Abstract
Although pain is widely recognized to be a multidimensional experience and defined as such, unidimensional pain measurement focusing on pain intensity prevails in the pediatric acute pain context. Unidimensional assessments fail to provide a comprehensive picture of a child’s pain experience and commonly do little to shape clinical interventions. The current review paper overviews the theoretical and empirical literature supporting the multidimensional nature of pediatric acute pain. Literature reporting concordance data for children’s self-reported sensory, affective and evaluative pain scores in the acute pain context has been reviewed and supports the distinct nature of these dimensions. Multidimensional acute pain measurement holds particular promise for identifying predictive markers of chronicity and may provide the basis for tailoring clinical management. The current paper has described key reasons contributing to the widespread use of unidimensional, rather than multidimensional, acute pediatric pain assessment protocols. Implications for clinical practice, education and future research are considered.
Highlights
A comprehensive and concise assessment of acute pediatric pain is critical in helping health professionals understand a patient’s pain experience, identify changes in the patient’s condition, informing clinical responses, and establishing the efficacy of a clinical response
If the potential benefits of multidimensional acute pain assessment are to be actualized in the clinical pediatric acute pain context, further work is needed in the development of age-appropriate affective and evaluative self-report assessment tools [9], research into the potential clinical application and value of multidimensional assessment [1], education of health professionals on the multidimensional nature of the acute pain experience and possible assessment methods [14], and expansion of multidimensional assessment to include the child’s social context [15]
Despite pain being widely acknowledged to be a multidimensional experience, sensory-focused, unidimensional pain assessments are still common in the pediatric acute pain context
Summary
A comprehensive and concise assessment of acute pediatric pain is critical in helping health professionals understand a patient’s pain experience, identify changes in the patient’s condition, informing clinical responses, and establishing the efficacy of a clinical response. The focus of the current review is on the nature and importance of eliciting multidimensional self-reported information about the pediatric acute pain experience. While a strong case has been made elsewhere for the value of multidimensional acute pain assessment for the purposes of a diagnostic aid and achieving more nuanced acute pain taxonomy [12], the current paper has adopted a broader conceptual focus on the importance of eliciting multidimensional self-report information about a child’s pain experience, giving consideration to the potential benefits this may confer on clinical response and outcomes. This review was carried out in light of the surprising lack of research evidence and clinical practice that utilizes and integrates measurement of sensation together with assessment of affective and cognitive dimensions of children’s acute pain. This review focuses on the internal pain experience and psychological aspects, rather than on functional outcomes (e.g., sleep disturbance, daily activities, school functioning, etc.) which are important to assess and consider but are outside the scope of the current review
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