Remembering the hurt of childhood: A psychological review and call for future research.

Abstract

From the first days of life, children encounter pain. Whether a result of commonly experienced medical procedures (e.g., vaccine injections) or minor injuries resulting in bumps and bruises, children frequently experience pain. Given the highly subjective nature of pain (Merskey & Bogduk, 1994) and the powerful modulating influence that one's cognitions, emotions, and behaviours can have on how pain is experienced, pain is a fascinating field for psychological inquiry. Early pain experiences provide rich learning contexts within which children's pain cognitions and behaviours are socialized. Childhood pain experiences set the stage for pain coping across the life span.One particularly important aspect of pain phenomenology is memory for pain. Pain memory is a critical cognitive requirement for children to self-report on their pain (Chan & von Baeyer, 2016) and invariably shapes their future pain coping (Noel, Chambers, Petter, et al., 2012; von Baeyer, Marche, Rocha, & Salmon, 2004). How individuals remember pain from childhood can have a lasting impact on their future pain and health behaviours well into adulthood. Children's explicit memories for pain have been implicated in the development of fears (e.g., needle phobias) and avoidance of medical care into adulthood (McMurtry et al., 2015). Moreover, conceptual models put forth to understand the development and maintenance of pediatric chronic pain and comorbid mental health issues posit that distressing pain memories may be an underlying cognitive mechanism (Holley, Willson, Noel, & Palermo, 2016). Importantly, pain memories are malleable, particularly in early childhood, making them a powerful target in psychological pain management interventions (Noel, 2016). Changing the pain memory can change the pain experience (Chen, Zeltzer, Craske, & Katz, 1999; Pickrell et al., 2007). Given the deleterious long-term impact of poorly managed acute pain (McMurtry et al., 2015) and the growing (King et al., 2011), costly (Groenewald, Wright, & Palermo, 2015), and debilitating (Palermo, 2000) epidemic of pediatric chronic pain, which pain memories may underlie, understanding the development and modifiable nature of children's pain memories is critically important.Early research on children's pain memories focused on whether or not children could be accurate reporters of their pain. This research had forensic and clinical implications, shedding light on whether or not children could reliably provide eyewitness testimony following stressful/painful events (e.g., abuse) and report on past pain for treatment purposes (e.g., prescribing of pain medications). Researchers then began to examine individual predictors of recall accuracy. Longitudinal studies on the role of pain memories in shaping subsequent pain experiences have been few and far between (Chen, Zeltzer, Craske, & Katz, 2000), and although some researchers have developed and tested interventions to modify pain memories to, in turn, alter subsequent pain experiences (Chen et al., 1999; Pickrell et al., 2007), there has been a dearth of treatment research in this area.This article provides a narrative review of the literature on children's memory for pain. It builds upon previous reviews on this topic (Noel, Chambers, Petter, et al., 2012; Ornstein, Manning, & Pelphrey, 1999; von Baeyer et al., 2004) by synthesizing literature published in the past 5 years. In light of advances in neuroimaging techniques and research in pediatric pain, we summarise relevant literature on the neurobiology of pain memories to stimulate future interdisciplinary research in this area. Given the integral role of children's pain memories in subsequent pain experiences, the potential role of pain memories in the development and maintenance of chronic pain and comorbid psychopathology (e.g., PTSD; Holley et al., 2016), and the development of new memory reframing techniques (Marche, Briere, & von Baeyer, 2016), understanding this literature, and how to advance it, is timely. …