Preschoolers' Ability to Differentiate Levels of Pain: Relative Efficacy of Three Self-Report Measures

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Abstract
In a sample of 50 nonpatient 3- to 6-year-old preschoolers, a series of hypothetical pain stimuli—Charleston Pediatric Pain Pictures (CPPP)—was used to evaluate the ability to differentiate levels of pain intensity and the reliability of three self-report measures of pain intensity (Pain Thermometer, Faces Scale, Oucher scale). Results indicated poor test-retest reliability for single item ratings but acceptable levels of test-retest reliability for ratings of subscales consisting of clusters of items representing different levels of pain. The three self-report measures appeared to be essentially comparable in their test-retest reliability, which appeared to be greatly enhanced when several pain intensity ratings were combined into a single score. The preschoolers were able to differentiate these basic levels of pain intensity effectively (e.g., no pain from low pain, moderate pain from high pain), using each of the self-report measures. Discussion includes recommendations for the appropriate use of these self-report measures and of hypothetical pain stimuli such as the CPPP with preschool-age children in clinical settings.