“Reluctant to Assess Pain”: A Qualitative Study of Health Care Professionals’ Beliefs About the Role of Pain in Juvenile Idiopathic Arthritis

Abstract

ObjectiveReducing pain is one of the main health priorities for children and young people with juvenile idiopathic arthritis (JIA); however, some studies indicate that pain is not routinely assessed in this patient group. The aim of this study was to explore health care professionals’ (HCPs) beliefs about the role of pain and the prioritization of its assessment in children and young people with JIA.MethodsSemi‐structured interviews were conducted with HCPs who manage children and young people with JIA in the UK (including consultant and trainee pediatric rheumatologists, nurses, physical therapists, and occupational therapists). Data were analyzed qualitatively following a framework analysis approach.ResultsTwenty‐one HCPs participated. Analyses of the data identified 6 themes, including lack of training and low confidence in pain assessment, reluctance to engage in pain discussions, low prioritization of pain assessment, specific beliefs about the nature of pain in JIA, treatment of pain in JIA, and undervaluing pain reports. Assessment of pain symptoms was regarded as a low priority and some HCPs actively avoided conversations about pain.ConclusionThese findings indicate that the assessment of pain in children and young people with JIA may be limited by knowledge, skills, and attitudinal factors. HCPs’ accounts of their beliefs about pain in JIA and their low prioritization of pain in clinical practice suggest that a shift in perceptions about pain management may be helpful for professionals managing children and young people with this condition.

“Asking Too Much?”: Randomized N-of-1 Trial Exploring Patient Preferences and Measurement Reactivity to Frequent Use of Remote Multidimensional Pain Assessments in Children and Young People With Juvenile Idiopathic Arthritis

“…However, health care professionals in pediatric rheumatology sometimes neglect to assess pain because of a lack of time and tools available to do so. In addition, professionals may not perceive pain as a priority for their patients because the focus of consultations may be on disease activity and function rather than pain [7,8]. Pain conversations are difficult to have with patients.…”

“…Decisions regarding the frequency of pain assessment administration rarely appear to be evidence based. This is a particular concern for health care professionals managing children and young people with JIA because they fear that more intense, regular pain assessment may lead to over-reporting or overexaggeration of pain or pain-related problems [7]. This phenomenon is called measurement reactivity, which is defined as a change in the variable being measured, because of the nature of the measurement method [21,22].…”

Characterizing pain flares in adolescent inflammatory and non‐inflammatory musculoskeletal disorders: A qualitative study using an interpretative phenomenological approach

“…But while there is greater awareness of the importance of managing the psychosocial aspects of pain, this is often not addressed adequately in clinical practice. Healthcare professionals continue to use a more biomedical approach to understanding and managing pain, especially in JIA where pain is perceived by some to be directly and proportionately related to disease activity (Lee, Rashid, Thomson, & Cordingley, 2020). This suggests further research is needed to support healthcare professionals in translating understanding from pain theory and young people's experiences into their current practice.…”

Outcome Measures for Pediatric Pain: Practical Guidance on Clinical Use in Juvenile Arthritis

“…The assessment of pain in children with arthritis is a common challenge for clinicians. A recent qualitative study found that health care professionals report gaps in pain‐specific knowledge and skills to assess pain in children with arthritis . In the context of assessment, it is important to recognize pain as a multidimensional experience that is comprised of sensory, affective, and evaluative components .…”

“…A recent qualitative study found that health care professionals report gaps in pain‐specific knowledge and skills to assess pain in children with arthritis . In the context of assessment, it is important to recognize pain as a multidimensional experience that is comprised of sensory, affective, and evaluative components . The sensory dimension is related to quality (what pain feels like), intensity (how much pain hurts), location (spatial distribution of pain), and duration (how long pain lasts).…”