Perceived injustice and pain-related outcomes in children with pain conditions: A systematic review

OBJECTIVE

Research indicates that perceived injustice significantly influences pain-related outcomes and is associated with delayed recovery in adults. This systematic review examines the relationship between perceived injustice and pain-related outcomes in children with pain conditions.

METHODS

A search of published studies in English in PubMed, PsychInfo, and Cochrane Database of Systematic Reviews from database inception through December 2022 were performed. The search criteria focused on studies that measured perceived injustice and pain-related outcomes in children with pain conditions. Out of 56 articles screened, 8 met the inclusion criteria, providing data on 1240 children with pain conditions.

RESULTS

The average age of participants across all studies was 14.12 years (SD = 2.25), with 68.2% being female. There was strong evidence that higher perceived injustice is associated with worse pain intensity, functional disability, mental health outcomes, and emotional, social, and school functioning.

CONCLUSION

The results of this study underscore how perceptions of injustice are associated various pain-related outcomes across different domains of children's lives. The findings highlight the need for screening and treatments targeting injustice appraisals in pediatric populations with pain conditions. The discussion addresses possible determinants and mechanisms of perceived injustice, along with implications for research and clinical practice.

Temporal relationship between pain and mental health conditions among children and young people - A population-based register study in Sweden

Both pain and mental health conditions are common among young people. They often co-occur, but we wanted to investigate further whether it is pain (abdominal pain, headache, musculoskeletal pain, menstrual pain) that precedes mental health conditions (depression, anxiety, stress, phobia) or whether it is the other way around, mental health conditions that precedes pain. Using electronic health records - the Skåne Healthcare Register - we identified and followed young people aged 7-18 over a 13-year period and tracked all their registered diagnoses. Using Poisson regression, we analyzed the incidence rate ratio (IRR) of being diagnosed with mental health conditions after an initial diagnosis of pain and vice versa the IRR of being diagnosed with pain after an initial diagnosis of a mental health condition. Among individuals with pain, 12 054 (23%) later received a diagnosis of a mental health condition. The IRR for a mental health condition after pain was 2.86 (95% CI 2.78-2.94) compared to not having pain, adjusted for age, sex and prior healthcare consultations. Among individuals with mental health conditions, 3688 (17%) later received a diagnosis of pain. The adjusted IRR was 1.57 (95% CI=1.52-1.63). Compared to boys, girls had consistently higher estimates and the same was found for the younger individuals compared to the older ones. Individuals with pain have a threefold increased risk of developing mental health conditions while the risk of developing pain after mental health conditions was lower although still elevated compared to young people seeking care regardless of cause. PERSPECTIVE: Young people with pain have a threefold increased risk of developing mental health conditions while the reverse risk is lower but still elevated compared to young people without these conditions. Healthcare professionals must recognize the interplay between pain and mental health in young patients when diagnosing and planning treatment. DATA AVAILABILITY: The data included in this study are stored within the Skåne county council. To access similar data, The Swedish National Board of Health and welfare and The Skåne county council can provide information about how to apply for access.

The Mediation Pathway Linking Dental Caries and Academic Performance in Children

INTRODUCTION

There is little discussion in the literature on the pathway linking oral health problems and academic performance (AP) in children. This study investigated the hypothesis that the influence of dental caries on academic performance is mediated through toothache and impacted sleep and study activities.

METHODS

This cross-sectional study on children aged 12-14 years collected data on the exposure (decayed tooth index), outcome (school examination results), and mediator (school absence due to toothache, and oral health impact on sleep and study performances using the Child-Oral Impact on Daily Performance instrument) variables. It used mediation analysis to examine the indirect effects of a single and two serial mediators using model 4 (caries → mediator → AP) and model 6 (caries → mediator 1 → mediator 2 → AP), respectively, in PROCESS macro add-on software in IBM SPSS v24. Analyses were carried out separately for boys and girls at a 5% significance level.

RESULTS

In model 4, school absence due to toothache (boys: 95% CI: 0.42, 1.01; girls: 95% CI: 0.58, 0.98), and impacted sleep (95% CI: 0.13, 0.41; 95% CI: 2.17, 13.03), and study (95% CI: 0.05, 0.42; 95% CI: 0.54, 0.94) performance were significant single mediators in both sexes. In model 6, school absence due to toothache and impacted sleep activity (boys: 95% CI: 0.02, 0.29 and girls: 95% CI: 1.37, 12.81), and school absence due to toothache and impacted study activity (girls: 95% CI: 1.37, 12.81) were significant two serial-mediators.

