I overheard the nurse working with a child in the same room as our son at the hospital. She was asking the little girl if she felt helpless or scared. Doesn’t this kind of questioning put ideas into kids’ heads? What’s the point of asking questions like these?

The nurse may have been evaluating the child’s level of pain and anxiety about that pain. Pain is a subjective symptom, meaning you can’t see it or take a picture of it. Describing pain becomes something we trust that the person who is telling us about their pain is accurate. Measuring pain in adults is difficult enough. Imagine getting a similar report from children who may not even have the words to describe what they are feeling.

There are several tools health care professionals can use when evaluating pain in children and teens. It sounds like the nurse may have been using one called the Child Pain Anxiety Symptoms Scale or CPASS. It is a way to gauge how much pain, anxiety, and pain-anxiety children have and how sensitive they are to anxiety.

The test has several subsections designed to help sort out anxiety, sensitivity to anxiety, depression pain levels, function, and disability. The children do rate statements like “It scares me when I throw up” or “I feel helpless about my pain” on a scale from “not at all” to a lot”.

Activities and function (“I can walk to the bathroom by myself” or “I can eat regular meals”) are measured on a five-point scale from zero (no trouble with the task) to five (impossible).

Assessing children for pain anxiety in the early stages of pain might help us identify who is at risk for poor outcomes related to pain. Then we could potentially do something about it as soon as possible.

Measuring how much children misinterpret pain and anxiety symptoms as harmful is a good way to predict pain intensity and unpleasantness after surgery. Of course, the goal is to alleviate the child’s pain and suffering. Giving them an opportunity to express how they feel may be suggestive but more likely helpful in getting them the treatment they need to keep the pain and anxiety at a minimum.