Pain In Children Research Articles

Effects of Pain-Reporting Education Program on Children's Pain Reports-Results From a Randomized Controlled Post-operative Pediatric Pain Trial.

Objective: Accurate assessment of patients' pain is an essential part of adequate analgesic treatment. Although reporting pain is a complex task, limited-to-no instructions are provided to pediatric patients regarding this process. Our goal in this randomized parallel-group clinical trial (Clinicaltrial.gov study protocol number NCT04306679) was to evaluate if a training program designed to improve children's ability to understand and use pain scales in a post-surgical setting would affect their pain scores.Methods: Eligible children (aged 8–17), hospitalized for elective surgery and their parents were randomized into two groups. Pre-surgery the intervention group underwent a multi-media program aimed to teach and train how to report pain. The control group received standard pre-surgical instructions. Post-surgery, the children reported their pain on 4 pain scales. The primary outcome was the concordance between children's pain intensity scores reported on four pain scales, both in terms of within-child standard deviation and absolute difference.Results: Ninety-six children met inclusion criteria and completed the study. The trained subjects' pain reports had significantly (p = 0.002) lower within-subject standard deviation (0.41 ± 0.31) than the control group (0.67 ± 0.46). In line, regarding absolute difference, the concordance of children's pain reports was twice better in the trained group (mean difference of 0.43 ± 0.40) than in the control group (0.88 ± 0.70) (p < 0.001).Discussion: Our results suggests that children's ability to report pain is a skill that can be improved. Future studies should test the potential clinical impacts of educational interventions aimed to improve pain assessment in children and adults.

Standard procedure for the pharmacotherapy of pain in childhood

Physicians of all specialties encounter patients in pain. The basis of the philosophy of caring children is not to question the existence of pain but to predict, prevent, and adequately treat it. Acute pain services implement preventive and multimodal analgesic treatment to increase the analgesic effect at the lowest possible doses to minimize undesirable effects of individual drugs. However, this service cannot be provided in all hospitals 24 hours a day. This study provides a clear, color-coded recommendation for pain relief in children, which provides a quick, rational, and safe choice of analgesics or their safe and effective combinations and dosage for each age group.

High-intensity activity is more strongly associated with metabolic health in children compared to sedentary time: a cross-sectional study of the I.Family cohort

BackgroundPhysical activity (PA) during childhood is important for preventing future metabolic syndrome (MetS). To examine the relationship between PA and MetS in more detail, accurate measures of PA are needed. Previous studies have only utilized a small part of the information available from accelerometer measured PA. This study investigated the association between measured PA and MetS in children with a new method for data processing and analyses that enable more detailed interpretation of PA intensity level.MethodsThe association between PA pattern and risk factors related to MetS was investigated in a cross- sectional sample of children (n = 2592, mean age 10.9 years, 49.4% male) participating in the European multicenter I. Family study. The risk factors examined include body mass index, blood pressure, high-density lipoprotein cholesterol, insulin resistance and a combined risk factor score (MetS score). PA was measured by triaxial accelerometers and raw data was processed using the 10 Hz frequency extended method (FEM). The PA output was divided into an intensity spectrum and the association with MetS risk factors was analyzed by partial least squares regression.ResultsPA patterns differed between the European countries investigated, with Swedish children being most active and Italian children least active. Moderate intensity physical activity was associated with lower insulin resistance (R2 = 2.8%), while vigorous intensity physical activity was associated with lower body mass index (R2 = 3.6%), MetS score (R2 = 3.1%) and higher high-density lipoprotein cholesterol (R2 = 2.3%). PA of all intensities was associated with lower systolic- and diastolic blood pressure, although the associations were weaker than for the other risk factors (R2 = 1.5% and R2 = 1.4%). However, the multivariate analysis implies that the entire PA pattern must be considered. The main difference in PA was observed between normal weight and overweight children.ConclusionsThe present study suggests a greater importance of more PA corresponding to an intensity of at least brisk walking with inclusion of high-intense exercise, rather than a limited time spent sedentary, in the association to metabolic health in children. The methods of data processing and statistical analysis enabled accurate analysis and interpretation of the health benefits of high intensity PA that have not been shown previously.

Effects of therapeutic clowning on pain and anxiety during venous blood sampling in Turkey: Randomised controlled trial.

