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Pediatric Pain Questionnaire (PPQ)
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Exploratory: Cerebral Palsy (CP)
Short Description of Instrument
The Varni/Thompson pediatric pain questionnaire (PPQ) assesses pain intensity and location and the sensory, affective, and evaluative qualities of pain. The PPQ is appropriate for children and adolescents. The PPQ provides a developmental step toward the comprehensive assessment of the pain experience in children with chronic pain (Varni et al., 1987).
Comments/Special Instructions
CP-specific Pain Categories: Pain intensity, Quality and Location
CP-specific ICF Domains: Body Structures, Body Functions (World Health Organization, 2001)
Scoring and Psychometric Properties
Scoring: The PPQ includes visual analog scales (VAS) that are used to assess present and worst pain intensity for the previous week. The child VAS is a 100-mm horizonal line anchored with developmentally appropriate pain descriptors (e.g., "not hurting," "hurting a whole lot") and happy and sad faces. The adolescent and parent VAS are anchored by phrases "no pain" and "severe pain" in addition to the pain descriptors "hurting" and "discomfort." The instructions for the VAS ask the raters to place a vertical line through the horizontal VAS line to represent the intensity of pain along the continuum from no pain to severe pain (Gragg et al., 1996).
Psychometric Properties:  Psychometric properties are well-established.  The PPQ was modified and validated for use in children with CP and Gross Motor Functions Classification System (GMFCS) levels I to III; however, the modified version of the PPQ for use with children with GMFCS levels IV to V requires additional validation (Kingsnorth et al., 2015).
Strengths: The PPQ measures the socio-environmental and emotional factors that may influence pain perception (Varni et al., 1987).
The PPQ provides useful diagnostic and treatment information. The body outline drawings that are included in the PPQ allow children to indicate the location and severity of their pain (Gragg et al., 1996).
The PPQ is validated with children with chronic pain conditions and has been adapted for use with children with CP (Kingsnorth et al., 2015). Within this modified version, parents were instructed to use verbal and nonverbal cues to indicate the presence and quality of their child's pain (Houlihan et al., 2008).
This tool has been translated into other languages, including Danish, Norwegian, Portuguese, Spanish, Swedish and French.
Weaknesses: Routine clinical use of the entire questionnaire might be prohibitive, given the length of the PPQ and the inclusion of a detailed pain history information (Gragg et al., 1996). The modified version of the PPQ for use with children with CP is not validated with GMFCS levels IV to V (Kingsnorth et al, 2015).
Key Reference:
Varni JW, Thompson KL, Hanson V. The Varni/Thompson Pediatric Pain Questionnaire. I. Chronic musculoskeletal pain in juvenile rheumatoid arthritis. Pain. 1987 Jan;28(1):27-38.
Additional References:
Benestad B, Vinje O, VeierØd MB, Vandvik IH. Quantitative and qualitative assessments of pain in children with juvenile chronic arthritis based on the Norwegian version of the Pediatric Pain Questionnaire. Scand J Rheumatol. 1996;25(5):293-9.
Gragg RA, Rapoff MA, Danovsky MB, Lindsley CB, Varni JW, Waldron SA, Bernstein BH. Assessing chronic musculoskeletal pain associated with rheumatic disease: further validation of the pediatric pain questionnaire. J Pediatr Psychol. 1996 Apr;21(2):237-50.
Houlihan C., Hanson A., Quinlan N., Puryear C., Stevenson R.  Intensity, perception, and descriptive characteristics of chronic pain in children with cerebral palsy.  Journal of Pediatric Rehabilitation Medicine. 2008. 1(2), pp. 145-153
Kingsnorth S, Orava T, Provvidenza C, Adler E, Ami N, Gresley-Jones T, Mankad D, Slonim N, Fay L, Joachimides N, Hoffman A, Hung R, Fehlings D. Chronic Pain Assessment Tools for Cerebral Palsy: A Systematic Review. Pediatrics. 2015 Oct;136(4):e947-60.
World health Organization (2001). International Classification of Functioning, Disability and Health (ICF) Retrieved 19August2021
Document last updated August 2022