Wong-Baker FACES Pain Rating Scale

Instrument Name: Wong-Baker FACES Pain Rating Scale

Abbreviation: Wong-Baker FACES; WBS

Points for Consideration:

The FACES Scale is now used with people aged three and older, not just children; the patient needs to be able to understand the instructions and select a face that illustrates the pain he/she is experiencing; it should never be used with unresponsive patients or to compare the patient's face to the scale to determine the level of paint.

Description of Tool:

The Wong-Baker FACES is a PRO that combines six pictures and numbers, developed originally "with children for children", now the scale is used with children and adults to communicate about their pain. It is explained to the patient that each face represents a person who has no pain (hurt), or some, or a lot of pain. The patient is asked to choose one of 10 faces that best depicts the pain they are experiencing "No hurt", "Hurts Little bit", "Hurts Even More", "Hurts Whole Lot", "Hurts Worst". Higher scores represent greater pain.

Other Related Tools (if applicable):

None identified

Minimum Qualification Required by COA Administrator: No degree requirement

Comment:

The Wong-Baker FACES has been validated in non-rare disease, pediatric populations, and summarised in a systematic review (Tomlinson et al., 2010)

Year: 1983

Objective of Development:

To help children effectively communicate about their pain

Population of Development: Age range (therapeutic indication):

Age range: Children from preschool through young school-age (9-10 years) and adolescents (General pediatric population; Burn pain)

Pediatric Population(s) in which COA has been used:

3-18 years; Analgesia; Cancer; Cerebral Palsy; Chronic pain; Fractures; Lacerations; Pain assessment in the emergency department; Postoperative pain; Procedural pain; Sickle cell disease

COA type: PRO

Number of Items 1

Mode of Administration: Self-administered

Data Collection Mode: Pen and paper administration

Time for Completion: No information

Response Scales: 10-point Visual Analog Scale (VAS) comprising of six hand-drawn faces depicting a spectrum of emotions ranging from a smiling face to crying face ranging from 0 to 10: 0="No hurt", 2="Hurts Little Bit", 4="Hurts Little More", 6="Hurts Even More", 8="Hurts Whole Lot", 10="Hurts Worst"

Summary of Scoring:

Available scores: Global score ranging from 0 to 10

Weighting: No

Score Interpretation: Higher score = Greater pain

Evidence of Literature Review: None identified

Evidence of Instrument Review: Yes

Evidence of Clinical or Expert Input: None identified

Evidence of concept elicitation in target patient population: `Yes

Evidence of a Saturation Grid: None identified

Evidence for Selection of Data Collection Method: None identified

Recall/Observation Period: Present time.

Evidence for Selection of Reponse Options: Yes

Evidence of cognitive interviewing of draft instrument in target patient population: Yes

Evidence of Preliminary Scoring of Items and Domains: Yes

Evidence related to respondent and administrator burden: None identified

Evidence of a Conceptual Framework: None identified

Evidence of an item-tracking matrix: None identified

Evidence related to item selection: None identified

Evidence of re-testing the final version: Yes

Internal consistency (Cronbach's alpha): None identified

Evidence of internal consistency: None identified

Test-retest Reliability (ICC):

Luffy G (2003)
Test-retest reliability
- Adjusted reliability: 67% (scores were considered reliable if the retest score matched one face or above the face selected on initial testing).
- Was a definition of stability applied to identify stable patients: No
- Time frame between the two administrations: 15 minutes
- Population/Disease: African-American children (aged 3-18) with sickle cell disease; n=100

Inter-rater/ inter-interviewer reliability (kappa):

None identified

Evidence of test-retest or inter-rater reliability: None identified

Concurrent validity (convergent, divergent):

Garra G (2010)
Convergent validity
- Correlation coefficient used: Spearman's correlation (p)
- Measures: WBS; Visual Analog Scale (VAS)
- Results: Agreement between the WBS and VAS was excellent (p=0/90; 95% CI= 0.86 to 0.93).
- Population/Disease: `Children (8-17 years; median age=13 years) presenting in the emergency department with painful conditions; n=120

Luffy G (2003)
Convergent validity
- Correlation coefficient used: Validity was determined by comparing the rank order of the two identified painful items with pain scores on three pain scales. The number of consistent responses for each pain scale was totaled for each age group and divided by the number of subjects to arrive at a percentage of consistent responses.
- Measures: WBS; American-American Oucher; (VAS)
- Results: 70%
- Population/Disease: African-American children (aged 3-18) with sickle cell disease; n=100

Known-group validity:

