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Wallwork SB, Nichols S, Jordan A, Noel M, Madden VJ, Lorimer Moseley G. Harnessing Children's Picture Books to Socialize Children About Pain and Injury: A Qualitative Study. THE JOURNAL OF PAIN 2024; 25:104520. [PMID: 38580100 DOI: 10.1016/j.jpain.2024.03.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 03/18/2024] [Accepted: 03/29/2024] [Indexed: 04/07/2024]
Abstract
Pain experiences are common during childhood (eg, "everyday" pain, vaccine injections) and are powerful opportunities for children to learn about pain and injury. These experiences likely inform fundamental and life-long beliefs about pain. There is scant research investigating the sociocultural contexts in which children learn about pain and injury. One unexplored context is the shared reading of picture books (eg, between parents/caregivers and children). In this study, we investigated whether shared reading of picture books that included depictions of pain and/or injury prompted parent/caregiver-child interactions. If interactions were observed, we explored what those interactions entailed. Twenty parents/caregivers (8 men, 12 women) and their children (n = 27; 10 boys, 17 girls) were recruited from libraries in South Australia. Parent/caregiver-child families chose from 8 books (7 fiction, 1 nonfiction) with varying amounts of pain/injury-related content. Shared reading interactions were video recorded, transcribed, and analyzed alongside analysis of the picture books using reflexive thematic analysis. Pain/injury-related interactions were observed between parents/caregivers and children during shared reading of picture books. Qualitative analyses generated 1 main theme and 3 subthemes. Findings identified that shared reading presented an opportunity for children's understanding of pain and injury to be socialized through discussion of characters' experiences. This included teaching children about pain and injury, as well as promoting empathy and emotional attunement toward characters who were depicted as being in pain. Finally, parents/caregivers often responded with observable/expressed amusement if pain/injury was depicted in a light-hearted or unrealistic way. Overall, shared reading of picture books presents an untapped opportunity to socialize children about pain and injury. PERSPECTIVE: Shared reading of picture books that have depictions of pain and/or injury can prompt parent/caregiver-child interactions about pain and injury. These interactions present critical opportunities that can be harnessed to promote children's learning of adaptive pain-related concepts and behaviors during a critical developmental period.
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Affiliation(s)
- Sarah B Wallwork
- IIMPACT in Health, Allied Health and Human Performance, University of South Australia, Adelaide, South Australia, Australia
| | - Sue Nichols
- Education Futures, University of South Australia, Adelaide, South Australia, Australia
| | - Abbie Jordan
- Department of Psychology & Centre for Pain Research, University of Bath, Bath, United Kingdom
| | - Melanie Noel
- Department of Psychology, University of Calgary, Calgary, Alberta, Canada
| | - Victoria J Madden
- IIMPACT in Health, Allied Health and Human Performance, University of South Australia, Adelaide, South Australia, Australia; Pain Unit, Department of Anaesthesia and Perioperative Medicine, University of Cape Town, Cape Town, South Africa; HIV Mental Health Research Unit, Department of Psychiatry and Mental Health, Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - G Lorimer Moseley
- IIMPACT in Health, Allied Health and Human Performance, University of South Australia, Adelaide, South Australia, Australia
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Wallwork SB, Shenk C, McMurtry CM, Hood AM, Pavlova M, Olson AE, Moseley GL, Noel M. "I hear you". Validation in the context of children's pain as an untapped opportunity to prevent chronic pain. Pain 2024:00006396-990000000-00669. [PMID: 39073392 DOI: 10.1097/j.pain.0000000000003350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Accepted: 06/24/2024] [Indexed: 07/30/2024]
Affiliation(s)
- Sarah B Wallwork
- IIMPACT in Health, Allied Health and Human Performance, Kaurna Country, University of South Australia, Adelaide, Australia
| | - Chad Shenk
- Department of Human Development and Family Studies, The Pennsylvania State University, University Park, PA, United States
- Department of Pediatrics, The Pennsylvania State University College of Medicine, Hershey, PA, United States
| | - C Meghan McMurtry
- Department of Psychology, University of Guelph, Guelph and Pediatric Chronic Pain Program, McMaster Children's Hospital, Hamilton, ON, Canada
| | - Anna M Hood
- Manchester Centre for Health Psychology, Division of Psychology and Mental Health, University of Manchester, Manchester, United Kingdom
| | - Maria Pavlova
- School of Psychology, University of Ottawa, Ottawa, ON, Canada
| | - Anneke E Olson
- Department of Human Development and Family Studies, The Pennsylvania State University, University Park, PA, United States
| | - G Lorimer Moseley
- IIMPACT in Health, Allied Health and Human Performance, Kaurna Country, University of South Australia, Adelaide, Australia
| | - Melanie Noel
- Department of Psychology, University of Calgary, Calgary, AB, Canada