CONCLUSION

This study provides empirical evidence showing that dental caries and toothache can impact academic performance as they disrupt sleep and study performances to influence the learning and cognition process. The finding bridges the understanding of the mechanism underpinning the relationship and thus, further emphasizes the importance of caries prevention in children with high caries risk for improving their health outcomes and educational experience.

[Pediatric inpatient interdisciplinary multimodal pain treatment in Germany]

BACKGROUND

Severely disabling chronic pain affects approximately half a million children in Germany. If there is a lack of response to unimodal treatment, an inpatient interdisciplinary multimodal pain treatment (IMPT) can be considered.

OBJECTIVE

This review article describes the supply situation of pediatric inpatient IMPT in Germany and presents the current evidence on the effectiveness.

MATERIAL AND METHODS

Based on a systematic literature search, studies addressing the effectiveness of pediatric inpatient IMPT in Germany were identified. In addition, further sources were used to extract information on pediatric IMPT treatment centers in Germany in order to describe the treatment approaches, the qualification of personnel and characteristics of patients.

RESULTS

There are four pediatric pain centers in Germany that are specialized in inpatient IMPT for children and adolescents. Treatment duration ranges between 3 and 4 weeks. The multimodal treatment is carried out by a multiprofessional team and is generally available for patients up to 18 years. The majority of patients are female. The effectiveness of pediatric IMPT in Germany was investigated up to 4 years after treatment. Positive effects were shown for pain characteristics and also for the emotional burden. Additional treatment modules can facilitate further optimization of treatment effects.

CONCLUSION

Further research on the effectiveness of IMPT in Germany is important in order to refine and optimize the available treatment programs.

The prevalence of chronic pain in adolescents in Central Switzerland: A cross- sectional school-based study protocol

BACKGROUND

Chronic pain is associated with substantial personal suffering and societal costs and is a growing healthcare concern worldwide. While chronic pain has been extensively studied in adults, limited data exists on its prevalence and impact in adolescents. Understanding the prevalence and impact of chronic pain and pain beliefs in adolescents is crucial for developing effective prevention and treatment strategies. This study aims to estimate the prevalence, characteristics, and impact of chronic pain, and explore adolescents' knowledge and beliefs about pain.

METHODS

This is an observational cohort study of school-going adolescents aged 11 to 17 years in Central Switzerland. The study will estimate the point prevalence, characteristics (location, intensity, frequency, duration) and impact (PROMIS Pediatric Short Form v2.0 -Pain Interference Scale, PPIS) of chronic pain in school-going adolescents. We will also measure and investigate pupils' beliefs about pain (Concept of Pain Inventory (COPI)). Data will be collected through manual and digital self-report questionnaires and from participants in primary, secondary, and high schools between September 2023 and January 2024.

ANALYSES

The primary analyses will utilise descriptive statistics to estimate the point prevalence, characteristics, and impact of chronic pain. Secondary analyses will analyse associations and correlations between chronic pain, impact of pain and beliefs about pain.

OUTCOMES

This study will provide an estimate of the prevalence, characteristics and impact of chronic pain in adolescents in Central Switzerland and a measure of adolescents' understanding and beliefs about pain. In doing so, this study will provide insights into the scale of chronic pain as a public health concern. By understanding adolescents' pain beliefs and their influence on pain experience, this study can contribute to the development of educational approaches to enhance adolescents' knowledge and understanding of pain in order to optimise the prevention and treatment of chronic pain in adolescents. The findings may be useful to healthcare professionals and funders, policymakers, and researchers involved in the prevention, assessment, and treatment of pain in adolescents.

Parent-perceived recurrent pain in children: associations with maternal pain, depressiveness, socioeconomic status, and children's behavioural difficulties

Objectives

The current study aimed to examine the potential transgenerational associations between maternal pain and depressiveness and childhood pain, and to explore the associations between the children's difficulties and recurrent pain (defined as pain occurring at least once a month in the previous 6 month) in healthy children aged 3-13 years.

Methods

We collected Data between 2015 and 2019 as part of the LIFE Child study in Germany and investigated associations of maternal pain and depressiveness, child age, sex, pubertal stage, emotional difficulties, conduct difficulties, hyperactivity/inattention, peer group difficulties, and prosocial skills, and family socioeconomic status with the frequency of parent-perceived headache, backache, and stomachache in a sample of 1,850 children (4,819 documented visits) using logistic and ordinal regression analyses.

