Children's Behavioral Pain Cues: Implicit Automaticity and Control Dimensions in Observational Measures.

Kamal Kaur Sekhon,Judith Versloot,Samantha R Fashler,Kenneth D Craig,Spencer Lee

doi:10.1155/2017/3017837

Abstract

Some pain behaviors appear to be automatic, reflexive manifestations of pain, whereas others present as voluntarily controlled. This project examined whether this distinction would characterize pain cues used in observational pain measures for children aged 4–12. To develop a comprehensive list of cues, a systematic literature search of studies describing development of children's observational pain assessment tools was conducted using MEDLINE, PsycINFO, and Web of Science. Twenty-one articles satisfied the criteria. A total of 66 nonredundant pain behavior items were identified. To determine whether items would be perceived as automatic or controlled, 277 research participants rated each on multiple scales associated with the distinction. Factor analyses yielded three major factors: the “Automatic” factor included items related to facial expression, paralinguistics, and consolability; the “Controlled” factor included items related to intentional movements, verbalizations, and social actions; and the “Ambiguous” factor included items related to voluntary facial expressions. Pain behaviors in observational pain scales for children can be characterized as automatic, controlled, and ambiguous, supporting a dual-processing, neuroregulatory model of pain expression. These dimensions would be expected to influence judgments of the nature and severity of pain being experienced and the extent to which the child is attempting to control the social environment.

Highlights

Success in communicating an experience of pain to others can be a vital social transaction when there are threats to personal safety [1]
The capacity to signal pain to others is manifest in the neonate [2, 3] and improves with the advent of language and rapidly expanding vocabularies of words related to pain in children [4, 5]
Observational pain scales focusing upon nonverbal behaviors have emerged to provide comprehensive pain assessment of children [7], either in conjunction with self-report or when self-report is not available or unreliable [10]

Summary

Introduction

Success in communicating an experience of pain to others can be a vital social transaction when there are threats to personal safety [1]. Observer skill in understanding the location, quality, and severity of pain, as well as the reason for pain expression, may facilitate delivery of care. Children may be (1) too young to understand or use the self-report scale; (2) experiencing pain that is too severe for use of self-report; (3) cognitively or communicatively impaired; (4) restricted from use of self-report by bandages or mechanical ventilation; or (5) voluntarily suppressing or exaggerating their report of pain [8, 9]. Observational pain scales focusing upon nonverbal behaviors have emerged to provide comprehensive pain assessment of children [7], either in conjunction with self-report or when self-report is not available or unreliable [10]

Methods

Results

Conclusion