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Tutelman PR, Chambers CT, Parker JA, Eisen SJ, Noel M. Preliminary development of a measure of parental behavioral responses to everyday pains in young children: the PREP. Pain Rep 2024; 9:e1154. [PMID: 38586593 PMCID: PMC10994502 DOI: 10.1097/pr9.0000000000001154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 01/25/2024] [Accepted: 02/20/2024] [Indexed: 04/09/2024] Open
Abstract
Introduction Everyday pains are experienced frequently by young children. Parent responses shape how young children learn about and experience pain. However, research on everyday pains in toddlers and preschoolers is scarce, and no self-report measures of parent responses to their child's pain exist for this age group. Objectives The objective of this study was to develop a preliminary self-report measure of parent behavioral responses to everyday pains in the toddler and preschool years (the PREP) and examine its relationship with child age, sex, and parent and child distress. Methods Items for the PREP were based on a behavioural checklist used in a past observational study of caregiver responses to toddler's everyday pains. Parents (N = 290; 93% mothers) of healthy children (47.9% boys) between 18 and 60 months (Mage = 34.98 months, SD = 11.88 months) completed an online survey of 46 initial PREP items, demographic characteristics, and their child's typical distress following everyday pains. An exploratory factor analysis was performed on the PREP items that describe observable actions parents may take in response to their young child's everyday pains. Results The final solution included 10 items across 3 factors: Distract, Physical Soothe, and Extra Attention and explained 60% of the model variance. All PREP subscales were related to child distress; only Physical Soothe and Extra Attention were related to parent distress. Conclusion This study was a preliminary step in the development and testing of a new self-report measure of parental responses to everyday pains during early childhood.
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Affiliation(s)
- Perri R. Tutelman
- Department of Psychology & Neuroscience, Dalhousie University, Halifax, NS, Canada
- Centre for Pediatric Pain Research, IWK Health, Halifax, NS, Canada
- Departments of Oncology and
- Psychology, University of Calgary, Calgary, AB, Canada
| | - Christine T. Chambers
- Department of Psychology & Neuroscience, Dalhousie University, Halifax, NS, Canada
- Centre for Pediatric Pain Research, IWK Health, Halifax, NS, Canada
- Department of Pediatrics, Dalhousie University, Halifax, NS, Canada
| | - Jennifer A. Parker
- Department of Psychology & Neuroscience, Dalhousie University, Halifax, NS, Canada
- Centre for Pediatric Pain Research, IWK Health, Halifax, NS, Canada
| | - Samantha J. Eisen
- Department of Psychology & Neuroscience, Dalhousie University, Halifax, NS, Canada
- Centre for Pediatric Pain Research, IWK Health, Halifax, NS, Canada
| | - Melanie Noel
- Psychology, University of Calgary, Calgary, AB, Canada
- Children's Hospital Research Institute, Calgary, AB, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
- Owerko Centre, Calgary, AB, Canada
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Lorimer Moseley G, Leake HB, Beetsma AJ, Watson JA, Butler DS, van der Mee A, Stinson JN, Harvie D, Palermo TM, Meeus M, Ryan CG. Teaching Patients About Pain: The Emergence of Pain Science Education, its Learning Frameworks and Delivery Strategies. THE JOURNAL OF PAIN 2024; 25:104425. [PMID: 37984510 DOI: 10.1016/j.jpain.2023.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Revised: 11/07/2023] [Accepted: 11/09/2023] [Indexed: 11/22/2023]
Abstract
Since it emerged in the early 2000's, intensive education about 'how pain works', widely known as pain neuroscience education or explaining pain, has evolved into a new educational approach, with new content and new strategies. The substantial differences from the original have led the PETAL collaboration to call the current iteration 'Pain Science Education'. This review presents a brief historical context for Pain Science Education, the clinical trials, consumer perspective, and real-world clinical data that have pushed the field to update both content and method. We describe the key role of educational psychology in driving this change, the central role of constructivism, and the constructivist learning frameworks around which Pain Science Education is now planned and delivered. We integrate terminology and concepts from the learning frameworks currently being used across the PETAL collaboration in both research and practice-the Interactive, Constructive, Active, Passive framework, transformative learning theory, and dynamic model of conceptual change. We then discuss strategies that are being used to enhance learning within clinical encounters, which focus on the skill, will, and thrill of learning. Finally, we provide practical examples of these strategies so as to assist the reader to drive their own patient pain education offerings towards more effective learning. PERSPECTIVE: Rapid progress in several fields and research groups has led to the emergence 'Pain Science Education'. This PETAL review describes challenges that have spurred the field forward, the learning frameworks and educational strategies that are addressing those challenges, and some easy wins to implement and mistakes to avoid.
