Huskisson, “Measurement of pain in juvenile chronic polyarthritis

SUMMARY Pain can be measured using a visual analogue scale in children with juvenile chronic polyarthritis. In a study of 100 children failures were uncommon after the age of 5. Pain severity was strikingly lower than in a group of adults with rheumatoid arthritis and correlated poorly with other measures of disease severity and activity. Because of the low scores, measurement of pain is likely to be less useful in children for assessing the effects of treatment than it is in adults. Measurement of pain has proved to be particularly useful in assessing the effects of treatment in adults with rheumatoid arthritis. Visual analogue scales have been shown to be a satisfactory method of measurement with the advantage ofgreater sensitivity than the more conventional simple descriptive scale (Huskisson, 1974a; Scott and Huskisson, 1976). In this study the method has been applied to children with arthritis. Methods Pain severity was measured in 100 children with juvenile chronic polyarthritis, either inpatients or outpatients attending the Canadian Red Cross Memorial Hospital. Juvenile chronic polyarthritis was defined as polyarthritis beginning before the 16th birthday, and any patient over the age of 17 at the time of the study was excluded. A visual analogue scale without definitions or divisions was used at the same time as a 4-point simple descriptive scale; these scales were used as described by Huskisson (1974a). At the same time an independent assessment was made of the activity of the disease, based on swelling of joints and erythrocyte sedimentation rate, and severity of the disease, based on the number and severity of joints involved and functional status. Both were graded on a 4-point scale. Results The age distribution of the children is shown in Fig. 1, divided according to whether or not they were able to complete a visual analogue pain scale. 11 % faile