The research aim was to investigate the effects of therapeutic clowning on pain and fear during the process of venous blood sampling in children. This study was conducted in a randomised controlled trial from January to March 2020. The study population consisted of children from 7 to 12 years of age who came to the research centre for blood sampling. The research sample consisted of 166 children (83 in the intervention group and 83 in the control group) who met the research criteria and came to the research centre on a specific date through probable sampling. For the data collection, a questionnaire form, the Visual Analogue Scaleand the Children's Fear Scalewere used. Therapeutic clowning was used in this process for the intervention group. There was no intervention for children who were in the control group. The calculation of percentage distribution and means, χ2 test, analysis of variance analysis in repeated measures and least significant difference and independent t-test were used to analyse the data. The results of the research indicated that children in the intervention group had significantly lower pain and fear than children in the control group (p < .001). Therapeutic clowning seems to effectively reduce pain and fear during venous blood sampling for children from 7 to 12 years of age. Our results support using therapeutic clowns which is an inexpensive, safe, and effective method for lowering children's pain and fear during venous blood sampling. The use of therapeutic clowns could become the standard of care in blood sampling for children from 7 to 12 years of age in hospitals. Therapeutic clowning, which is an easy-to-use, low-cost and practical method to provide better communication and cooperation with the family and the child, can be used as a complementary therapy in all nursing areas, especially in the field of paediatrics. Nurses could be encouraged to be trained on the use of therapeutic humour based upon a standardised approach and offered guidance on how to apply entertaining methods such as clowns. Therapeutic clowning can be examined in other applications in nursing care in light of these results.

Parental Catastrophizing and Goal Pursuit in the Context of Child Chronic Pain: A Daily Diary Study.

Background: Despite daily variability in children's chronic pain experiences, little is known about how parents' emotions and goals toward their child's pain are influenced by these daily changes. This diary study examined how daily child pain intensity (as perceived by parents) moderates the associations between parental catastrophic thoughts about child pain on the one hand, and daily parental distress and parents' goals with regard to their child's pain (pain control vs. activity engagement) on the other hand.Method: Participants were 25 parents of 20 different children (N = 18; 90% girls). Children, aged 8–14 years (M = 9.5, SD = 2.09), experienced either chronic headache or functional abdominal pain with an average pain duration of 22.5 months (SD = 24.5 months). Daily parental responses (i.e., perceived child pain intensity, distress and goal endorsement) were collected through a 3-week daily diary (resulting in 413 valid diary reports). Parents completed the Pain Catastrophizing Scale for Parents prior to starting the diary (PCS-P general) and a daily measure (PCS-P daily) included in the diary. To account for the interdependence of the data, the data were analyzed using multilevel modeling.Results: Perceived daily child pain intensity moderated the impact of parental general and daily catastrophic thoughts on parents' daily distress. Only for parents experiencing low general catastrophic thoughts an increase in distress was observed on days when they perceived their child's pain intensity as high. For all parents, high levels of perceived child pain intensity were related to more distress on days where parents reported high levels of catastrophic thinking (i.e., PCS-P daily). Perceived daily child pain intensity also moderated the impact of parental general catastrophic thinking on parents' daily endorsement of goals. Parents with high levels of general catastrophic thinking reported a lower focus on child pain control on days when child pain intensity was perceived to be low. Parents with low general catastrophic thinking reported lower endorsement of the activity engagement goal on days where the child's pain intensity was perceived to be low.Conclusion: These findings highlight the complexity of daily fluctuations in parental distress and goals regarding their child's pain. Clinical implications and future directions are critically assessed.

Structures of paediatric pain management: a PERUKI service evaluation study

BackgroundPain is very common in childhood emergency department (ED) attendances, but is under-recognised and undertreated. Sequential national paediatric analgesia audits demonstrate suboptimal outcomes in several domains. The Donabedian framework examines...

Episodic Unilateral Limb Pain and Migraine–A Case Report, Hitherto an Unnamed Entity!

