Chambers Christine T, Craig Kenneth D
Department of Psychology, University of British Columbia, 2136 West Mall, Vancouver, BC V6T 1Z4, Canada.
Pain. 1998 Oct;78(1):27-37. doi: 10.1016/S0304-3959(98)00112-2.
The numerous pain rating scales using faces depicting varying degrees of distress to elicit reports of pain from children fall into two categories; those with a neutral face as the 'no pain' anchor, and those with a smiling face as the 'no pain' anchor. This study examined the potentially biasing impact of these anchor types on children's self-reports of pain in response to a series of vignettes. Participants were 100 children stratified by age (5-6 years, 7-8 years, 9-12 years) and randomly assigned to one of three groups: (1) neutral scale/sensory instructions; (2) smiling scale/sensory instructions; (3) smiling scale/affective instructions. Children completed a faces scale, a VAS, and emotions ratings in response to four scenarios depicting: (1) no pain/negative emotions; (2) pain/negative emotions; (3) no pain/positive emotions: (4) pain/positive emotions. Results showed that children who used the smiling scale had significantly higher pain scores for no pain and pain/negative emotions vignettes and significantly lower faces scale scores for pain/positive vignettes than children who used the neutral faces scale. Instructions varying in focus on sensory or affective qualities of pain had no effect on children's pain ratings. Group differences in children's ratings with the VAS and emotions measure suggested that rating pain with a smiling faces scale may alter a child's concept of pain. Age differences indicated the younger children rated the negative emotion vignettes as more painful than the older children. These findings suggest that children's pain ratings vary depending on the types of faces scale used, and that faces scales with smiling anchors may confound affective states with pain ratings.
一类以中性面部表情作为“无疼痛”基准，另一类以微笑面部表情作为“无疼痛”基准。本研究考察了这些基准类型对儿童针对一系列情景描述的疼痛自我报告的潜在偏差影响。研究参与者为100名按年龄分层（5 - 6岁、7 - 8岁、9 - 12岁）的儿童，他们被随机分配到三个组之一：（1）中性量表/感觉指导组；（2）微笑量表/感觉指导组；（3）微笑量表/情感指导组。儿童针对描绘以下四种情景的内容完成面部表情量表、视觉模拟评分法（VAS）及情绪评分：（1）无疼痛/负面情绪；（2）疼痛/负面情绪；（3）无疼痛/正面情绪；（4）疼痛/正面情绪。结果显示，与使用中性面部表情量表的儿童相比，使用微笑量表的儿童在无疼痛及疼痛/负面情绪情景描述中的疼痛评分显著更高，而在疼痛/正面情景描述中的面部表情量表得分显著更低。聚焦于疼痛感觉或情感特质的指导对儿童的疼痛评分没有影响。儿童在VAS及情绪测量中的评分存在组间差异，这表明使用微笑面部表情量表来评定疼痛可能会改变儿童对疼痛的概念。年龄差异表明，年幼儿童对负面情绪情景描述的疼痛评分高于年长儿童。这些研究结果表明，儿童的疼痛评分因所使用的面部表情量表类型而异，且以微笑为基准的面部表情量表可能会使情感状态与疼痛评分相互混淆。
