.ca/resources/our-measures/
PPP10
 • A 20-item pain-assessment tool for children with severe to profound cognitive impairment
 • Scores of ≥14 were generally associated, by observers, with moderate or severe pain
 • A cutoff of 14 provided a sensitivity of 1.0 and specificity of 0.91
 • The tool is arranged to provide different scores to indicate a rating for “on a good day,” “most troublesome pain,” “second-most troublesome pain,” etc
 • Available to download from the Web, after registration at www.ppprofile.org.uk
  • Adapted with permission from Hauer, JM. Caring for Children Who Have Severe Neurologic Impairment: A Life with Grace. Baltimore, MD: Johns Hopkins University Press; 2013:52-53. FLACC, Face, Legs, Activity, Cry, Consolability; INRS, Individualized Numeric Rating Scale; NCCPC-PV, Non-Communicating Children’s Pain Checklist–Postoperative Version; NCCPC-R, Non-Communicating Children’s Pain Checklist–Revised; PPP, Pediatric Pain Profile.