Background: Migraine limb pain is a very under-recognized manifestation of migraine in which episodic pain happens in the peripheral limbs. Despite its description for many years, only limited clinical details are known. Only case reports and case series with limb pain as a symptom of migraine are reported in the literature. In this case report, important features of episodic unilateral limb pain and it’s association with migraine has been discussed. Case presentation: Here the author (a neurologist) describes episodic limb pain from his own experience, which started in childhood and used to be episodic, unilateral and with changing sides. In view of various features mimicking migraine, classical manifestation of migraine in later life and a strong family history , episodic unilateral limb pain in childhood is likely a form of peripheral migraine. Conclusion: Unilateral episodic limb pain with various features mimicking migraine is a very important clinical entity. This case should help in understanding the clinical details of peripheral limb pain -a relatively under-diagnosed symptom of migraine

Cold and Mechanical Hypersensitivity Is Exacerbated during Acute Pain in Children and Adolescents with Sickle Cell Disease

▪Background: Sickle cell disease (SCD) pain is associated with colder temperatures, touch and increased wind speed suggesting thermal and mechanical pain nociceptors may be activated during and/or precipitate acute SCD pain. Patients with SCD and SCD mice display features of nervous system sensitization during baseline health as evidenced by hypersensitivity to thermal and mechanical pain. In SCD mice, this pain hypersensitivity is exacerbated with hypoxia-reoxygenation that mimics acute vaso-occlusive crises. However, it is unknown if exacerbations of thermal and mechanical pain hypersensitivity occur during acute pain in SCD patients. Thus, we sought to quantify thermal and mechanical pain sensitivity differences between SCD patients in baseline health and during pain. We hypothesized SCD patients will experience increased hypersensitivity to thermal and mechanical pain during acute pain as compared to baseline health.Methods: We conducted a prospective cohort study of SCD patients ≥ 7 yrs assessed in baseline health and during hospitalization for pain to detect patients' sensitivity to thermal and mechanical stimuli as measured by quantitative sensory testing (QST). We excluded patients with pain phenotype other than SCD, known overt/silent stroke or those chronically transfused. Patients underwent QST to thermal (cold/heat) and mechanical stimuli during baseline health and within 48 hrs of hospitalization for pain. QST detects sensory loss (hyposensitivity) or gain (hypersensitivity). Thermal testing was done with a Thermal Sensory Analyzer (Medoc;Israel), a computer-assisted device that delivers cold/warm stimuli via a skin thermode (starting temperature, 32ºC; range, 0-50ºC). Mechanical testing was done using graded vonFrey filaments (force range 0.026-110 g). Testing sites were the thenar eminence of non-dominant hand (glabrous skin) and lateral dorsum of foot (hairy skin). Primary outcomes were: 1) Cold Pain Threshold (ºC), 2) Heat Pain Threshold (ºC) and 3) Mechanical Pain Threshold (g) assessed by “method of limits” where patients pushed a button (thermal) or spoke (mechanical) when the progressive stimulus was painful. The final outcome was the median of 3 (thermal) and 5 (mechanical) tests. Patient-report of pain precipitators related to temperature was collected. Descriptive statistics were performed and comparison of medians between baseline and pain was done with Wilcoxon-signed rank due to non-normally distributed data. Linear effect model with repeated measure analysis was done to adjust for age, gender and hydroxyurea use. Statistical significance was set at p<0.05.Results: We enrolled 24 SCD patients that were tested both in baseline health and when hospitalized for pain. The median age of baseline testing was 10.5 (IQR 9-14.8) yrs, 66.7% were female and 91.7% were on hydroxyurea. Median time between baseline and pain testing was 15.8 (IQR 5.1-22.1) mos. Genotypes were 62.5% HbSS, 29.2% HbSC, 4.2% HbSβ+thal, and 4.2% HbSOArab. SCD patients had significantly increased cold pain sensitivity in the hand during pain as compared to baseline health and also had significantly increased mechanical pain sensitivity in the foot during pain as compared to baseline health (Table 1). There were no differences in heat pain sensitivity during pain (Table 1). Significant changes in cold (1.6 ºC, p=0.03) and mechanical (-6.6g, p=0.002) pain sensitivity persisted after adjusting for age, gender and hydroxyurea use. Significantly more patients reported temperature change from warm to cold exacerbates their pain as compared to change from cold to warm (63.2% vs. 26.3%, p=0.03; McNemar Test).Conclusions: SCD patients experience exacerbations of cold and mechanical pain sensitivity during hospitalization for pain, however, no changes in heat pain sensitivity. This differential pattern is consistent with patient reports of cold temperatures exacerbating pain, hypersensitivity to touch during pain events and heat providing pain relief. The exacerbation of mechanical and cold pain emulate findings in the SCD mouse model and suggest cold and mechanical pain nociceptors may contribute to SCD pain biology. Modulation of these pathways could be novel therapeutic targets to treat and/or prevent SCD pain. Investigation into why these pain nociceptors are activated in SCD patients could lead to increased understanding of SCD pain biology and additional therapeutic targets. [Display omitted] DisclosuresNo relevant conflicts of interest to declare.

