Pain In Children Research Articles

Intravenous Versus Oral Acetaminophen for Post-Tonsillectomy Pain in Children: Which Route Leads to Better Outcomes?

Intravenous Versus Oral Acetaminophen for Post-Tonsillectomy Pain in Children: Which Route Leads to Better Outcomes?

"I hear you". Validation in the context of children's pain as an untapped opportunity to prevent chronic pain.

"I hear you". Validation in the context of children's pain as an untapped opportunity to prevent chronic pain.

Modification of an outcome measure to follow symptoms of children with acute otitis media.

To modify a parent-reported acute otitis media severity of symptoms scale (AOM-SOS) to ensure that it accurately reflects parental concerns. Using qualitative interviews with parents of children with acute otitis media (AOM) (n = 24), we generated 39 candidate items for inclusion in the new version of the scale. We determined the importance of each item by enrolling 50 other parents of children with AOM. We selected 15 items with high importance and used them to create a new version of the scale. During successive rounds of cognitive interviews, 3 items were dropped. Two additional items were dropped because they were highly correlated. We evaluated the psychometric properties of the new, 10-item version (version 6.0) in 139 children with AOM. AOM-SOS scores correlated with functional status (r = -0.53), parent assessment of child's pain level (r = 0.69), and overall symptom severity (r = 0.41). The internal consistency of the scale, as measured by Cronbach's alpha, was 0.90. Responsiveness (standardized response mean = 1.82) and test-retest reliability (0.77) were excellent and good, respectively. Data presented here support the use of the new version of the scale as a longitudinal measure of symptom burden in clinical trials of children with AOM. The AOM-SOS scale, which now incorporates parental views, can be used to track symptom severity in future efficacy trials in young children with acute otitis media. Data is presented on the validity, reliability, and responsiveness of the AOM-SOS scale. Otitis media is the most frequent indication for antibiotic use in young children. The AOM-SOS is one of the few validated disease specific scales available for use in efficacy trials of children with acute otitis media.

Associations between adverse childhood experiences and pain in middle-aged and older adults: findings from the China Health and Retirement Longitudinal Study

ObjectiveAdverse childhood experiences (ACEs) have been associated with a range of adverse health outcomes, with pain being potentially one of them. This population-based cross-sectional study aimed to investigate the associations between Adverse Childhood Experiences (ACEs) and pain in Chinese adults and evaluate whether physical activity and demographic and socioeconomic characteristics modify this associations.MethodsCross-sectional data from the China Health and Retirement Longitudinal Study (CHARLS), were utilized in this study. A total of 9923 respondents with information on 12 ACE indicators and 15 self-reported body pains were included. Logistic regression models were used to assess associations of the ACEs and pain. Modification of the associations by physical activity, demographic and socioeconomic characteristics was assessed by stratified analyses and tests for interaction.ResultsAmong the 9923 individuals included in the primary analyses, 5098 (51.4%) males and the mean (SD) age was 61.18 (10·.44) years. Compared with individuals with 0 ACEs, those who with ≥ 5 ACEs had increased risk of single pains and multiple pain. A dose–response association was found between the number of ACEs and the risk of pain (e.g. neck pain for ≥ 5 ACEs vs. none: OR, 1.107; 95% CI, 0.903–1.356; p < 0.001 for trend). In the associations of each body pain with each ACE indicator, most ACE indicators were associated with an increased risk of pain. In addition, physical activity, sociodemographic and socioeconomic characteristics, such as age, sex, educational level, area of residence, childhood economic hardship, did not demonstrate a significant modify on the associations between ACEs and pain.ConclusionsThese findings indicate that cumulative ACE exposure is associated with increased odds of self-reported pain in Chinese adults, regardless of adult physical activity, sociodemographic and socioeconomic characteristics.

PV and SST neurons in the anterior cingulate cortex regulate social disorders in adulthood induced by sensory abnormalities in childhood.

