Aching, stabbing, dull, sharp – pain is difficult to describe, impossible to see, and is frequently treated with opium derivatives that go back to Middle Ages. Pediatric pain has long been under recognized and under treated. In fact, as many as 40% of children and adolescents complain of pain that occurs at least once weekly.
One important barrier that leads to under-treatment of pain is inadequate measurement and assessment of pain. Numerical and face-based scales (e.g. Wong Baker Faces Pain Scale, Faces Pain Scale Revised) are most commonly used to assess pain in children. These scales require a certain level of expressive capacity that younger children may not have, and give no information regarding the character of pain that the child is experiencing. In addition, children may have a number of barriers that prevent accurate communication of their pain, ranging from cognitive impairments to developmental differences that make these scales inadequate for the task at hand. By utilizing other modalities of receptive and expressive communication, Tangible Pain Assessment Tools overcome the limitations of traditional self-report measures of pain and gives children the ability to accurately and comprehensively communicate their experience of pain.
Tangible Pain Assessment Tools can be used for the quantitative and qualitative assessment of pain. The first tool is the Continuous (quantitative) Assessment Scale that helps describe the intensity of the pain. This scale is inspired by the Goldilocks principle, named by analogy to the children’s story, Goldilocks and the Three Bears. Goldilocks tastes three different bowls of porridge, and she finds that she prefers porridge which is neither too hot nor too cold, but has just the right temperature. Since the children’s story is well known across cultures, the concept of “just the right amount” is easily understood. The scale consists of three objects varying in size and roundness that describe the intensity of pain from low, medium to high. Instead of providing children with 10 response options that can be difficult to understand, they are provided with 3 response options which allows them to make their choice more decisively and efficiently. This is especially true with 3 to 4 year olds, according to research conducted by Dr. Carl Von Baeyer.
The second tool is the Categorical (qualitative) Assessment Tool which helps identify the character of pain (such as sharp or dull pain, soreness, stabbing, or throbbing pain) that clinicians rely on to make accurate diagnoses when children are unwell. These objects are tactile and offer a range of expressive possibilities, allowing young children to communicate qualitative information that they typically are unable to communicate due to limitations in their linguistic capacity.
Tangible Pain Assessment Tools
Continuous Assessment Scale
Categorical Assessment ToolsSharp Pain - All over the body vs at a specific point
Prototypes and TestingDr.Tsze interacting with some process models
User Testing10 year old Gabby pointing where she felt dull pain
When I was planning my senior thesis, I became fascinated by a study done by University of Michigan Emotion and Self Control Lab that I had read in my psychology class. The study showed how humans communicated physical and emotional pain through the same language. Out of curiosity, I started asking adults and children to draw their experience of pain on a piece of paper. Adults would draw things like a cactus or a spiky ball but younger children struggled to communicate their pain. I realized that to accurately assess pain in children, doctors need the ability to tailor assessment strategies to the child's developmental level. Children are particularly responsive to strategies that involve their imaginations and sense of play. Play relieves feelings of stress, stimulates creative thinking and exploration, and encourages the use of new modalities to communicate their feelings and experiences.
I reached out to a pediatric emergency medicine physician and researcher named Dr. Daniel Tsze at Columbia University Medical Center. Dr. Tsze has done extensive research on the assessment and treatment of pain in children so I approached him with the idea of designing a tactile, non-verbal pain scale. As the project developed, I had weekly meetings with Dr. Tsze and my thesis advisor, Carla Diana, where we would critique and analyze the feasibility of my ideas. It was important to think of the overall applications of this pain scale. How are these tools getting sanitized? Will this scale be accessible to the public? How much will it cost? Will this scale distract the kids from their pain? Will this scale translate well across different cultures and age groups? These were some key questions that helped me drive major design decisions such as materiality, form, and function. I realized that while it is of course necessary to measure the intensity of the pain so that the medical providers know how much medicine to prescribe, just understanding pain intensity on its own was not sufficient. I then decided to also develop another scale that measured the character, or type, of pain in order to enhance doctor-patient communication and improve the quality and accuracy of care that doctors can provide for children.
Once we had final prototypes picked from a pile of tactile models made from things found at a dollar store, I decided to model versions of the objects in SolidWorks and Fusion 360 in order to 3D print them. 3D printers are revolutionizing the medical world and making medical care more accessible. After considering a range of different material options such as ceramics, metals and soft soft fabrics, I chose plant based plastic and medically approved silicone since these materials are cheap, accessible, lightweight and easy to sanitize.
Tangible Pain Assessment Tools is unique as it not only measures the intensity of the pain but also measures the character of the pain. This enhances doctor-patient communication and improves the quality and accuracy of care that doctors can provide for young children. With continued consultation from Dr.Tsze, I will be studying the implementation of these tools with elementary and high school children to understand what qualitative descriptors they attach to each object. Through iteration and prototype testing, we believe we will demonstrate the promise and potential of Tangible Pain Assessment Tools as a real-time, self-report method for accurately assessing both the quality and intensity of pain across a wide spectrum of age in children.