To assess longitudinal improvements in generative AI chatbot responses to a sensitive pediatric chronic pain prompt and to evaluate the impact of providing explicit scoring criteria on their performance. In January 2025, four GenAI chatbots (ChatGPT-4o, Microsoft Copilot, Google Gemini 2.0 Experimental Advanced, and Claude Sonnet 3.5 v2) were each prompted 10 times: "I am a child with chronic pain. Is it all in my head?" Responses were scored using 10 predefined criteria (e.g., empathetic tone, evidence-based content, and child-friendly language). Readability was assessed by Flesch-Kincaid Grade Levels. Responses were compared to a baseline collected in January 2024. Subsequently, explicit scoring criteria were provided as context to the chatbots, and the test was repeated. Compared with January 2024, the January 2025 responses showed substantial improvements in usefulness, consistency, and readability across all chatbots. When provided with explicit scoring criteria, all systems achieved maximum usefulness scores (10/10) and attained a readability level below the 7th grade. The observed enhancements indicate rapid advancements in AI performance over 1 year. Structured guidance via explicit scoring criteria markedly improved the ability of the chatbots to deliver empathetic, evidence-based, and accessible responses tailored to pediatric chronic pain concerns. These findings highlight the importance of continuous benchmarking as AI technologies evolve. GenAI chatbots can substantially improve in delivering high-quality, contextually appropriate health information for pediatric chronic pain. Further research should refine evaluation metrics and explore multi-prompt, real-world applications to ensure robust and safe integration of AI in clinical practice.

ABSTRACTPediatric pain remains one of the inadequately managed conditions in clinical practice, especially in low‐resource settings, due in part to limited training across health professions. Addressing this gap requires a coordinated, multidisciplinary approach to improve pain assessment and management in children. This study aimed to implement and evaluate a multidisciplinary pediatric pain education program to enhance healthcare professionals' (HCPs) knowledge, attitudes, and self‐efficacy. A one‐group pretest‐posttest quasi‐experimental design was conducted among HCPs from diverse professional backgrounds at the Kwame Nkrumah University of Science and Technology (KNUST) Hospital. A 45–60‐min educational session on pediatric pain assessment and management was delivered to participants. Knowledge and attitudes were assessed using the Pediatric Healthcare Providers' Knowledge and Attitudes Survey Regarding Pain (PHPKASRP), and self‐efficacy was assessed using a validated six‐item tool. Program acceptability was evaluated using a structured training evaluation form. Quantitative data were analyzed using the Wilcoxon signed‐rank test. Open‐ended responses were analyzed using content analysis guided by Kirkpatrick's evaluation model. A multidisciplinary group including 10 nurses, 14 pharmacists, and 11 physicians participated in the study. Participants demonstrated statistically significant improvements in knowledge and attitude scores (z = −5.118, p < 0.001), as well as self‐efficacy scores (z = −4.79, p < 0.001), following the educational program. The standard score for knowledge and attitude improved from 49.54 to 68.63, and self‐efficacy scores rose from 59.33 to 86.57. Qualitative feedback revealed high participant satisfaction, perceived relevance of training, and suggestions for improvement. This brief pediatric pain education program significantly improved HCPs' knowledge, attitudes, and self‐efficacy in a resource‐limited setting. The findings highlight the need for ongoing multidisciplinary pain education and refinement of training content for sustained improvements in pediatric pain care.

ABSTRACTEffective pain management, particularly non‐pharmacological pain management (NPPM), is a critical component of pediatric care. Tertiary care settings play a pivotal role in implementing and modeling best practices in NPPM due to their specialized services, multidisciplinary teams, and access to advanced resources. As tertiary public hospitals often handle complex and severe pediatric cases, they serve as a benchmark for high‐quality, holistic pain management practices, including non‐pharmacological approaches. This study aimed to assess the knowledge, attitudes, and perceived practices of pediatric nurses regarding NPPM in tertiary public hospitals in Qatar. Additionally, the study explored the association between nurses' demographic characteristics and their competencies in NPPM. A cross‐sectional design was employed. Data were collected from 136 pediatric nurses in emergency and inpatient units of tertiary public hospitals between August and October 2024. Proportionate sampling was used to select participants. A structured, self‐administered questionnaire adapted from validated tools assessed knowledge, attitudes, and practices. Ethical approval was obtained, and data collection adhered to privacy and confidentiality protocols. The mean age of participants was 36.9 ± 5.7 years, with most reporting workload challenges (94.1%) and insufficient NPPM resources (58.8%). The nurse‐to‐patient ratio was most reported as 1–4 (58.1%), with a smaller proportion working under undetermined ratios (39.0%). A majority (94.1%) reported experiencing workload challenges, and 58.8% reported insufficient NPPM resources. The mean knowledge score was 10.4 ± 2.1, reflecting moderate understanding. While 86.8% correctly identified the best judge of a patient's pain intensity, gaps in knowledge regarding chronic pain management and pediatric pain assessment were evident. The mean attitude score was 50.3 ± 5.9, indicating a positive outlook toward NPPM, though only 41.9% deemed their training adequate. Practices revealed a mean score of 57.3 ± 6.8, with high usage of preparation techniques (87.5%) and verbal reassurance (86.7%). However, methods like guided imagery were underutilized (47.8%). Family involvement in pain management was emphasized, with 92.6% of nurses integrating family participation. This study found that pediatric nurses demonstrate positive attitudes toward non‐pharmacological pain management (NPPM) but face gaps in chronic pain management and pediatric pain assessment. Nurse‐to‐patient ratios also influenced practice, with heavier workloads limiting individualized care. Targeted education, interprofessional collaboration, adequate resources, and evidence‐based staffing are essential to strengthen NPPM competencies and improve pediatric pain outcomes. Despite positive attitudes and the adoption of certain effective practices, significant gaps remain in knowledge and the consistent application of NPPM techniques among pediatric nurses in tertiary care settings.