Chronic pain in pediatric primary care : What do adolescents and parents expect and how do they perceive treatment?

Recurrent pain in childhood and adolescence is acommon health problem. Pediatricians are usually the patients' first contact person. The current study investigated patients' and parents' expectations when consulting apediatrician and their rating of the treatment. In 36pediatric practices, 224patients with recurrent pain and 273 parents participated in this cross-sectional tablet survey. The collected data included the motivation for arranging aphysician consultation, pain concept, treatment expectations, and assessment of treatment. Additionally, the patients' age was investigated as an influencing factor. The patients' and parents' predominant motivation for arranging aconsultation was the clarification of the cause of pain. Older patients were additionally motivated by frequent but ineffective drug use. Predominantly in older patients, abiopsychosocial pain explanation was identified. Approximately half of all patients and parents indicated biological and psychological influencing factors. The most frequent expectation of the consultation was obtaining information on pain management. Overall, consultations were rated very positively, especially when patients and parents felt understood and taken seriously. Information about the cause of pain and pain management are essential for patients and parents. Besides good communication, sufficient time resources of the practitioner are required.

Evaluation of Pain in the Pediatric Emergency Department and the Request of Analgesia.

To determine the acute pain level associated with request for analgesia by children and their parents in the pediatric emergency department (ED) when pain was assessed by verbal numeric scale (VNS), visual analog scale (VAS), and verbal rating scale (VRS). A secondary analysis of a prospective cohort study using a sample of children aged 8 to 17 presenting to the ED with acute pain. Patients and their parents were asked to quantify the child's pain on the VNS, VAS, and VRS. Scores for patients and parents who answered "yes" to the request of analgesia were compared with those responding "no." A total of 202 patients aged 12.2 ± 2.6 years were enrolled. The median levels of pain associated with a request of analgesia and no request for analgesia by the patient were: 6.0 (4.0-7.4) and 5.0 (3.0-6.0) (Δ 1.0; 95% confidence interval [CI], 0.5-2.0) for the VNS; 5.7 (3.9-7.2) and 4.3 (2.6-5.8) (Δ 1.3; 95% CI, 0.6-1.9) for the VAS; and 2.0 (2.0-2.0) and 2.0 (1.0-2.0) (Δ 0.0; 95% CI, 0.0-0.0) for the VRS. Children who requested analgesia had higher pain scores on the VNS and the VAS, than those who did not request analgesia. No difference was demonstrated with the VRS. The pain scores between the analgesia request categories could overlap. This suggests that children seen in the ED should be asked if they want analgesia to decrease their acute pain.

To relieve pain or avoid opioid-related risk? A comparison of parents' analgesic trade-off preferences and decision-making in 2019 versus 2013 in a single U.S. pediatric hospital.

Analgesic trade-off preferences, or the relative preference for pain relief vs. risk aversion, shape parents' decisions to give prescription opioids to their children. These preferences may be influenced by personal experiences and societal factors. To examine whether parental analgesic trade-off preferences and opioid decision-making have shifted toward risk aversion during the opioid crisis in the United States. We conducted a secondary analysis of the preoperative survey data of parents from a single U.S. pediatric hospital whose children aged 5-17years were to undergo painful surgery in 2013 (Time 1) or 2017/2019 (Time 2). Surveys assessed parents' analgesic trade-off preference (-12 or risk-averse to +12 or pain relief preferent, scores around 0=ambivalent) and their hypothetical decisions to give a prescribed opioid to a child in pain. Data from 847 parents were included (Time 1, n=361; Time 2, n=486). Parents at Time 2 were significantly more risk-averse compared with Time 1 (adj.β: -0.84 [95% CI: -1.09, -0.60]). Parents at Time 2 were more than twice as likely to be risk-averse or ambivalent (OR: 2.17 [95% CI: 1.62, 2.91]). There was a significant interaction effect of Time*Preference on parents' decision to give the opioid (adj. OR: 1.09 [95% CI: 1.03, 1.16]). At Time 2, parents who were ambivalent or risk-averse were less likely than those who preferred to relieve pain to administer the prescribed opioid (OR: 0.57 [95% CI: 0.37, 0.89]). In contrast, there was no association between the preference group and the opioid decision at Time 1. Findings suggest that parents of children scheduled for painful surgery at our pediatric hospital have become more analgesic risk-averse during the past decade. Parents' analgesic trade-off preferences may influence their decisions to administer prescribed opioids after surgery, which may contribute to children's pain outcomes.