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Affiliation(s)
- G Lorimer Moseley
- The Pain Education Team to Advance Learning (PETAL) Collaboration; IIMPACT in Health, Allied Health and Human Performance, University of South Australia, Kaurna Country, Adelaide, Australia.
| | - Hayley B Leake
- The Pain Education Team to Advance Learning (PETAL) Collaboration; IIMPACT in Health, Allied Health and Human Performance, University of South Australia, Kaurna Country, Adelaide, Australia
| | - Anneke J Beetsma
- The Pain Education Team to Advance Learning (PETAL) Collaboration; Research group Healthy Ageing, Allied Health Care and Nursing, Hanze University of Applied Sciences Groningen, the Netherlands
| | - James A Watson
- The Pain Education Team to Advance Learning (PETAL) Collaboration; Centre for Rehabilitation, School of Health and Life Sciences, Teesside University, Middlesbrough, UK; Integrated Musculoskeletal Service, Community Pain Management, North Tees and Hartlepool NHS Foundation Trust, Stockton-on-Tees, UK
| | - David S Butler
- The Pain Education Team to Advance Learning (PETAL) Collaboration; IIMPACT in Health, Allied Health and Human Performance, University of South Australia, Kaurna Country, Adelaide, Australia
| | - Annika van der Mee
- The Pain Education Team to Advance Learning (PETAL) Collaboration; Consumer Representative, Research group Healthy Ageing, Allied Health Care and Nursing, Hanze University of Applied Sciences Groningen, the Netherlands
| | - Jennifer N Stinson
- The Pain Education Team to Advance Learning (PETAL) Collaboration; Child Health Evaluative Sciences, The Research Institute, The Hospital for Sick Children and Lawrence S. Bloomberg, Faculty of Nursing, The University of Toronto, Toronto, Ontario, Canada
| | - Daniel Harvie
- The Pain Education Team to Advance Learning (PETAL) Collaboration; IIMPACT in Health, Allied Health and Human Performance, University of South Australia, Kaurna Country, Adelaide, Australia
| | - Tonya M Palermo
- The Pain Education Team to Advance Learning (PETAL) Collaboration; Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, Washington
| | - Mira Meeus
- The Pain Education Team to Advance Learning (PETAL) Collaboration; MOVANT research group, Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, Belgium
| | - Cormac G Ryan
- The Pain Education Team to Advance Learning (PETAL) Collaboration; Centre for Rehabilitation, School of Health and Life Sciences, Teesside University, Middlesbrough, UK
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Djurtoft C, Bruun MK, Riel H, Hoegh MS, Darlow B, Rathleff MS. How do we explain painful non-traumatic knee conditions to adolescents? A multiple-method study to develop credible explanations. Eur J Pain 2024; 28:659-672. [PMID: 37987218 DOI: 10.1002/ejp.2210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 09/19/2023] [Accepted: 11/07/2023] [Indexed: 11/22/2023]
Abstract
BACKGROUND Perceived diagnostic uncertainty can leave adolescents confused about their condition and impede their ability to understand "what's wrong with me". Our aim is to develop credible explanations about the condition for adolescents suffering from non-traumatic knee pain. METHODS This multiple-method study integrated findings from two systematic literature searches of qualitative and quantitative studies, an Argumentative Delphi with international experts (n = 16) and think-aloud interviews with adolescents (n = 16). Experts provided feedback with arguments on how to communicate credible explanations to meet adolescents' needs; we analysed feedback using thematic analysis. The explanations were tailored based on the adolescent end-users' input. RESULTS We screened 3239 titles/abstracts and included 16 papers exploring diagnostic uncertainty from adolescents' and parents' perspectives. Five themes were generated: (1) understanding causes and contributors to the pain experience, (2) feeling stigmatized for having an invisible condition, (3) having a name for pain, (4) controllability of pain, and (5) worried about something being missed. The Argumentative Delphi identified the following themes: (1) multidimensional perspective, (2) tailored to adolescents, (3) validation