Results

Overall, 10.4%, 24.4%, and 45.2% of parents reported their children had recurrent backache, headache, and stomachache, respectively, with 5.5% of children were reported to experience all three types of pain simultaneously. Higher age, female sex, puberty, emotional difficulties, low family socioeconomic status, as well as higher maternal impairment due to pain and maternal depressiveness were significantly associated with more frequent pain.

Conclusions

Our study suggests that maternal pain, maternal depressiveness, and lower family socioeconomic status as well as child's emotional difficulties are significantly associated with a higher frequency of recurrent pain in children perceived by their parents.

School nurses and menstrual communication: Destigmatizing the stigma among adolescents

OBJECTIVE

The purpose of this study is to understand how school nurses, often the first line of defense for menstruating adolescents, use communication to assist adolescents in destigmatizing menstruation.

DESIGN

I conducted semi-structured narrative interviews with nine nurses employed in a large school district in Northeast Indiana.

METHODS

Interviews were coded, categorized, and used a phronetic iterative approach.

RESULTS

Analysis determines that nurses assist menstruating students using steps toward accepting menstruation and suggesting ways to avoid menstrual stigmatization.

CONCLUSION

This study suggests that school nurses use positive language to assist students in handling their menstruation problems, develop allyships with parents and other teachers, and stress menstrual education. This study highlights the need for more funding for menstrual products and additional school nurses.

Adolescents' Experience of Pain: A Focus Group Study in Sweden

The purpose of this study was to describe experiences of pain among students at upper secondary schools (adolescents aged 16-19 years) in Sweden. Focus group (n = 9) interviews with 41 adolescents were conducted in southern Sweden in 2021. The interviews were analyzed by qualitative content analysis, which identified four categories encompassing the theme how pain expressed itself: (1) a warning bell-the body's way of saying that something is wrong; (2) school- and work-related pain; (3) interpersonal physical and emotional pain; and (4) heartache-a sign of humanity; and four categories describing the theme ways of dealing with pain: (1) turn your attention elsewhere; (2) "bite the bullet" and endure the pain; and (3) use painkillers or complementary treatments; and (4) ask for help from others. Findings are linked to the crucial role of school nurses in supporting students who experience pain.

Umbrella systematic review finds limited evidence that school absence explains the association between chronic health conditions and lower academic attainment

Introduction

Absence from school is more frequent for children with chronic health conditions (CHCs) than their peers and may be one reason why average academic attainment scores are lower among children with CHCs.

Methods

We determined whether school absence explains the association between CHCs and academic attainment through a systematic review of systematic reviews of comparative studies involving children with or without CHCs and academic attainment. We extracted results from any studies that tested whether school absence mediated the association between CHCs and academic attainment.

Results

We identified 27 systematic reviews which included 441 unique studies of 7, 549, 267 children from 47 jurisdictions. Reviews either covered CHCs generally or were condition-specific (e.g., chronic pain, depression, or asthma). Whereas reviews found an association between a range of CHCs (CHCs generally, cystic fibrosis, hemophilia A, end-stage renal disease (pre-transplant), end-stage kidney disease (pre-transplant), spina bifida, congenital heart disease, orofacial clefts, mental disorders, depression, and chronic pain) and academic attainment, and though it was widely hypothesized that absence was a mediator in these associations, only 7 of 441 studies tested this, and all findings show no evidence of absence mediation.

Conclusion

CHCs are associated with lower academic attainment, but we found limited evidence of whether school absence mediates this association. Policies that focus solely on reducing school absence, without adequate additional support, are unlikely to benefit children with CHCs.

Systematic review registration

https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=285031, identifier: CRD42021285031.

Teaching the Subject of Nursing—Academic Teaching Based on Dossey's Holistic Nursing Theory

Introduction

Being a teacher of nursing education can be challenging. Nursing theories can guide clinical nurses in their work, but is it possible to apply a nursing theory in the context of academic teaching?

Purpose

To investigate if it is possible to apply Dossey's holistic nursing theory into the context of teaching the subject of nursing.

Conclusion

This article proposes that Dosseys holistic nursing theory could be applied in the context of nursing education.

