Évaluation de la douleur par les enfants, les parents, les soignants et les médecins lors des ponctions lombaires et myélogrammes : concordances ou discordances ?

In this study, we aimed to compare how children, caregivers and physicians assessed the pain caused by painful procedures (i.e. bone marrow aspiration [BMA] or lumbar puncture [LP]) in our paediatric oncology and haematology unit. Over a period of nine months, in 2009, every child who underwent a LP or a BMA self-reported their pain (Visual Analogue Scale [VAS] if they were older than five years) or had a hetero-assessment of their pain if they were younger than five year (Face-legs-arms-cry-consolability [FLACC]). Parents, caregivers and physicians rated the pain with VAS. Two hundred and ten procedures (159 LP and 51 BMA) were carried out and assessed in 51 patients. We noticed that parents under-estimated the pain when using the FLACC scale and had a good assessment of it with the VAS. Caregivers and physicians under-estimated the pain of their patient and moreover, under-estimated it more when the VAS was higher. We found mixed results in the literature: some papers did show a certain consistency in the assessment of pain by children vs parents or children vs caregivers, others did not. It is difficult to compare the studies because of the different scales used and of the different causes of pain. We can conclude that only self-assessment by the child himself or hetero-assessment according to the child's behaviour is reliable and that assessment by an adult (parent, caregiver or physician) only gives a partial idea of the child's feeling, even less representative when the pain is higher, which brings a real challenge for the management of pain.