Childhood sensory abnormalities experience has a crucial influence on the structure and function of the adult brain. The underlying mechanism of neurological function induced by childhood sensory abnormalities experience is still unclear. Our study was to investigate whether the GABAergic neurons in the anterior cingulate cortex (ACC) regulate social disorders caused by childhood sensory abnormalities experience. We used two mouse models, complete Freund's adjuvant (CFA) injection mice and bilateral whisker trimming (BWT) mice in childhood. We applied immunofluorescence, chemogenetic and optogenetic to study the mechanism of parvalbumin (PV) neurons and somatostatin (SST) neurons in ACC in regulating social disorders induced by sensory abnormalities in childhood. Inflammatory pain in childhood leads to social preference disorders, while BWT in childhood leads to social novelty disorders in adult mice. Inflammatory pain and BWT in childhood caused an increase in the number of PV and SST neurons, respectively, in adult mice ACC. Inhibiting PV neurons in ACC improved social preference disorders in adult mice that experienced inflammatory pain during childhood. Inhibiting SST neurons in ACC improved social novelty disorders in adult mice that experienced BWT in childhood. Our study reveals that PV and SST neurons of the ACC may play a critical role in regulating social disorders induced by sensory abnormalities in childhood.

Effects of Virtual Reality on Pain and Anxiety During Children's Circumcision: A Systematic Review and Meta-Analysis

Circumcision-a common pediatric procedure-can cause significant pain and anxiety. Virtual reality has been proposed as a nonpharmacological intervention to alleviate these negative experiences. This systematic review and meta-analysis was conducted to evaluate the effects of virtual reality interventions on pain and anxiety in children undergoing circumcision. This study comprehensively searched PubMed, Embase, and Cochrane Library for articles published from database inception to October 2, 2023. Randomized controlled trials that investigated the effects of virtual reality interventions on pain and anxiety during circumcision in children were included. The Cochrane risk-of-bias tool was used to appraise the included studies. The primary outcomes were pain and anxiety scores. Three randomized controlled trials and four data sets involving a total of 224 children were included in our meta-analysis. Virtual reality interventions significantly reduced children's pain and anxiety scores. Virtual reality interventions are promising nonpharmacological strategies for alleviating children's pain and anxiety during circumcision. Pediatric healthcare professionals use virtual reality interventions to create a child-friendly and healthy healthcare environment.

Individualized Numeric Rating Scale to Assess Pain in Critically Ill Children With Neurodevelopmental Disabilities.

Pain is a significant burden for children with neurodevelopmental disabilities but is difficult for clinicians to identify. No pain assessment tools for children with neurodevelopmental disabilities have been validated for use in pediatric intensive care units. The Individualized Numeric Rating Scale (INRS) is an adapted 0-to-10 rating that includes parents' input on their child's pain indicators. To evaluate the reliability, validity, and feasibility and acceptability of use of the INRS for assessing pain in critically ill children with neurodevelopmental disabilities. This observational study enrolled critically ill patients with neurodevelopmental disabilities aged 3 to 17 years in 2 pediatric intensive care units at a children's hospital using a prospective repeated-measures cohort design. Structured parent interviews were used to populate each patient's INRS. Bedside nurses assessed pain using the INRS throughout the study. The research team completed independent INRS ratings using video clips. Participating parents and nurses completed feasibility and acceptability surveys. Psychometric properties of the INRS and survey responses were evaluated with appropriate statistical methods. For 481 paired INRS pain ratings in 34 patients, interrater reliability between nurse and research team ratings was moderate (weighted κ = 0.56). Parents said that creating the INRS was easy, made them feel more involved in care, and helped them communicate with nurses. The INRS has adequate measurement properties for assessing pain in critically ill children with neurodevelopmental disabilities. It furthers goals of patient- and family-centered care but may have implementation barriers.

Comparative Evaluation of Pain Perception with Conventional and Septoject XL Needle in 6-8-year-old Children: A Randomized Controlled Trial.

To evaluate and compare pain perception with Septoject XL and conventional needles in 6-8 years old children. In this split-mouth randomized controlled trial, a single-blinded study, 24 children (6-8 years) were assigned at random to receive the local anesthetic (LA) injection for treatment needs either with Septoject XL or conventional needle for the first visit in one of the quadrants, while during the second visit in a different quadrant with the other one. Children's pain levels were assessed during each visit using an objective sound eye motor (SEM) scale and subjective Wong-Baker faces rating scale (FRS). The mean objective score rating using SEM for the conventional needle (3.8 ± 2.35) and Septoject XL needle (3.3 ± 2.01) was not found to be statistically significant among the two study groups Septoject XL or conventional needle (Z score-0.996, p = 0.3). Using the Wilcoxon test, the mean subjective rating score was not found to be statistically significant among the two study groups [Z score = 0.636 and p-value = 0.524, nonsignificant (NS)]. In the gender-wise comparison of male (n =15), (6.8667 ± 91548) and female (n = 9), (6.8889 ± 1.05409), NS mean ages of male and female study participants was observed (p = 0.873). Statistically, NS difference was observed in the pain perception while administration of LA using Septoject XL or conventional needle in 6-8-year-old children. This research can be useful in the selection of the gauge of the needle to be used while planning the treatment for different behavior groups.

