The Concept of Pain Inventory (COPI): Assessing a Child's Concept of Pain.

OBJECTIVES: Clinical guidelines recommend that health care providers assist children to understand their experience of persistent pain, with pain science education a key component of clinical management in pediatric pain clinics. Currently, no tool exists to assess a child's concept of pain. The aim of this study was to develop such a tool and to evaluate its psychometric properties. METHODS: After a rigorous process to generate items, assess content validity, evaluate readability and understandability, and pretest items, a cohort of 124 children (aged 8 to 12 y) independently completed the measure on 2 occasions, along with additional measures of pain, function, and pain-related distress. RESULTS: The resulting unidimensional 14-item Concept of Pain Inventory (COPI) had acceptable internal consistency (α= 0.78) and moderate test-retest reliability (intraclass correlation coefficient (3,1) = 0.55; 95% CI, 0.37-0.68). Higher COPI scores reflect greater alignment with contemporary pain science. COPI scores were inversely correlated with pain intensity and functional disability, but unrelated to pain catastrophizing and pain-related fear. At 1 to 2 months' follow-up, baseline COPI scores were inversely correlated with clinical variables of functional disability and pain intensity. DISCUSSION: These results support the COPI as a brief, psychometrically sound tool to assess a child's concept of pain. Clinically, this tool may facilitate individualized pain science education to target identified conceptual "gaps" or misconceptions and to evaluate the effectiveness of pain science education in children. Further research examining its efficacy and impact is warranted.

Prognostic factors for pain and functional disability in children and adolescents with persisting pain: A systematic review and meta-analysis.

BACKGROUND AND OBJECTIVE: The aim of this study was to investigate prognostic factors for pain and functional disability in children and/or adolescents with persisting pain. DATABASES AND DATA TREATMENT: To be included, studies had to be published, peer-reviewed prospective cohort studies of children and/or adolescents with persisting pain at baseline, that reported at least one baseline prognostic factor and its relationship with pain or functional disability at least 1 month after baseline. Two reviewers independently assessed study eligibility, completed data extraction and undertook quality assessment. Meta-analyses were performed when a prognostic factor was reported in two or more studies. RESULTS: Of 10,992 studies identified from electronic database searches, 18 were included, investigating 62 potential prognostic factors. In clinical settings, insufficient data were available for meta-analysis. Some positive associations with pain and/or disability were reported by single studies for older age, baseline pain intensity and baseline functional disability across multiple combinations of follow-up times and outcomes. In community settings, meta-analyses of two studies found that prognostic factors for the ongoing presence of pain at medium-term (1-year) follow-up were older age (OR 1.25; 95% CI = 1.05-1.47), weekly day tiredness (OR 1.69; 95% CI = 1.14-2.51), weekly abdominal pain (OR 1.44; 95% CI = 1.03-2.02) and waking during the night (OR 1.49; 95% CI = 1.05-2.13). No studies in community settings reported on prognostic factors for functional disability. CONCLUSIONS: Prognostic factors having significant associations with future pain and disability were identified; however, as few were investigated in more than one comparable study, the results need to be interpreted with caution. SIGNIFICANCE: Prognostic factors from across the biopsychosocial spectrum are important to consider in paediatric pain clinical practice. However, most prognostic factors that experts have previously agreed upon have not been assessed in prospective cohort studies to date. The findings may help with prioritising data to collect during clinical assessments of children presenting with pain, in the context of pain and functional disability outcomes.

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

OBJECTIVE: A 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. DESIGN: In-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. SETTING: Children 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. PARTICIPANTS: Eight children had persistent pain and eight children were pain free. RESULTS: Four 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. CONCLUSIONS: Gaining 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.

The Management of Complex Pain in Children Referred to a Pain Clinic at a Tertiary Children's Hospital in Australia.

Synopsis One of the key aspects of good health care for children and young people is the prevention and management of pain. The experience of persistent pain in children and adolescents not only has a major impact on physical, emotional, social, and developmental well-being, but also impacts the broader world, which includes family, school, and social networks. The multidisciplinary pediatric pain clinic adopts a holistic approach to care through a biopsychosocial model. One outcome of an initial pediatric pain clinic review is the creation of a pain management plan that addresses the pharmacological, physical, psychological, and other domains of care. Pediatric pain clinics are improving access by embracing technology through tele-health and internet-based treatment options. Outcome measurement will guide the development of models of care in the future. J Orthop Sports Phys Ther 2017;47(10):806-813. Epub 12 Sep 2017. doi:10.2519/jospt.2017.7355.