Introduction: As pain is both subjective and multidimensional, its assessment is challenging especially in children with cancer. The Adolescent Pediatric Pain Tool is a measure with 3 components: a word graphic rating scale (pain intensity), a body outline diagram (pain location) and a list of pain descriptors (pain quality). Aims: To culturally validate the APPT to european Portuguese and to examine the psychometrics properties of the translated version. Methods: Methodological study conducted in two phases.Phase 1 included the translation and back translation of the tool and its validation by a pannel of experts and the author of the original version. The semantic and cultural validation of the list of descriptors was performed through Q-sort method with 48 portuguese children, equaly distributed by age (8-12yo; 13-17yo), sex and health condition (healthy/cancer). Children were given 67 cards with printed descriptors and were asked to sort them in three groups: words that I know and use to describe pain, words that I know but don't use to describe pain and words that I don?t know. To be included on the final list of pain descriptors, a criterion was set of at least 75% of the children knowing the word. Phase 2 examined the psychometric properties of the APPT. One hundred portuguese cancer children equaly distributed by age (8-12yo; 13-17yo) and sex were included. Children were asked to report their present pain or their last pain episode. Outcome measures: For phase 1, demographic data and percentage of words known, not known and used to describe pain were calculated. For phase 2, demographic data, number of pain sites and surface area, pain intensity and quality scores (total, sensory, evaluative, affective and temporal) were obtained. Psychometric properties were established by calculating the correlation between location, intensity and quality scores (Spearman test) and by testing the differences between age groups and sex (Mann-Whitney U test). Construct validity of the theoretically organized dimensions was assessed using optimal scaling method. Results: In Phase 1, out of the 67 descriptors presented, 9 were unknown to 75% or more children. These decriptors were replaced by semantically equivalent words. These new words, along with a word that was suggested by some children were again submitted to the Q-sort and since they were known by more than 75% of the children, they were included on the final list. Analysis of psychometric properties revealed that the three components of the APPT are positive and significantly correlated to each other (rs= 0,21 to 0,34, p<0.05) as well as quality scores (rs=0,39 to 0,89, p=0,00). Pain location, intensity and quality did not differ by age groups or sex. Factor analysis did not fit the predicted model. Conclusion: The Portuguese (PT) version of the APPT is a validated and reliable tool to assess pain in portuguese children with cancer. Future psychometric studies should employ longitudinal data to evaluate the fitness of a short form of the tool. This multidimensional pain assessment tool is useful in both clinical practice and research, allowing multiple features of the pain experience to be examined. â&mdash; Acknowledgements [PTDC/PSI-PCL/114652/2009]

Pain perception is influenced by age and gender. As children grow, their ability to express and understand the pain experience changes. Illness experience may also play a role in children's choice of words to describe pain. Aim To compare the use of pain descriptors by children and adolescents of different age groups, gender and health condition. Methods As part of a larger study, 67 pain descriptors from Adolescent Pediatric Pain Tool were presented to two groups of children (8-12 years old) and adolescents (13-17 years old): healthy and diagnosed with cancer (n=48). In each group, 24 subjects were included: 6 boys and 6 girls. Following Q-sort procedure, children were asked to recall their pain experiences and allocate each descriptor to one of three categories: a) words that I know and use to describe pain; b) words that I know but don't use to describe pain; c) words that I don't know. For each subject, the percentage of words that were used within the number of words that were known was calculated and used as dependant variable in stepwise regression analysis. Results Cancer subjects use fewer words to describe their pain compared to healthy subjects. Although there were no age and gender related differences in whole group analysis, sub-analysis in the cancer group showed that adolescents (13-17 yo) and girls use more words to describe their pain. Health condition and age group were retained as predictors in regression analysis. Conclusions Illness experience seems to ply a role in the use of words to describe pain. Health professionals should also be aware of age and gender related differences in pain language to avoid underestimating the experience of less communicative groups.

Pain perception is influenced by age and gender. As children grow, their ability to express and understand the pain experience changes. Illness experience may also play a role in children's choice of words to describe pain. Aim To compare the use of pain descriptors by children and adolescents of different age groups, gender and health condition. Methods As part of a larger study, 67 pain descriptors from Adolescent Pediatric Pain Tool were presented to two groups of children (8-12 years old) and adolescents (13-17 years old): healthy and diagnosed with cancer (n=48). In each group, 24 subjects were included at random: 6 boys and 6 girls. Following Q-sort procedure, children were asked to recall their pain experiences and allocate each descriptor to one of three categories: a) words that I know and use to describe pain; b) words that I know but don't use to describe pain; c) words that I don't know. For each subject, the percentage of words that are used within the number of words that are known was calculated and used as dependant variable in stepwise regression analysis. Results Findings show that cancer subjects use fewer words to describe their pain compared to healthy subjects. In whole group analysis no age and gender difference were observerd. In cancer group analysis, older children (13-17yo) and girls use more words to describe their pain. Health condition and age group were retained as predictors in stepwise regression analysis. Conclusions These results offer some direction in the choice of pain assessment tools for cancer children. Health professionals should be aware of age and gender related differences in pain language to avoid underestimating the experience of less communicative groups.