Celiac disease and upper secondary school achievement in Sweden A retrospective cohort study

BACKGROUND

Both undiagnosed celiac disease and some chronic childhood diseases are associated with lower academic achievement. However, there is little knowledge of achievements in those diagnosed with celiac disease. Our aim was to investigate school achievements in upper secondary school among Swedish adolescents with celiac disease.

METHODS

We performed a retrospective cohort study using register data. We analyzed choice of upper secondary school program, completion of upper secondary school including achievements of basic eligibility for college/university, and final grade in individuals with celiac disease diagnosed before 15 years of age, born 1991-97. We compared with the Swedish population of the same birth years. Analyses were adjusted for sex, year of birth, living region at 17 years of age, and parental education as well as income.

RESULTS

The cohort included 734 074 individuals, whereof 3 257 (62% females) with celiac disease. There was no significant difference in choice of upper secondary school program. No significant difference was found in completion or achieving basic eligibility for college/university in adjusted analyses. The mean final grade in the celiac disease group was 13.34 (standard deviation 4.85) compared to 12.78 (standard deviation 5.01) in the reference population (p < 0.001), out of a maximum of 20. The effect of celiac disease on final grade remained in adjusted analyses (p = 0.012).

CONCLUSIONS

We found that diagnosed celiac disease does not negatively affect school achievements in upper secondary school. This finding suggests the diagnosis, treatment and follow-up programs of celiac disease could reverse potential deleterious academic processes.

Laboured reading and musculoskeletal pain in school children - the role of lifestyle behaviour and eye wear: a cross-sectional study

Background

Lifestyle behaviour in children and adolescents has become increasingly sedentary and occupied with digital work. Concurrently, there has been an increase in the prevalence of headache, neck- and low back pain, which are leading causes of disability globally. Extensive near work and use of digital devices are demanding for both the visual system and the upper body head-stabilizing musculature. Uncorrected vision problems are present in up to 40% of Nordic school children, and a lack of corrective eye wear may cause eyestrain, musculoskeletal pain and headache. The aim of this study was to investigate associations between laboured reading, musculoskeletal pain, uncorrected vision, and lifestyle behaviours in children and adolescents.

Methods

This was a cross-sectional study with a total of 192 Norwegian school children aged 10–11 and 15–16 years. As a part of a school vision testing program, the children completed an online questionnaire about general and ocular health, socioeconomic status, academic ambition, near work and related symptoms, upper body musculoskeletal pain, and physical and outdoor activities.

Results

The 15–16-year-olds had a more indoor, sedentary, digital-based lifestyle with higher academic demands, compared with the 10–11-year-olds. Concurrently, reading became more laboured and upper body musculoskeletal pain increased with age. Girls reported more symptoms, higher academic ambitions, and more time spent on schoolwork and reading, compared with boys. Non-compliance in wearing prescribed eye wear (glasses or contact lenses), increased use of near digital devices, and experiencing visual stress (glare) were positively associated with laboured reading and upper body musculoskeletal pain.

Conclusions

A screen-based lifestyle with high academic demands challenges the ability to sustain long hours of static, intensive near work. Extensive near work tires the visual system and upper body musculature and provokes laboured reading and musculoskeletal pain symptoms. This study emphasizes the importance of regular eye examinations in school children, and the need to raise awareness among children, parents, and school- and health personnel about the importance of optimal vision and visual environment for academic performance and health.

Palestinian and Norwegian Kindergarten Teachers' Perspectives on Psychosocial Support: A Qualitative Study

The current qualitative case study aims to explore and map the concepts and the conditions for providing psychosocial support in kindergarten across two vastly different countries, Palestine and Norway. The global challenge of providing psychosocial support toward children is increasingly acknowledged. Although education is described as crucial for psychosocial support from the health sector, studies dealing with the educational perspective on this topic are rare. Data from 26 participants (10 from Gaza, 10 from Hebron and 6 from Norway) were collected in qualitative semi-structured interviews. Despite vastly different contexts, the analysis showed some important common features. Kindergarten teachers in both countries link psychosocial support conceptually to psychological and emotional knowledge. The teachers in both countries are concerned about the psychosocial support being performed repeatedly in everyday situations, such as establishing routines, paying extra attention, and calming children and creating everyday safe spaces. They give detailed descriptions of the quality of their long-term, yet professional relations with the child. Time and space are crucial challenges in both countries, and they call for more knowledge on mental health. A main difference between the two countries was the role of the community and relation to parents. The Palestinian teachers defined psychosocial support as a “set of community services,” the teachers were frustrated with the lack of parental collaboration. The Norwegian teachers downscaled or overlooked the importance of community or parents and community. The findings give overall presentations of the concepts and the conditions for providing psychosocial support in education Palestine and Norway. We argue that education not only represents sites for conducting health-directed interventions but represents important resources for developing the field of psychosocial support in collaboration with community services. Education – and especially kindergarten provides other values, knowledge, and structural resources for the development programs and knowledge on psychosocial support.