The Effect of Music Therapy on the Pain Level of 3 to 6-year-old Children Undergoing Wound Repair by Suturing and Their Parents' Anxiety in the Emergency Department: A Randomized Controlled Trial

Background: Music can serve as a passive distraction to reduce pain and anxiety. Due to the limited number of studies in this field, a study was designed and implemented to determine the effect of music therapy on the pain level of 3 - 6-year-old children undergoing wound repair by suturing and their parents' anxiety in the emergency department. Objectives: This study aimed to examine the effect of music therapy on the pain level of 3 to 6-year-old children undergoing wound repair by suturing and their parents' anxiety in the emergency department. Methods: The present study is a parallel, controlled, randomized clinical trial. Sixty children aged 3 to 6 years referred to the emergency room for sutures were included in the study. In the test group, music was played on a mobile phone from the time the child entered the outpatient operating room until the end of the procedure and discharge. In the control group, children were sutured as usual. The behavioral reactions of both groups were assessed using Wong-Baker's pain scale before washing the wound, immediately after the injection of lidocaine, and at the end of the suture. The abbreviated Spielberger Situational Anxiety Questionnaire was used to measure parents' anxiety before washing the wound and at the end of the suture. These measures were recorded by the researcher. Results: Comparing the mean (standard deviation) of pain before washing the wound in the test group (9.90 ± 0.44) and the control group (9.97 ± 0.258) showed no statistically significant difference (P = 0.311). Using the GEE model, the average pain score immediately after lidocaine injection and at the end of the suture decreased by 1.77 and 4.9 units, respectively, compared to the phase before washing the wound (P &lt; 0.001). The average anxiety of parents before washing the wound was 21.05 ± 2.59 in the test group and 21.05 ± 2.09 in the control group, showing no statistically significant difference (P = 0.801). Conclusions: Based on the results of this study, there was no statistically significant difference between the two groups in terms of children's pain and parents' anxiety. However, clinically, the average levels of children's pain and parents' anxiety in the intervention group decreased at all three times. Music therapy seems to be effective in the emergency department during painful procedures.

Comparing the use of colored Trace Images in Kids' Books with passive distractions to decrease pain and fear during cannulation in children: A randomized clinical trial

IntroductionCannulation can be frightening and a source of pain and fear for pediatric patients. The study evaluated the effectiveness of Trace Image and Coloring for Kids-Book (TICK-B) as active distraction with two passive distractions in reducing children's pain and fear during cannulation. MethodsThis study employed a prospective, controlled, randomized experiment conducted from January 2023 to April 2023 at Heevi Pediatric hospital in the Kurdistan region of Iraq. A total of 176 participants were randomly assigned in to one of four study groups, with 44 participants assigned to each group. The interventions were administered 2–3 min before continued until the cannulation procedure finished. Data were collected through interviews conducted before and after the procedure. Children reported pain using Wong-Baker FACES® scale, and fear evaluated with the Child Fear Scale as an outcome after the cannulation procedure. Children's outcomes during and after procedure were measured 2–3 min after completed procedure. ResultsAll distraction methods significantly reduced children's pain and fear compared to the control group. TICK-B showed large effects in reducing average pain (mean difference = -4.65, 95 % CI: -5.67 to -3.65) and fear (mean difference = -2.18, 95 % CI: -2.67 to -1.69) during cannulation. Post-procedure, TICK-B maintained large pain relief (mean difference = -4.10, 95 % CI: -4.98 to -3.22) and fear reduction (mean difference = -1.89, 95 % CI: -2.39 to -1.39) effects. Music listening and cartoon watching both showed improvements compared to the control group, with minimal differences between them in terms of pain and fear during the procedure. Also, the differences were the same after the procedure. No adverse events were reported. ConclusionAll distraction techniques effectively and safely decreased children's pain and fear during cannulation. The TICK-B technique most effectively reduced children's pain and fear during cannulation procedures compared to music-listening and cartoon-watching techniques. Trial registrationNCT04977323.

Assessing parental comprehension of online resources on childhood pain.

