Measuring Pain in Adolescents

Abstract

Pain is one of the more common complaints of adolescents, but research on adolescent pain lags behind that of pain in adults. Research has increased during the past decade, calling attention to the need for improved measurement of adolescent pain. Although children become more able to accurately report pain as they develop, measuring pain in adolescents can be complex. With the cognitive and psychological development that occurs throughout adolescence, pain becomes a multifaceted experience, not merely a sensory experience. In addition, the nature of the pain (e.g., acute, chronic, or complex) can influence the experience. Accurate measurement of pain is important not only for understanding illness phenomena but also for evaluating the effects of interventions. Therefore, using developmentally appropriate, reliable, and valid pain measures with adolescents is critical. Numerous pain measures are available; determining which measure is most suitable for adolescents in research can be challenging. Better understanding of pain measurement may lead to increased reliability in the measurement of adolescent pain in research studies. Untreated pain has detrimental effects on major body systems because of the activation of the stress response (Rothley & Therrien, 1999). The stress response causes cardiovascular changes such as tachycardia and hypertension. Stress on the gastrointestinal system can cause decreased peristalsis, resulting in constipation. In addition, early diagnosis and treatment is extremely important with respect to outcomes in certain pain conditions. For example, in cases of Complex Regional Pain Syndrome (CRPS) type 1, early intervention, specifically physiotherapy, leads to better prognoses (Eccleston, Connell, & Carmichael, 2006). Chronic pain is not just a problem of adults; up to 25% of children have chronic pain (Perquin et al., 2000), with it peaking at ages 12 to 15 years (Goodman & McGrath, 1991). Disability associated with chronic pain, particularly untreated chronic pain, is not as clearly defined as with acute pain, nor is the degree of suffering associated with it. However, children with chronic pain have exhibited lower pain thresholds; in other words, they do not get ‘‘used to’’ the pain (Walco, Dampier, Hartstein, Djordjevic, & Miller, 1990). Thus, it is important to carefully consider how pain should be measured when conducting research involving adolescents. Although pain is multidimensional, the dimension that is frequently measured is pain intensity. Other sensory dimensions (e.g., quality, location, and temporal aspects) should be measured, as should affective dimensions of pain (e.g., impact on physical and psychosocial function). The impact of pain on functioning often