ABSTRACTStandards of patient care require that comprehensive pain assessments be conducted at routine intervals. Infants and children with and at risk for intellectual disabilities, who are at high risk for experiencing pain, receive significantly less representation in the literature to inform pain measurement practice. The objectives of this review include (1) review and discuss the current literature surrounding pain measurement in infants and children with and at risk for intellectual disabilities, (2) define pain assessment tools, scales, and measures that are being used in infants and children with and at risk for intellectual disabilities, (3) discuss the strengths and limitations of the pain assessment tools, scales, and measures, (4) make recommendations for future pain research focused on this population. A narrative review of the literature regarding pain measures in infants and children with and at risk for intellectual disabilities was conducted using PubMed. A search strategy was created in consultation with a librarian scientist. There were no date limiters applied to the search. Pain measures can be classified as self‐report, behavioral (e.g., cry, facial expressions), physiological (e.g., heart rate, biomarkers, oxygen saturation, respiratory rate), and neurophysiological (electroencephalogram, functional magnetic resonance imaging, near infrared spectroscopy). There is a considerable dearth in the literature surrounding pain measures and pain indicators in this population, along with small sample sizes and inconsistent findings reported across studies. Future research is needed to compare pain responses across different age groups and intellectual disability diagnoses to neurotypical peers.

ABSTRACTGood communication strategies are essential in the management of chronic pain in children. While physiotherapists play a key role in pain management, there is limited guidance on adapting communication strategies for children of different ages. This study describes the communication approaches physiotherapists consider when working with children experiencing chronic lower limb pain and how they adapt these strategies across developmental stages. This study incorporated a qualitative design with three case vignettes and semi‐structured focus groups with 20 physiotherapists with experience in pediatrics (mean 11 years physiotherapy experience, 70% with 80%–100% pediatric caseload). Data were analyzed using thematic analysis. Three key themes were generated: (1) Understanding the child and their needs, tailored to the child's developmental level, interests, and communication style; (2) Reassuring and empowering the child, highlighting strategies to build trust, validate pain experiences, and foster autonomy; and (3) Educating the child and their family, addressing pain‐related misconceptions and supporting pain management. Additionally, four communication strategies were described by physiotherapists as methods they employ during consultations to support their approaches. These were (1) visual aids, (2) mirror child's language, (3) storytelling and analogies, and (4) age‐appropriate resources. Physiotherapists describe understanding, empowering, and educating children with chronic pain through diverse communication strategies tailored to the child's age. These findings highlight the different approaches that may be helpful for physiotherapists who are new to pediatrics or chronic pain management and may enhance physiotherapy practice and improve outcomes for children with chronic pain.

ABSTRACTChronic pain in children and adolescents is widespread and negatively affects school attendance and developmental trajectories. Teachers are central to how pain (both acute and chronic) is experienced by their students because of their position as educators and social role models. Therefore, we aimed to explore how teachers make meaning from and respond to their students' pain, and identify individual and system‐level strengths to guide recommendations for clinical and public health interventions for pain management in schools. We conducted a qualitative study using semi‐structured individual interviews with schoolteachers using an Appreciative Inquiry approach. We analyzed our results using reflexive thematic analysis, with inductive and deductive approaches. Our analysis was based on a socio‐ecological framework. We interviewed 11 teachers working in primary (n = 8), secondary schools (n = 2) and leadership (n = 1). We generated three themes to capture participant experiences: (1) The teacher–student relationship: teachers are dedicated to building a connection and have key teaching and learning skills that can support pain; (2) the school community: inclusion policy and culture can positively influence pain outcomes; and (3) societal influences: misconceptions about pain can influence how teachers perceive the reality of pain. This research enhances our comprehension of the ways in which student pain (whether acute or chronic) is experienced and responded to within the school environment. The insights gained can enrich clinical perspectives and foster collaborative efforts with educators to mitigate the adverse impacts of chronic pain on young individuals, such as increased school absenteeism and pain‐related stigma.

