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Tangible Pain Assessment Tools [TPAT]

Tangible Pain Assessment Tools consist of expressive, tactile objects to help overcome a multitude of communication barriers so that children can self-report and describe their pain accurately.

 

Advisor - Carla Diana

Consultation and Guidance - Dr. Daniel Tsze, Columbia University Medical Center. Currently working on analysis and testing. 

Awards + Publications

PROBLEM

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. 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. 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, patients 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. 

Understanding pain starts by first defining the most basic aspect of pain: acute pain versus chronic pain.

RETHINKING PAIN ASSESSMENT 

Each of us experiences our pain differently, making it highly subjective. Moreover, children vary widely in their perception and expression of pain. Therefore 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. Therefore, I was inspired to create a tangible and interactive tool that can be widely used and could allow children to communicate with others and express feelings that current tools are unable to facilitate. The playful and tactile forms empower children to learn how to self-report their pain from a young age.

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. 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.

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CONTINUOUS ASSESSMENT

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.

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CATEGORICAL ASSESSMENT

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.

TESTING AND VALIDATION

PROCESS

I began my research by 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 whereas kids struggled to communicate their pain as they didn’t fully understand the concept of pain. At the same time, the images they drew made me think about how children perceive hurt differently. For example, a 10 year old girl drew a picture of a car because being in pain makes her feel nauseous and she get motion sickness when she is in a car. This inspired me to create a tactile scale that could speak the same language as the children.

To effectively solve this problem, I realized it would be valuable to collaborate with a pain management expert. I reached out to pediatric emergency medicine physician and researcher Dr. Daniel Tsze from Columbia University Medical Center, who has done extensive research on the assessment and treatment of pain in children. With his guidance, I started prototyping different iterations of the objects. I had weekly meetings with Dr. Tsze and my thesis advisor, Carla Diana, where we could go over the form, function and the descriptions one would associate to the objects. 

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 fabrics, I chose plant based plastic and medically approved silicone since these materials are cheap, accessible, lightweight and easy to sanitize.

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REFERENCES

  • https://www.cdc.gov/drugoverdose/data/index.html

  • https://www.cdc.gov/infectioncontrol/guidelines/disinfection/rational-approach.html

  • https://bodyinmind.org/children-reporting-pain/

  • https://www.nih.gov/news-events/news-releases/nih-analysis-shows-americans-are-pain

  • https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3140088/

  • https://academic.oup.com/jpepsy/article/33/9/939/925236

  • http://www.indianjpain.org/article.asp?issn=0970-5333;year=2014;volume=28;issue=2;spage=61;epage=70;aulast=Kumar