A Philosophical Review of School Nursing Framed by the Holistic Nursing Theory of Barbara Dossey

This article is a philosophical review of school nursing and its constructs framed by Barbara Dossey's holistic nursing theory. The author describes the application of holistic nursing theory within the school nurse's area of activity. The review suggests that holistic nursing theory can be applied in several areas of school nursing. School nurses have a multifaceted occupation that includes meetings with students, parents, and school staff. Barbara Dossey's holistic nursing theory offers the school nurse tools to deal with people's varied experiences, feelings, and needs.

Anger as a Mechanism of Injustice Appraisals in Pediatric Chronic Pain

Mechanisms explaining the relationship between pain-related injustice appraisals and functional outcomes in youth with chronic pain have yet to be examined. In studies of adults, greater pain-related injustice is associated with worse depressive symptoms and greater pain through greater anger. No study to date has examined anger expression as a mediator in the relationships between pain-related injustice appraisals and physical and psychosocial functioning in youth with chronic pain. The current sample consisted of 385 youth with varied pain conditions (75% female, 88% White, M_age=14.4 years) presenting to a university-affiliated pain clinic. Patients completed self-report measures assessing anger expression (anger-out and anger-in), pain-related injustice, pain intensity, functional disability, and emotional, social, and school functioning. Bootstrapped mediation analyses indicated that only anger-out (indirect effect= -.12, 95% CI: -.21, -.05) mediated the relationship between pain-related injustice and emotional functioning, whereas both anger-out (indirect effect= -.17, 95% CI: -.27, -.09) and anger-in (indirect effect= -.13, 95% CI: -.09, -.001) mediated the relationship between pain-related injustice and social functioning. Neither mode of anger expression mediated the relationship between pain-related injustice and pain intensity, functional disability, or school functioning. Collectively, these findings implicate anger as one mechanism by which pain-related injustice impacts psychosocial outcomes for youth with chronic pain. Perspective: Anger expression plays a mediating role in the relationship between pain-related injustice appraisals and psychosocial outcomes for youth with chronic pain. Anger represents one target for clinical care to decrease the deleterious impact of pain-related injustice on emotional and social functioning.

Educational Needs and Resources for Teachers Working with Students with Chronic Pain: Results of a Delphi Study

Children and adolescents spend most of their time at school. Therefore, teachers could be of help to improve the quality of life of students with chronic pain while they are at school. The aim of this study was to identify teachers’ educational needs and resources to help improve the adjustment to and function in the school of students with chronic pain. A Delphi survey including two rounds was conducted. Overall, 49 needs were identified in the first round. They were related to education, training, organization/logistics, and communication with the family and the health care center. Among the most important needs, based on the importance given and consensus reached, were (1) having information about the most appropriate attitudes and responses to a student with chronic pain, (2) how to reduce absenteeism, (3) how to ease the return to school after a long absence due to his or her pain problem, and (4) how to establish effective communication with the family. The results of this study provide new important data on the educational needs and resources which teachers would like to have to help their students with chronic pain at school, which could be used to develop educative programs for teachers.

Schoolchildren's experience of pain-A focus group interview study

AIM

To explore the experience of pain in 10- to 12-year-old children.

METHODS

This interview study included students (n = 42) in grade 4-6 in focus groups (n = 10) in southern Sweden (52% girls); mean age, 11.3 years (range 10-12 years). The interviews were audio-recorded and transcribed verbatim and analysed with qualitative content analysis.

RESULTS

The analysis resulted in one theme: Pain as a unique experience for each individual, which was divided into five categories: (a) Feeling bodily pain; (b) Pain related to the school environment and schoolwork; (c) Internal pain related to sorrow and grief; (d) Pain related to conflicts and remorse; and (e) Pain can be good.

CONCLUSION

The children made distinctions between physical pain and emotional pain. Bullying, noisy school environments, grief and remorse were reported to be linked with headaches, stomachache and heartache.