Este estudo objetivou verificar influência de fatores culturais na expressão do sintoma álgico. Foi baseado na avaliação de 57 pacientes com doença oncológica avançada, atendidos no serviço de radioterapia de um hospital geral, público e de ensino que experienciaram dor na semana anterior à entrevista. A duração média do quadro álgico foi 10 meses. A dor foi moderada na maioria dos doentes e intensa em cerca de 1/ 5 deles. Observou-se que concepções culturais errôneas dos doentes acerca da incontrolabilidade da dor no câncer e de que recebiam remédios em demasia, correlacionaram-se à, dor de maior intensidade (p

Pain is a complex phenomenon that arises from the interaction of multiple neuroanatomic and neurochemical systems with several cognitive and affective processes. Nowadays, the assessment of pain intensity still relies on the use of self-reports. However, recent research has shown a connection between the perception of pain and exacerbated stress response in the Autonomic Nervous System. As a result, there has been an increasing analysis of the use of autonomic reactivity with the objective to assess pain. In the present study, the methods include pre-processing, feature extraction, and feature analysis. For the purpose of understanding and characterizing physiological responses of pain, different physiological signals were, simultaneously, recorded while a pain-inducing protocol was performed. The obtained results, for the electrocardiogram (ECG), showed a statistically significant increase in the heart rate, during the painful period compared to non-painful periods. Additionally, heart rate variability features demonstrated a decrease in the Parasympathetic Nervous System influence. The features from the electromyogram (EMG) showed an increase in power and contraction force of the muscle during the pain induction task. Lastly, the electrodermal activity (EDA) showed an adjustment of the sudomotor activity, implying an increase in the Sympathetic Nervous System activity during the experience of pain.

Pain is a complex phenomenon that arises from the interaction of multiple neuroanatomic and neurochemical systems with several cognitive and affective processes. Nowadays, the assessment of pain intensity still relies on the use of self-reports. However, recent research has shown a connection between the perception of pain and exacerbated stress response on the Autonomic Nervous System (ANS). The ANS, which is divided into the Parasympathetic Nervous System (PNS) and the Sympathetic Nervous System (SNS), functions as the subconscious regulator of the body. As a result, there has been increasing analysis of the autonomic reactivity with the objective to assess pain. The goal of this study was to explore and understand different responses in the electrocardiogram (ECG) signal when in the experience of pain. For this study, ECG was simultaneously recorded while a pain-inducing protocol (Cold Pressor Task - CPT) was implemented. Several features were extracted from the ECG to analyse differences related to pain induction tasks. The results obtained showed a statistically significant increase in the heart rate during the painful periods in comparison with non-painful periods. Additionally, heart rate variability features demonstrated a decrease in the PNS influence. These results are a step further in understanding the ECG response during the experience of pain, supporting the awareness and insights over physiological interactions within the pain experience.

The Visual Analogue Scale (VAS), Numerical Rating Scale (NRS), Verbal Rating Scale (VRS), and the Faces Pain Scale-Revised (FPS-R) are among the most commonly used measures of pain intensity in clinical and research settings. Although evidence supports their validity as measures of pain intensity, few studies have compared them with respect to the critical validity criteria of responsivity, and no experiment has directly compared all 4 measures in the same study. The current study compared the relative validity of VAS, NRS, VRS, and FPS-R for detecting differences in painful stimulus intensity and differences between men and women in response to experimentally induced pain. One hundred twenty-seven subjects underwent four 20-second cold pressor trials with temperature order counterbalanced across 1 C, 3 C, 5 C, and 7 C and rated pain intensity using all 4 scales. Results showed statistically significant differences in pain intensity between temperatures for each scale, with lower temperatures resulting in higher pain intensity. The order of responsivity was as follows: NRS, VAS, VRS, and FPS-R. However, there were relatively small differences in the responsivity between scales. A statistically significant sex main effect was also found for the NRS, VRS, and FPS-R. The findings are consistent with previous studies supporting the validity of each scale. The most support emerged for the NRS as being both (1) most responsive and (2) able to detect sex differences in pain intensity. The results also provide support for the validity of the scales for use in Portuguese samples.

La douleur est une expérience personnelle et subjective influencée par la culture, de la situation, les facteurs attentive, et d'autres variables psychologiques. Approches à la mesure de la douleur sont verbales et numériques des échelles d'auto-évaluation, échelles d'observation du comportement, et les indicateurs physiologiques. Dans cette revue, nous avons décrit et analysé comme des techniques sophistiquées de psychophysique peut être conçu pour mesurer séparément les dimensions sensorielles et cognitives de la douleur. Ces procédures se sont révélées être des mesures valides et fiables de la douleur avec des propriétés d'échelle ratio et ont récemment été utilisés en milieu clinique.