We aimed to examine the patient education materials (PEMs) on the internet about "Child Pain" in terms of readability, reliability, quality and content. For our observational study, a search was made on February 28, 2024, using the keywords "Child Pain," "Pediatric Pain," and "Children Pain" in the Google search engine. The readability of PEMs was assessed using computer-based readability formulas (Flesch Reading Ease Score [FRES], Flesch-Kincaid Grade Level [FKGL], Automated readability index (ARI), Gunning Fog [GFOG], Coleman-Liau score [CL], Linsear Write [LW], Simple Measure of Gobbledygook [SMOG]). The reliability and quality of websites were determined using the Journal of American Medical Association (JAMA) score, Global Quality Score (GQS), and DISCERN score. 96 PEM websites included in our study. We determined that the FRES was 64 (32-84), the FKGL was 8.24 (4.01-15.19), ARI was 8.95 (4.67-17.38), GFOG was 11 (7.1-19.2), CL was 10.1 (6.95-15.64), LW was 8.08 (3.94-19.0) and SMOG was 8.1 (4.98-13.93). The scores of readability formulas showed that, the readability level of PEMs was statistically higher than sixth-grade level with all formulas (P = .011 for FRES, P < .001 for GFOG, P < .001 for ARI, P < .001 for FKGL, P < .001 for CL and P < .001 for SMOG), except LW formula (P = .112). The websites had moderate-to-low reliability and quality. Health-related websites had the highest quality with JAMA score. We found a weak negative correlation between Blexb score and JAMA score (P = .013). Compared to the sixth-grade level recommended by the American Medical Association and the National Institutes of Health, the readability grade level of child pain-related internet-based PEMs is quite high. On the other hand, the reliability and quality of PEMs were determined as moderate-to-low. The low readability and quality of PEMs could cause an anxious parent and unnecessary hospital admissions. PEMs on issues threatening public health should be prepared with attention to the recommendations on readability.

MAMSAGATA VATA W.R.T MYALGIA/IDIOPATHIC MUSCULOSKELETAL PAIN IN CHILDREN: A CASE STUDY

Introduction: A 13-year-old male patient reported to the Outpatient Department (OPD) of Kaumarabhrithya at Shree Swaminarayan Ayurvedic College and Hospital with complaints of diffused (un-localized) severe muscle pain, slurred speech and sleeplessness from the past one year. Another associated complaint was the inability to pronounce the word ‘r’. The main complaint, though, was the muscular pain throughout the body. Though the patient was previously diagnosed and treated for pain as per the conventional science/medical hospitals, the pa-tient and his parents did not have the records. They were unable to recall the names of the medicines prescribed. At Swaminarayan Ayurvedic Hospital, he was diagnosed with Mamsagata Vata and treated with a combination of internal medications and Panchakarma procedures. Methods- The patient was treated with internal medica-tions Brahmi vati Swarnauyukta (250 mg/BD), Brahmi Gritha (5 ml/BD) and Dashamularishta (10 ml with 20 ml water/BD); Panchakarma therapies of Sarvanga Abhyanga (full body therapeutic massage therapy), Sarvanga Swedana (full body fomentation therapy) and Matra Basti (therapeutic enema with medicated oil with low quan-tity) for seven days. The primary objective was to treat Mamsagata Vata and associated symptoms with Snehana, Vatagna dravyas and Medhya rasayana. Results- The patient was treated with internal medications and Panchakarma therapies for seven days. There was a significant reduction in muscular pain and an improve-ment in sleep. No adverse effects were reported. This case study elucidates Snehana's (Matra Basti) efficacy in managing Mamsagata Vata. Discussion- The clinical data from this study suggests that Ayurvedic treatment in managing Mamsagata Vata w.r.t Myalgia/Idiopathic musculoskeletal pain in Children can provide effective re-sults.

Preliminary development of a measure of parental behavioral responses to everyday pains in young children: the PREP.