A Focus Group Interview Study of the Experience of Stress amongst School-Aged Children in Sweden

The study explored experiences of stress in children aged 10–12. An inductive qualitative design was used. Ten focus group interviews were conducted with Swedish schoolchildren (n = 42) aged 10–12. The interviews were audio-recorded, transcribed verbatim, and analyzed using qualitative content analysis. The study identified one theme—“Body and mind react”—and three subthemes: (1) Friendships matters, (2) Parental stress affect, and (3) Trying to do my best. Stress often occurred in the children’s everyday environment. The children had experienced how stress could be expressed both physically and mentally, inside and outside school. The children also had the experience of seeing people in their environment being stressed, which could create feelings that affected the children. The experience of the children was also that stress can sometimes be good. Stress related to peers, family, school, and society was commonly experienced by children aged 10–12. Both positive and negative stress was reported.

Longitudinal study of associated factors with adolescent health: Method and sample profile

Abstract The aim of this work was to describe the methodological procedures of a longitudinal study on adolescent health, as well as to characterize the sample profile. This research enrolled a sample of 302 adolescents from Londrina - Paraná. Two data collections were carried out with an interval of three years. Anthropometric indicators, blood pressure, heart rate, back pain, academic achievement, physical activity, sedentary behavior, eating habits, alcohol consumption, smoking, socioeconomic status, and motor tests were collected. There was a frequency of high blood pressure of 10.4%; body mass index in conditions associated with health risk of 22.4%; and spinal pain with moderate intensity of 22.1%. Sport and/or physical exercise practice (moderate-to-vigorous; ≥150 minutes/week) was 33.1%. High consumption of unhealthy foods and beverages ranged from 21.2% (coffee or tea) to 58.0% (fried foods). A high proportion (87.1%) reported never having smoked. The grades frequency ≥ seven varied between 21.4% (Biology) and 71.1% (Physical Education). Only 33.2% presented high academic achievement. The highest compliance with criteria was in the curl-up (76.4%) and the lowest in the 90º push-up (37.2%). This work will make it possible to verify the tracking of different behavioral and biological indicators related to health, as well as academic achievement. It will also allow the identification of the association between health outcomes and exposure factors prospectively, considering the influence of potential confounding variables. This information could contribute to the planning of public health interventions and policies.

Perceived problems with academic achievement in school-aged children with recurrent pain - a longitudinal study

Aims: The overall aim was to explore the relationship between recurrent pain and perceived problems with academic achievement among boys and girls in middle and late elementary school. Methods: This 3-year follow-up study was based on data from the Study of Health in School-aged Children from Umeå (Sweden) and included children attending grade 6 in years 2003 and 2006, and a follow-up 3 years later in grade 9 (n = 1524, participation rate 90%). Results: Recurrent pain (head, stomach or back) at least doubled the odds of concurrent- and subsequent perceived problems with academic achievement. This applied for pain on a monthly and weekly basis, from single and multiple sites, and from each of the three studied pain sites. The odds increased with increasing pain frequency and number of pain sites. Problems with sleep, concentration or school absenteeism did not explain the association. Conclusions: Recurrent pain seems to be a potential predictor of perceived problems with academic achievement for school-aged children. This emphasises the importance of early identification and prevention of recurrent pain problems.

Development of the Help Overcoming Pain Early (HOPE) Programme Built on a Person-Centred Approach to Support School Nurses in the Care of Adolescents with Chronic Pain-A Feasibility Study

Chronic pain and its consequences are major global health challenges, and the prevalence is increasing worldwide among adolescents. Adolescents spend most of their waking hours in school; however, there is limited research available on how school nurses can address chronic pain among adolescents in the Swedish school context. Therefore, we designed a person-centred intervention, known as Help Overcoming Pain Early (HOPE), to enable school nurses to offer adolescents strategies to manage their stress and pain. We used the Medical Research Council (MRC) framework for developing and designing this new complex intervention. For this study, we describe two of the four phases: (a) development and (b) feasibility and piloting. The final version of the HOPE programme consists of (i) an educational package for school nurses in the areas person-centred care, stress and pain education/management and gender perspective; and (ii) an intervention package for adolescents with chronic pain. The programme consists of four sessions during which adolescents with chronic pain have person-centred dialogues with a school nurse. The HOPE programme is based on the existing evidence of managing chronic pain and on the assumption that school nurses can support adolescents with chronic pain by using person-centred care.