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Comparison of two self-report pain intensity scales in children and adolescents with chronic abdominal pain associated with Helicobacter pylori-dyspepsia and Irritable bowel syndrome

Journal of Pediatrics & Neonatal Care
Mary de Assis Carvalho,1 Carine Dias Ferreira de Jesus,2 Debora Avellaneda Penatti,3 Juliana Tedesco Dias,3 Nilton Carlos Machado1

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Purpose: To evaluate pain intensity and the agreement between the Visual Analogue Scale (VAS) and Faces Pain Scale (FAS) in children/adolescents with Chronic Abdominal Pain (CAP) both in Irritable Bowel Syndrome (IBS) and Helicobacter pylori dyspepsia (HpD).

Methods: Single-centre, observational, cross-sectional study including 217 children/ adolescents. Inclusion criteria: age (4-15 years); HpD diagnosis established with endoscopy and histopathological biopsies. IBS diagnosis based on Rome IV criteria. Exclusion criteria: chronic disorders (genetic, metabolic, cardiac, hepatic, renal diseases). In a standardized form, data was achieved, and children marked the “pain over the past month”.

Results: The age of first symptoms, first visits, pain (epigastric, retrosternal, nocturnal pain, burning), vomiting, and anorexia were higher in HpD than in IBS children. The pain intensity was categorized as severe (7-10) for the majority of children both in FAS and VAS scales (p>.0.05). Also, analysis between IBS and HpD concerning sex, first child, age at first visit (≤10 y or >10y), overweight/obese, average BMI child, and the number of episodes of pain during the week (p>0.05). There was a positive and statistically significant correlation between FAS and VAS pain intensity in IBS (All children, male and female) and HpD group (only for All children). On Bland-Altman plots of VAS vs FAS, the 2SD values of differences between scales were: IBS (3.8) and HpD (3.4) group. The calculated limits of agreement (95% CIs) exceeded the a priori limits of acceptability for all measured parameters, indicating that the scales are not interchangeable.

Conclusions: Pain scales were, without difficulty performed, widely accepted and provided evidence that FAS and VAS are valid measures for assessing pain intensity in children with CAP. However, both VAS and FAS did not discriminate IBS from HpD, and the scales are not interchangeable.


abdominal pain, pain measurement, irritable bowel syndrome, Helicobacter pylori, gastritis, dyspepsia, children