Arthritis & Rheumatism, Volume 60,
October 2009 Abstract Supplement

The 2009 ACR/ARHP Annual Scientific Meeting
Philadelphia October 16-21, 2009.

Ask Me Where It Hurts?- Developing a Standardized Approach to the Assessment of Pain in Children and Youth Presenting to Pediatric Rheumatology Providers

Stinson1,  Jennifer N., Connelly2,  Mark, Chalom3,  Elizabeth J., Chira4,  Peter, Schanberg5,  Laura E., Rapoff2,  Michael A., Walco6,  Gary

The Hospital for Sick Children, Toronto, ON,
University of Kansas Medical Center, Kansas City, KS,
St Barnabas Med Center-ACC, Livingston, NJ,
Stanford SOM, LPCH, Stanford, CA,
Duke University Medical Center, Durham, NC,
Seattle Children's Hospital, Seattle, WA


To develop a Standardized Universal Pain Evaluation by Rheumatology providers for children (SUPER-KIDZ) for use at Childhood Arthritis and Rheumatology Research Alliance (CARRA) sites in North America.


A 2-stage Delphi technique followed by a 2 day consensus conference (to resolve areas of disagreement and finalize items/response options) was conducted to develop consensus among CARRA members and pediatric pain experts regarding variables that should comprise pain assessment in children with rheumatic conditions. Delphi survey respondents rated importance of pain assessment domains from Ped-IMMPACT group for use in pediatric chronic pain trials (McGrath et al., 2008) in two iterative surveys.


Of the 251 CARRA members, 115 (46%) and 157(63%) completed the 1st and 2nd surveys respectively. All Ped-IMMPACT domains except one (economic factors) were retained. In survey 2, poor agreement on two additional domains (lifestyle and family factors) led to their proposed exclusion. Consensus conference discussion yielded general agreement on the following domains and items for both child self-report and parent proxy measures: Pain characteristics (current pain, average pain intensity over past 2 weeks, pain episode duration, pain frequency, pain location), associated symptoms (fatigue frequency), cognitive and emotional factors (catastrophizing, positive affect, sadness, anger, worry, stressors), and functioning (physical, social, and role). Areas agreed to be omitted from the pain assessment included: pain sensory descriptors, pain aggravating/alleviating factors, pain unpleasantness, comfort goal, global pain treatment satisfaction rating, appetite, pain self-efficacy, recent peer group changes or conflicts, and level of independence. During the consensus conference, lack of agreement over the specific questions and metrics to use for quantifying items (except for pain intensity) resulted in the assignment of workgroups to conduct further reviews of existent measures and provide recommendations thereafter.


A standardized approach to assessing pain that is feasible and easy to implement in clinical settings may improve pain outcomes and quality of life in children with rheumatic conditions.


This study was supported by a grant from the MayDay Fund and a meeting grant from the Institute for Musculoskeletal Health in Arthritis, Canadian Institute of Health Research. Dr. Stinson's work was supported by a CIHR Post-Doctoral Research Fellowship and Canadian Child Health Clinician Scientist Career Enhancement Award.

To cite this abstract, please use the following information:
Stinson, Jennifer N., Connelly, Mark, Chalom, Elizabeth J., Chira, Peter, Schanberg, Laura E., Rapoff, Michael A., et al; Ask Me Where It Hurts?- Developing a Standardized Approach to the Assessment of Pain in Children and Youth Presenting to Pediatric Rheumatology Providers [abstract]. Arthritis Rheum 2009;60 Suppl 10 :1546
DOI: 10.1002/art.26620

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