Everyday pains are experienced frequently by young children. Parent responses shape how young children learn about and experience pain. However, research on everyday pains in toddlers and preschoolers is scarce, and no self-report measures of parent responses to their child's pain exist for this age group. The objective of this study was to develop a preliminary self-report measure of parent behavioral responses to everyday pains in the toddler and preschool years (the PREP) and examine its relationship with child age, sex, and parent and child distress. Items for the PREP were based on a behavioural checklist used in a past observational study of caregiver responses to toddler's everyday pains. Parents (N = 290; 93% mothers) of healthy children (47.9% boys) between 18 and 60 months (Mage = 34.98 months, SD = 11.88 months) completed an online survey of 46 initial PREP items, demographic characteristics, and their child's typical distress following everyday pains. An exploratory factor analysis was performed on the PREP items that describe observable actions parents may take in response to their young child's everyday pains. The final solution included 10 items across 3 factors: Distract, Physical Soothe, and Extra Attention and explained 60% of the model variance. All PREP subscales were related to child distress; only Physical Soothe and Extra Attention were related to parent distress. This study was a preliminary step in the development and testing of a new self-report measure of parental responses to everyday pains during early childhood.

Effectiveness of Deep Breathing Technique on Pain Level of School Children during Catheterization

Abstract Background: Pediatric medical procedures mostly cause pain and fear among hospitalized children. Many nonpharmacological pain strategies can used to decrease children’s fear and pain in addition to decreasing the burden of medication. Objectives: This study aimed to determine the effectiveness of the deep breathing technique on children's pain intensity during urine catheterization procedures, at Children Welfare Teaching Hospital in Baghdad city. Materials and Methods: A quasi-experimental study was selected to determine the effects of pain strategies through achieving the manipulation and control group, conducted with a nonprobability (convenience) sample of 60 children of both genders at the age range of 6–12 years, divided into three groups of 20 children in each group. The study was carried out at Children Welfare Teaching Hospitals, from the period October 13, 2021, to July 28, 2022. The numeric Pain Rating Scale was used to assess pain level before and after nursing intervention with three pain management methods that included deep breathing technique, pharmacological, and combination methods. Results: The result of the study revealed that the application of deep breathing techniques, pharmacological, and combination methods were effective in reducing children’s pain at different levels. The deep breathing method has a significant influence on reducing children’s pain. The most effective method to reduce children’s pain was a combination method. Conclusion: This study concludes that the application of all pain management methods in this study was effective in reducing children’s pain at different levels during catheterization. The combination method (pharmacological and nonpharmacological) was most effective in reducing children’s pain. However, the deep breathing method approved its significant influence on children’s pain.

Functional Abdominal Pain in Children

Background: Functional abdominal pain (FAP), often affecting girls and those with mental health issues, is a prevalent pediatric disorder characterized by persistent symptoms without a clear identifiable organic pathology. The Rome IV Criteria classify it into subtypes, which have distinct symptoms and required tailored management approaches. Discussion: Subtypes classified by the Rome IV Criteria include irritable bowel syndrome (IBS), functional dyspepsia, abdominal migraine, and FAP - not otherwise specified (NOS). The pathophysiology involves gut hypersensitivity, hyperalgesia, genetic predispositions, and psychosocial triggers. Diagnosis relies on medical history, physical examination, the presence of alarm signs, and the characteristic of pain. Treatment strategies encompass dietary modifications, psychological interventions, pharmacology treatment including proton pump inhibitors, prokinetics, and antidepressants like amitriptyline. Conclusion: Recognizing the specific subtypes, as defined by the Rome IV Criteria, allows healthcare professionals to implement individualized care strategies for optimal outcomes.

An Australian survey of health professionals' perceptions of use and usefulness of electronic medical records in hospitalised children's pain care.

Pain in hospitalised children is common, yet inadequately treated. Electronic medical records (EMRs) can improve care quality and outcomes during hospitalisation. Little is known about how clinicians use EMRs in caring for children with pain. This national cross-sectional survey examined the perceptions of clinician-EMR users about current and potential use of EMRs in children's pain care. One hundred and ninety-four clinicians responded (n = 81, 74% nurses; n = 21, 19% doctors; n = 7, 6% other); most used Epic (n = 53/109, 49%) or Cerner (n = 42/109, 38%). Most (n = 84/113, 74%) agreed EMRs supported their initiation of pharmacological pain interventions. Fewer agreed EMRs supported initiation of physical (n = 49/113, 43%) or psychological interventions (n = 41/111, 37%). Forty-four percent reported their EMR had prompt reminders for pain care. Prompts were perceived as useful (n = 40/51, 78%). Most agreed EMRs supported pain care provision (n = 94/110, 85%) and documentation (n = 99/111, 89%). Only 39% (n = 40/102) agreed EMRs improved pain treatment, and 31% (n = 32/103) agreed EMRs improved how they involve children and families in pain care. Findings provide recommendations for EMR designs that support clinicians' understanding of the multidimensionality of children's pain and drive comprehensive assessments and treatments. This contribution will inform future translational research on harnessing technology to support child and family partnerships in care.

