Table 1.

Pain assessment scales.

Ages	Scales	Description/indicators	Websites and references	Validity
Preterm to full-term infants	Premature Infant Pain Profile (PIPP)	Gestational age, behavioral state before painful stimulus, change in heart rate during stimulus, change in oxygen saturation, brow bulge, eye squeeze nasolabial furrow	http://www.cebp.nl/vault_public/filesystem/?ID=1467	Stevens et al., [14, 86]
Preterm to full-term infants	Neonatal Facial Coding System (NFCS)	Brow bulge, eye squeeze, nasolabial furrow, open lips, stretched mouth (horizontal or vertical), lip purse, tout tongue, and chin quiver	http://www.cebp.nl/vault_public/filesystem/?ID=1425	Grunau et al., [18]
Preterm to full-term infants	Neonatal Infant Pain scale (NIPS)	Face, cry, breathing pattern, arms, legs, and state of arousal	http://www.cebp.nl/vault_public/filesystem/?ID=1426	Lawrence et al., [20]
32–60 weeks	Crying Requires Increased vital signs Expression Sleeplessness (CRIES)	Crying, increased oxygen requirements, expression, vitals signs, sleeping	http://www.cebp.nl/vault_public/filesystem/?ID=1295	Krechel and Bildner, [15]
Infants	Maximally discriminate facial movement coding system (MAX)	Brow, eye, and mouth movement	Izard C. Maximally Discriminate Facial Coding System,1983	Izard [23]
1–7 years	Chidren's Hospital of Eastern Ontario Pain Scale (CHEOPS)	Cry, facial, child verbal, torso, touch, legs	http://www.cebp.nl/vault_public/filesystem/?ID=1274.	McGrath et al., [28]
Infancy to 7 years	The Faces Legs Activity Cry Consolability Scale (FLACC)	Face, legs, activity, cry, and consolability	http://www2.massgeneral.org/painrelief/pcs_pain_files/app_d_flacc.pdf.	Merkel et al., [29]
1–4 years	Observational Pain Scale	Facial expression, cry, breathing, torso, arms and fingers, legs and toes, and states of arousal	https://www.cebp.nl/vault_public/filesystem/?ID=1451.	Boelen-Ven der Loo et al., [38]
1–5 years	Toddler-Preschooler Postoperative Pain Scale (TPPPS)	Vocal pain expression, facial pain expression, bodily pain expression	http://www.cebp.nl/vault_public/filesystem/?ID=1490.	Tarbell et al., [40]
1–6 years	Child Facial Coding System (CFCS)	Facial actions: brow lower, squint, eye squeeze, blink, flared nostril, nose wrinkle, nasolabial furrow, cheek raiser, open lips, upper lip raise, lip corner puller, vertical mouth stretch, and horizontal mouth stretch.	Manual: Pediatric Pain-Science Helping Children, IWK Grace Health Centre, Dalhousie University & the University of British Columbia C.T. (copyright 1996)	Gilbert et al., [47]
3–7 years	COMFORT Scale	Calmness/agitation, respiratory response, physical movement, blood pressure, heart rate, muscle tone, and facial tension	http://painconsortium.nih.gov/pain_scales/COMFORT_Scale.pdf	Ambuel 1990 [31]
≥3 years	Faces Pain Scale	Pain intensity Faces correspond to pain intensity	http://painconsortium.nih.gov/pain_scles/index.html, http://www.usask.ca/childpain/fpsr/	Wong and Baker, [51], Hicks et al., [45]
3–13 years	The Observational Scale of behavioral Distress (OSBD)	Eleven behaviors related to pain and/or anxiety		Elliot 1987 [34], Tucker et al., [35]
4–13 years	Poker Chip Tool	Pain intensity Poker chips represent “pieces of pain”	http://www.painresearch.utah.edu/cancerpain/attachb7.html	Hester et al., [49]
≥5 years	Oucher Scale	Pain intensityFaces correspond to pain intensity	http://www.oucher.org/the_scales.html	Beyer et al., [56]
7 years	Visual Analogue Scale (VAS)	Pain intensity (numeric, color)	http://www.cebp.nl/vault_public/filesystem/?ID=1478.
8–17 years	Pediatric Pain Questionnaire	Information seeking, problem solving, seeking social support, positive self-statements, behavioral distraction, cognitive distraction, externalizing, internalizing/	http://www.seattlechildrens.org/pdf/pediatric_pain_questionnaire.pdf	Varni et al., [58]
8–17 years	Adolescent Pediatric Pain Tool (APPT)	Intensity, location, and quality of pain		Savedra et al., [59]
≥12 years	McGill Pain Questionnaire	Sensory and affective pain experience	http://www.cebp.nl/vault_public/filesystem/?ID=1400	Melzack, [68]