Exploring the concept of pain of Australian children with and without pain: qualitative study

Abstract

ObjectiveA person’s concept of pain can be defined as how they understand what pain actually is, what function it serves and what biological processes are thought to underpin it. This study aimed to explore the concept of pain in children with and without persistent pain.DesignIn-depth, face-to-face interviews with drawing tasks were conducted with 16 children (aged 8–12 years) in New South Wales, Australia. Thematic analysis was used to analyse and synthesise the data.SettingChildren with persistent pain were identified from a pain clinic waiting list in Australia, and children without pain were identified through advertising flyers and email bulletins at a university and hospital.ParticipantsEight children had persistent pain and eight children were pain free.ResultsFour themes emerged from the data: ‘my pain-related knowledge’, ‘pain in the world around me’, ‘pain in me’ and ‘communicating my concept of pain’. A conceptual framework of the potential interactions between the themes resulting from the analysis is proposed. The concept of pain of Australian children aged 8–12 years varied depending on their knowledge, experiences and literacy levels. For example, when undertaking a drawing task, children with persistent pain tended to draw emotional elements to describe pain, whereas children who were pain free did not.ConclusionsGaining an in-depth understanding of a child’s previous pain-related experiences and knowledge is important to facilitate clear and meaningful pain science education. The use of age-appropriate language, in combination with appropriate assessment and education tasks such as drawing and discussing vignettes, allowed children to communicate their individual concept of pain.

Talking to Children and Families about Chronic Pain: The Importance of Pain Education—An Introduction for Pediatricians and Other Health Care Providers

“…Initially, health care providers should ask about the current understanding and concept of pain of the family. The idiosyncratic explanation of pain – of child and parents alike – should be the basis on which to build pain education on, since an individual’s interpretation of a pain problem can influence the pain itself and pain-related behavior, and a thorough understanding of a child’s previous experiences and knowledge is important to facilitate pain education [ 70 ]. Pain education is only successful when a common denominator between the subjective concept of the child and the health care provider’s scientific knowledge about the biopsychosocial nature of chronic pain can be found [ 71 ].…”

“…Finally, the fifth step refers to the transfer of knowledge to the social environment of the patient. Once patients and parents have gained in-depth understanding of the “what, why and how of pain” [ 70 ], health care providers should discuss with the family if there is any need to pass on relevant information about the child’s pain and treatment to other important people in the patient’s social environment. Chronic pain in young people can negatively affect relevant life domains such as school attendance and peer relationships [ 4 , 77 ], and some adolescents are under suspicion that they are “faking” their pain symptoms, which are by their nature not visible to others [ 78 ].…”

Communicating with Youth about Pain: Developmental Considerations

“…Pain expression also differs based on educational levels and prior pain experiences. For instance, children with chronic pain may use more emotional language to describe pain than children with no persistent pain experience [ 17 ]. As such, provision of accurate, developmentally-appropriate pain education should depend, not only on patients’ conceptual knowledge and literacy levels, but also on the degree to which children have experienced significant pain in their past [ 17 ].…”

Improving pain‐related communication in children with autism spectrum disorder and intellectual disability

“…The ways in which children in general learn about the concept of pain is relatively under‐researched. The limited literature in this area suggests that age‐appropriate language should be used and that tasks such as drawing and vignettes should be used to allow children to communicate their concept of pain, such as asking children about how the person may be feeling and what the person may need to feel better or different 16 . It is also known that children learn about how to express pain and how to manage pain through their observations and interactions with caregivers 17 .…”

“…The limited literature in this area suggests that age‐appropriate language should be used and that tasks such as drawing and vignettes should be used to allow children to communicate their concept of pain, such as asking children about how the person may be feeling and what the person may need to feel better or different. 16 It is also known that children learn about how to express pain and how to manage pain through their observations and interactions with caregivers. 17 Children can, in fact, influence the attention they receive from others depending on the strength of their display of distress and that of their facial cues.…”