Consolation Effect of Medical Clown Care Model in Children with Inguinal Hernia During Perioperative Period: A Single-Center Study in China

Background: Due to differences in medical backgrounds, there have been few studies on medical clown care in Chinese hospitals. Objectives: This study aimed to explore the consolatory effect of the medical clown care model on children in a Chinese hospital. Methods: This study included 236 children aged 4 - 6 years and divided them into an intervention group (n = 116) and a control group (n = 120). The control group received routine nursing measures, while the intervention group experienced the medical clown care model. To assess the children’s pain levels and the anxiety levels of their parents, the Face Legs Activity Cry and Consolability (FLACC) Scale, Wong-Baker FACES Pain Rating Scale (W-B FPS-R), and Self-Rating Anxiety Scale (SAS) were used. Results: The baseline data for both groups were comparable at admission (P &gt; 0.05). The FLACC score, W-B FPS-R score, and crying rate in the intervention group were significantly lower than those in the control group (4.81 vs 6.71, 4.69 vs 7.02, 44.83 % vs 79.16 %, P &lt; 0.05). Parents in the intervention group also had lower preoperative anxiety scores compared to those in the control group (42.85 vs 52.69, P &lt; 0.05). Furthermore, the postoperative pain incidence and drug use rates were significantly lower in the intervention group (18.97 % vs 30.83 %, 27.27 % vs 56.76 %, P &lt; 0.05). Compliance and satisfaction were significantly higher in the intervention group than in the control group (P &lt; 0.05). Conclusions: The application of the clown care model can effectively reduce children's pain, provide consolation, and relieve parental anxiety.

Clinical case of median arcuate ligament syndrome in the practice of a pediatric surgeon

Recurrent abdominal pain in childhood and adolescence may be indicative of chronic mesenteric ischemia with median arcuate ligament syndrome as a result of compression of the celiac artery by the median arcuate ligament of the diaphragm and its internal crura, neurofibrous tissue of the celiac plexus. The presence of symptoms characteristic of various diseases of gastrointestinal tract organs, absence of pathognomonic signs and complex approach in diagnostics of abdominal cavity vascular system, insufficient awareness of specialists of children’s outpatient clinics determine the urgency of timely diagnostics and treatment of patients with this pathology. Median arcuate ligament syndrome, or Dunbar syndrome, is more often a congenital malformation. This syndrome can be considered as an acquired pathology in the case of compression of the celiac artery by enlarged lymph nodes and neurofibrous tissue of the celiac plexus. In addition to hemodynamically significant disorders of blood supply to the gastrointestinal tract, Dunbar syndrome in children and adolescents is also accompanied by psycho-emotional disorders due to the presence of unstable stools, recurrent abdominal pain, and often repeated ineffective requests for medical care. Clinical observation, methods of diagnosis and surgical treatment of median arcuate ligament syndrome in a 14-year-old patient are presented in the study.

Assessment of the Effects of Physiotherapy on Back Care and Prevention of Non-Specific Low Back Pain in Children and Adolescents: A Systematic Review and Meta-Analysis.

Non-specific low back pain (NSLBP) in children and adolescents has increased in recent years, and the evidence of the physiotherapy interventions in back care needs to be updated. Our main goal was to quantify the effects of preventive physiotherapy interventions on improving behavior and knowledge related to back care and prevention of NSLBP in children and adolescents. Based on two previous meta-analyses, Cochrane Library, MEDLINE, PEDro, Web of Science, LILACS, IBECS, PsycINFO, and IME databases and several journals were searched. Two researchers independently extracted data and assessed the risk of bias in the studies using the RoB2 tool. Data were described according to PRISMA guidelines. A total of 24 studies (28 reports) were included. In the posttest, the behavior variable obtained an overall effect size of d+ = 1.48 (95%CI: 0.40 to 2.56), and the knowledge variable obtained an effect size of d+ = 1.41 (95%CI: 1.05 to 1.76). Physiotherapy has demonstrated beneficial impacts on behavior and knowledge concerning back care and to prevent NSLBP in children and adolescents. Interventions focusing on postural hygiene and exercise should be preferred, especially those that are shorter in number of weeks, more intense, and incorporate as many intervention hours as possible.

Pain assessment tools: A literature review

Pain assessment tools: A literature review