and reassurance, and (4) careful wording. Merging findings from the systematic search and the Delphi developed three essential domains to address in credible explanations: "What is non-traumatic knee pain and what does it mean?", "What is causing my knee pain?" and "How do I manage my knee pain?" CONCLUSIONS Six credible explanations for the six most common diagnoses of non-traumatic knee pain were developed. We identified three domains to consider when tailoring credible explanations to adolescents experiencing non-traumatic knee pain. SIGNIFICANCE This study provides credible explanations for the six most common diagnoses of non-traumatic knee pain. Additionally, we identified three key domains that may need to be addressed to reduce diagnostic uncertainty in adolescents suffering from pain complaints. Based on our findings, we believe that clinicians will benefit from exploring adolescents' own perceptions of why they experience pain and perceived management strategies, as this information might capture important clinical information when managing these young individuals.
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Affiliation(s)
- C Djurtoft
- Center for General Practice at Aalborg University, Aalborg, Denmark
- Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark
| | - M K Bruun
- Center for General Practice at Aalborg University, Aalborg, Denmark
| | - H Riel
- Center for General Practice at Aalborg University, Aalborg, Denmark
- Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark
- Department of Physiotherapy, University College of Northern Denmark, Aalborg, Denmark
| | - M S Hoegh
- Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark
| | - B Darlow
- Department of Primary Health Care and General Practice, University of Otago, Wellington, New Zealand
| | - M S Rathleff
- Center for General Practice at Aalborg University, Aalborg, Denmark
- Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark
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Selhorst M, Hoehn J, Schmitt L, Benedict J, Fernandez-Fernandez A. The Effect of a Psychologically Informed Video Series to Treat Adolescents With Patellofemoral Pain: A Randomized Controlled Trial. J Orthop Sports Phys Ther 2023; 53:634–642. [PMID: 37706686 DOI: 10.2519/jospt.2023.12041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/15/2023]
Abstract
OBJECTIVE: To test whether a series of brief, psychologically informed educational videos added to physical therapy improved function among adolescents with patellofemoral pain. The secondary aims were to assess pain and psychological beliefs. DESIGN: A double-blinded randomized controlled trial. METHODS: Sixty-eight adolescents with patellofemoral pain were randomly assigned to view brief, psychologically informed videos (n = 34) or control videos (n = 34) in addition to usual care physical therapy. The psychologically informed videos targeted fear-avoidance beliefs, kinesiophobia, and pain catastrophizing. The control videos conveyed basic anatomy, biomedical factors, and lower extremity mechanics. Outcomes were assessed at baseline, 3 weeks, 6 weeks (primary end point), and 3 months. The primary outcome was change in the Anterior Knee Pain Scale. Secondary outcomes were changes in Numeric Pain-Rating Scale and psychological beliefs (Modified Fear-Avoidance Beliefs Questionnaire-Physical Activity, Tampa Kinesiophobia Scale-11, and Pain Catastrophizing Scale-Child). RESULTS: Adolescents in the psychologically informed group experienced significantly greater improvements in function (Anterior Knee Pain Scale mean difference = 8 points; 95% CI: 2.2, 13.2; P = .01) and pain (Numeric Pain-Rating Scale mean difference = 1.2 points; 95% CI: 0.1, 2.4; P = .04) at 6 weeks compared to the control group. The psychologically informed group had significantly greater reductions in psychological beliefs over time than the control group (P≤.001; partial η2 = 0.32). CONCLUSION: Incorporating psychologically informed education into physical therapy care improved function, pain, and psychological beliefs to a greater extent than the control group. J Orthop Sports Phys Ther 2023;53(10):1-9. Epub: 14 September 2023. doi:10.2519/jospt.2023.12041.
