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Crying out in pain - a systematic review into the validity of vocalization as an indicator for pain

Helmer, LML; Weijenberg, RAF; de Vries, R; Achterberg, WP; Lautenbacher, S; Sampson, EL; Lobbezoo, F; (2020) Crying out in pain - a systematic review into the validity of vocalization as an indicator for pain. European Journal of Pain 10.1002/ejp.1623. (In press). Green open access

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Abstract

BACKGROUND: Vocalization is often used to assess pain, sometimes combined with other behaviors such as facial expressions. Contrary to facial expressions, however, for vocalization there is little evidence available on the association with pain. The aim of this systematic review was to critically analyze the association between vocalization and pain, to explore if vocalizations can be used as a 'stand-alone' indicator for pain. METHODS: The search was performed according to the Prisma Guidelines for systematic reviews and meta-analysis. The following terms were used: "Pain Measurement", "Vocalization", and "Verbalization". The study population included verbal and non-verbal individuals, including older people and children. The search was performed in three different databases: Pubmed, Embase, and Cinahl. A total of 35 studies were selected for detailed investigation. Quality assessments were made using two grading systems; Grading of Recommendations Assessment Development and Evaluation system and the Newcastle-Ottawa scale. RESULTS: An association between vocalization and pain was found in most studies, particularly when different types of vocalizations were included in the investigation. Different types of vocalization, but also different types of pain shape this association. The association is observed within all groups of individuals, although age, amongst others, may have an influence on preferred type of vocalization. CONCLUSIONS: There is an association between vocalization and pain. However, vocalization as a 'stand-alone' indicator for pain indicates only a limited aspect of this multifactorial phenomenon. Using vocalization as an indicator for pain may be more reliable if other pain indicators are also taken into account. SIGNIFICANCE: Vocalizations are frequently used in pain scales, although not yet thoroughly investigated as a 'single-indicator' for pain, like for example facial expression. This review confirms the role of vocalizations in pain scales, and stresses that vocalizations might be more reliable if used in combination with other pain indicators.

Type: Article
Title: Crying out in pain - a systematic review into the validity of vocalization as an indicator for pain
Location: England
Open access status: An open access version is available from UCL Discovery
DOI: 10.1002/ejp.1623
Publisher version: https://doi.org/10.1002/ejp.1623
Language: English
Additional information: © 2020 The Authors. European Journal of Pain published by John Wiley & Sons Ltd on behalf of European Pain Federation EFIC ® This is an open access article under the terms of the Creative Commons Attribution‐NonCommercial‐NoDerivs License (http://creativecommons.org/licenses/by-nc-nd/4.0/).
Keywords: Vocalization, pain, pain assessment, pain measurement, verbalization
UCL classification: UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences > Division of Psychiatry
URI: https://discovery.ucl.ac.uk/id/eprint/10105459
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