Frei-Jones MJ (2008)
- Measure/Groups of patients: addmitted vs discharged children
- A priori hypotheses: Not stated
- Were hypotheses confirmed: Not applicable
- Results:WBFPRS differed significantly (p=0.002) between the admitted (initial score=4.4) and discharged (initial score=3.9) children.
- Population/disease: Children aged 8-19 years with sickle cell disease experiencing a vaso-occlusive episode; n=105

Evidence of Translatability Assessment: None identified

Evidence related to missing data: None identified

Evidence for Selection of Recall Period: None identified

Evidence of Administration Instructions and Training Provided: Available: https://wongbakerfaces.org/instructions-use/

Evidence of concurrent validity: Yes

Evidence of known-groups validity: Yes

Evidence of ability to detect change over time: Yes

Ability to detect change (Responsiveness):

Frei-Jones MJ (2008)
- Method: Changes in WBFPRS scores after administration of morphine in addmitted and discharged children
- Results: Change in score following morphine administration for admitted patients was (-1.1 ± 0.14, p<0.0001) and discharged (-2.5 ± 0.16, p<0.001) children - Population/disease: Children aged 8-19 years with sickle cell disease experiencing a vaso-occlusive episode; n=105

Responder Thresholds:

None identified

Evidence of responder thresholds: None identified

Wong, D. and Baker, C.: Pain in children: comparison of assessment scales, Pediatric Nursing, 14(1):9-17, 1988. Full Text Article: Not available

Wong, D. L., & Baker, C. M. (1988). Wong-Baker FACES Pain Rating Scale [Database record]. APA PsycTests. Original measure: https://www.northwell.edu/sites/northwell.edu/files/d7/LHH%20Pain%20Management%20Tool.pdf

Development history described: https://wongbakerfaces.org/us/wong-baker-faces-history/

Garra, G., Singer, A. J., Taira, B. R., Chohan, J., Cardoz, H., Chisena, E., & Thode, H. C., Jr (2010). Validation of the Wong-Baker FACES Pain Rating Scale in pediatric emergency department patients. Academic emergency medicine : official journal of the Society for Academic Emergency Medicine, 17(1), 50–54. Full Text Article: https://pubmed.ncbi.nlm.nih.gov/20003121/

Luffy, R., & Grove, S. K. (2003). Examining the validity, reliability, and preference of three pediatric pain measurement tools in African-American children. Pediatric nursing, 29(1), 54–59. Full Text Article: https://pubmed.ncbi.nlm.nih.gov/12630508/

Frei-Jones, M. J., Baxter, A. L., Rogers, Z. R., & Buchanan, G. R. (2008). Vaso-occlusive episodes in older children with sickle cell disease: emergency department management and pain assessment. The Journal of pediatrics, 152(2), 281–285. Full Text Article: https://pubmed.ncbi.nlm.nih.gov/18206703/

Validation in non-rare disease populations: Tomlinson, D., von Baeyer, C. L., Stinson, J. N., & Sung, L. (2010). A systematic review of faces scales for the self-report of pain intensity in children. Pediatrics, 126(5), e1168–e1198. Full Text Article: https://pubmed.ncbi.nlm.nih.gov/20921070/

Research using Wong-Baker FACES® Pain Rating Scale avaliable: https://wongbakerfaces.org/resources/articles/

Prolabels search: https://eprovide.mapi-trust.org/advanced-search?database=prolabels&search=Wong-Baker%20FACES%20Pain%20rating%20scale

Translations: https://wongbakerfaces.org/list-available-language-translations-wong-baker-faces-pain-rating-scale/)

Yes

Agency: FDA
Drug: Zingo™
Drug approval date: 15-Aug-2007; Revised: 01-Nov-2018
Therapeutic indication: Anesthesia and Analgesia
COA results: Primary endpoint
Age: 3-18 years

Yes

Original language: English

Translations:
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Translations may be requested by completing a form here: https://wongbakerfaces.org/research-use/

None identified

Authors:
Dr Donna Wong
Connie M Baker

Contact: https://wongbakerfaces.org/contact-2/

Wong-Baker FACES® Foundation

Conditions of use:
The foundation offer licensing agreements to organizations using the Wong-Baker FACES® Pain Rating Scale, although licensing is not required for all situations.
- Personal
- Healthcare organization
- Healthcare provider
- Healthcare educator
- Healthcare student
- Research
- Publishing
- Commercial
- School nurse
No modifications should be made to this scale without the foundation's expressed permission. They are intentional about not adding color to the scale because colors are so subjective. If you see a scale with color added, that is a copyright infringement.
The scale is a self-assessment tool for physical pain only, use is not permitted for use in measuring emotions, moods, comfort etc.

The scale can be requested for research use here: https://wongbakerfaces.org/research-use/

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