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Alkhouli M, Al-Nerabieah Z, Dashash M. Analyzing facial action units in children to differentiate genuine and fake pain during inferior alveolar nerve block: a cross-sectional study. Sci Rep 2023; 13:15564. [PMID: 37730922 PMCID: PMC10511437 DOI: 10.1038/s41598-023-42982-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 09/17/2023] [Indexed: 09/22/2023] Open
Abstract
This study aimed to investigate the association between facial action units and pain levels in Syrian children, focusing on both genuine and fake pain expressions. A total of 300 Syrian children aged 6-9 years participated in the study. Pain levels were assessed using the validated Face, Legs, Activity, Cry, Consolability scale, and facial expressions were analyzed using the Facial Action Coding System. The children were asked to mimic their feelings after receiving a dental injection to elicit fake pain expressions. Statistical analysis, including multinomial logistic regression and chi-square tests, was conducted to determine the Action Units (AUs) associated with each pain level and to compare the differences between real and fake pain expressions. The results revealed significant associations between specific AUs and pain levels. For real pain expressions, the most activated AUs across different pain levels with positive coefficient values of correlation (P-value < 0.01) were analyzed. In contrast, for fake pain expressions, AU12 and AU38 were consistently observed to be the most activated. These findings suggest that certain AUs are uniquely associated with fake pain expressions, distinct from those observed in real pain expressions. Furthermore, there were no significant differences between boys and girls in terms of their genuine and fake pain expressions, indicating a similar pattern of AU activation (P-value > 0.05). It was concluded that AUs 4, 6, 41, and 46 were associated with mild pain, and AUs 4, 6, 41, 46, and 11 were associated with moderate pain cases. In severe pain, AUs 4, 6, 7, 9, 11, and 43 were associated. In fake pain feelings, AU43, AU38, and AU12 were the most activated with no difference between boys and girls.
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Affiliation(s)
- Muaaz Alkhouli
- Faculty of Dentistry, Damascus University, Damascus, Syrian Arab Republic.
| | | | - Mayssoon Dashash
- Faculty of Dentistry, Damascus University, Damascus, Syrian Arab Republic
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Do Teachers Question the Reality of Pain in Their Students? A Survey Using the Concept of Pain Inventory-Proxy (COPI-Proxy). CHILDREN (BASEL, SWITZERLAND) 2023; 10:children10020370. [PMID: 36832498 PMCID: PMC9955080 DOI: 10.3390/children10020370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 02/08/2023] [Accepted: 02/11/2023] [Indexed: 02/16/2023]
Abstract
An assessment of a teacher's concept of their student's pain could be useful to guide preventative and targeted school-based pain science education. We aimed to assess a teacher's own concept of pain against their concept of their student's pain and examine the psychometric properties of the tool. Teachers of 10-12-year-old children were invited to participate in an online survey via social media. We modified the Concept of Pain Inventory (COPI) by inserting a vignette (COPI-Proxy), and we included questions to explore teacher stigma. Overall, a sample of 233 teachers participated in the survey. The COPI-Proxy scores showed that teachers can conceptualize their student's pain separately but are influenced by their own beliefs. Only 76% affirmed the pain in the vignette as real. Teachers used potentially stigmatizing language to describe pain in their survey responses. The COPI-Proxy had acceptable internal consistency (Cronbach's alpha = 0.72) and moderate convergent validity with the COPI (r = 0.56). The results show the potential benefit of the COPI-Proxy for assessing someone's concept of another's pain, particularly for teachers who are important social influencers of children.
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Fitzpatrick R, McGuire BE, Lydon HK. Student Commentary: Targeting the Right Supports to Reduce Pediatric Procedural Pain and Distress. J Pediatr Psychol 2022; 48:120-122. [PMID: 36063410 PMCID: PMC9941802 DOI: 10.1093/jpepsy/jsac069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 08/18/2022] [Accepted: 08/18/2022] [Indexed: 11/12/2022] Open
Affiliation(s)
- Rachel Fitzpatrick
- All correspondence concerning this article should be addressed to Rachel Fitzpatrick, MSc, School of Psychology, National University of Ireland, Galway, Ireland. E-mail: ;
| | - Brian E McGuire
- School of Psychology and Centre for Pain Research and Applied Behaviour Research Clinic, National University of Ireland, Ireland
| | - Helena K Lydon
- School of Psychology and Centre for Pain Research and Applied Behaviour Research Clinic, National University of Ireland, Ireland
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