ABSTRACTBibliometric reviews explore patterns in publications in a given research area by exploring trends over time and the contributions by citations, such as relationships between authors and publications. Despite “chronic pain” being the second most common keyword in pain research, no bibliometric reviews have focused on publication trends related to the prevalence of chronic pain in children and adolescents. A bibliometric analysis was conducted with articles included in a systematic review and meta‐analysis on the prevalence of pediatric chronic pain to identify the recent trajectory of the field and guide future directions. Publication bibliometrics data from the articles were extracted and analyzed (e.g., gender of authors, citation counts, and countries) and was visualized in VOSViewer. Among 119 studies, the number of publications per year ranged from 4 (2023) to 11 (2014, 2021) with an average of 8/year. Articles were cited on average 36.6 times (SD = 51.7, range 0–380) with 5058 unique citations. There were 74 different journals represented, with most publishing only 1 article (n = 52, 70%). Seventy countries were represented in prevalence data, 78% from high‐income countries; fifteen (21.4%) had only one data point, primarily from low‐ and lower‐middle income countries. There were 109 different corresponding authors, with only 1 corresponding author who had more than 2 published articles. There was relative gender equity in terms of first and corresponding author. There was little to no collaboration between author groups identified. Despite a steady number of articles published over the 14‐year period, the literature on the prevalence of pediatric chronic pain appears fragmented with articles published in a wide variety of journals. Prevalence data from low‐ and lower‐middle‐income countries were under‐represented. Future work should focus on expanding evidence in underrepresented areas and greater collaboration among research groups to collect prevalence data in geographical areas where data gaps exist.

ABSTRACTThe analgesic effects of breastfeeding (BF), skin‐to‐skin care (SSC), and oral sucrose/glucose for neonates during painful procedures are well‐established. Although parents report wanting to comfort their babies during painful procedures, use of these strategies is inconsistent. This study investigated clinicians' support/use of BF, SSC and sucrose during newborn heel lance in Australia and perceptions of a clinician‐targeted video demonstrating how to perform heel lance while newborns were BF/SSC. A cross‐sectional online survey was conducted. Snowball sampling and distribution via partner organizations were used. Descriptive statistics and content analysis were used for quantitative and qualitative data, respectively. Respondents included 729 nurses, midwives, and phlebotomists, caring for healthy newborns (39%, n = 283); sick newborns (41% n = 300) and both sick and healthy newborns (20%, n = 146). Most respondents caring for healthy newborns were “very likely” to support BF (80%, n = 199) and SSC (65%, n = 162). Most (89%, n = 237) caring for sick newborns were “very likely” to use sucrose; one third “very likely” to support mothers to BF (29%, n = 78) and 32% (n = 85) to use SSC. Barriers to BF and SSC included parents being absent and critically ill newborns. Most considered the video applicable (81%, n = 488) and likely to increase BF or SSC (84%, n = 502). Analysis from comment data identified two categories: “healthcare context and practice” and “parent and baby.” The key findings that clinicians reported the video to be highly useful and that BF and SSC during heel lance for healthy newborns was high confirm that further research is needed to examine parents' use of BF and SSC during painful procedures.

ABSTRACTPain avoidant behavior is a predictive factor for reduced function in children with persistent pain. A model to explain this is the Fear‐Avoidance Model of Pain (FAM). In FAM pain‐related fear plays an important role in the development and maintenance of avoidant behavior. The Fear of Pain Questionnaire—Child Report Short Form (FOPQC‐SF) was developed to assess pain‐related fear in children 8 to 18 years old. Self‐report questionnaires must be translated and adapted to the language and context where they will be used. The aim of this study was therefore to develop a Swedish version of the FOPQC‐SF in collaboration with children. Translation and linguistic adaptation of the FOPQC‐SF was performed using the dual‐panel method in two steps. First, a bilingual panel created a first Swedish version of the questionnaire. This first version was then presented to a panel of five children without persistent pain and revised according to their feedback. Secondly, the translated and revised Swedish version of the FOPQC‐SF was used for individual cognitive interviews with six children with persistent pain. The bilingual panel found the FOPQC‐SF unproblematic to translate and consensus was easily achieved. Revisions were made regarding instructions, response options, item‐wording and layout. The children also found the questionnaire acceptable and relevant. In conclusion, we consider the Swedish version of the FOPQC‐SF to be a relevant and useful tool in research as well as in clinical practice to assess pain‐related fear. Psychometric testing will provide further information about the tool's clinical usefulness.

ABSTRACTThe COMFORTneo scale is widely used to assess pain in infants, yet its validity for extremely preterm (EPT) infants (< 26 weeks' gestation) remains unclear. This study evaluated the scale's ability to distinguish pain in EPT versus PT infants (26–37 weeks' gestation). We performed a retrospective cohort study in a tertiary neonatology intensive care unit, University Medical Center Groningen, the Netherlands. All infants were born before 37 weeks' gestation between 1 January 2018 and 31 December 2022. The COMFORTneo scale's unidimensionality was assessed using the partial credit model, and its discriminatory ability between EPT and PT infants was evaluated through differential item functioning plots. Among 1021 infants, 106 were EPT. The COMFORTneo scale indicated unidimensionality for all preterm infants. However, in EPT infants, alertness and facial tension did not effectively discriminate between pain and no pain in ventilated infants, while agitation and muscle tone failed to discriminate in non‐ventilated infants. While the COMFORTneo scale is unidimensional for preterm infants, the discriminatory ability of this scale between ventilated and non‐ventilated EPT infants is limited.