To Compare and Analyze the Potency of two Topical Anesthetic Gels in Reducing Inferior Alveolar Injection Pain in Children of 8-12 Years: A Double-Blinded Clinical Trial.

Aim:To compare and analyze the clinical adequacy of two topical anesthetic gels, Precaine (8% lidocaine + 0.8% dibucaine) and Precaine B (20% benzocaine) in children before intraoral local anesthetic injections.Materials and Methods:This clinical study included thirty children who needed an inferior alveolar nerve block. They were divided into three groups: Group A: Precaine topical gel group, Group B: Precaine B topical gel Group, Group C: no anesthetic topical gel group (control group). These two effective topical gels were applied before giving intraoral local anesthesia, and afterward, the child's pain response was surveyed utilizing the Wong-Baker Faces Pain Rating Scale. The scores obtained were subjected to statistical analysis.Results:Intergroup comparison showed a significant mean difference between the control group and Precaine group (P > 0.05) as well as Precaine B group (P > 0.05). However, there is no significant difference obtained between Group A and Group B (P < 0.05).Conclusion:It is psychologically and clinically beneficial to apply a topical anesthetic agent before injecting any intraoral anesthesia. In this study, both anesthetic gels showed a nonsignificant difference in reducing inferior alveolar injection pain, but Precaine B shows more promising results than Precaine.

A Systematic Review of the Prospective Relationship Between Bullying Victimization and Pain.

ObjectiveThis systematic review synthesized evidence about the relationship between childhood bullying victimization and chronic pain, with a focus on the temporal nature of the relationship and moderating factors, such as the type and intensity of victimization.MethodWe included prospective cohort studies that examined the relationship between childhood bullying victimization and pain measured at least three months later. We conducted electronic searches of Medline, EMBASE, PsycINFO, and CINAHL up to June 30, 2019. Standard methodological procedures consistent with Cochrane reviews of prognosis studies were used (PROSPERO record ID 133146).ResultsWe included four longitudinal studies (6275 participants) in this review. The mean age of participants at baseline ranged from 10 to 14 years and the follow-up periods ranged from 6 months to 12 years. Two of the four studies were judged as having high risk of bias. Meta-analysis of results from four studies revealed increased risk of pain among victimized compared to non-victimized youth (adjusted OR [95% CI] = 1.45 [1.06–1.97], but the effect size was small and not clinically important. Only one study examined the inverse association (ie, from pain to victimization), and there was not enough evidence to conduct a meaningful analysis of the proposed moderators.ConclusionsStudy findings were limited by few prospective studies. Meta-analytic findings suggested that victimization may incur some risk for later pain, although the evidence was judged to be very low quality. High-quality studies that measure and report the nuances of bullying victimization are needed to test the proposed moderator models.

Comparison of the Effects of Hugo’s Point Massage and Play on IV-Line Placement Pain in Children: A Randomized Clinical Trial

Reduction of intravenous line placement pain is one of the most important nursing priorities in the pediatric wards. The present study was aimed at comparing the effect of Hugo's point massage and play on the severity of IV-line placement pain in hospitalized children aged 3–6 years in the pediatric ward. 72 children were selected and assigned randomly to three groups, i.e., control, play, and Hugo point massage. In the massage group, the middle angle between the first and second bones of the palm of the opposite hand was massaged, and the playgroup encouraged bubble-making play. The one-way analysis of variance (ANOVA) did not show a statistically significant difference between the mean IV-line placement pain in play, Hugo's point, and control groups before interventions (p=0.838; p > 0.05). However, the ANOVA test revealed a significant difference between the mean IV-line placement pain in play, Hugo's point, and control groups after the interventions (p=0.006; p < 0.05). The result of the post hoc Scheffe test also showed a statistically significant difference between the mean intensity of IV-line placement pain in both play therapy and Hugo's point massage groups (p=0.028; p < 0.05). Moreover, this test showed that the playgroup children felt less pain than Hugo's point and control group children. This study showed that, in comparison with Hugo's point massage, the play was a more effective way for reducing pain caused by IV-line placement in children, and pediatric nurses can play a significant role in reducing and managing children's pain by using it.

The Effect of Cold Application on Relieving Drug Infusion-Related Pain in Children: A Randomized Controlled Experimental Trial in Turkey

BackgroundParenteral IV drug administration in hospital environments can cause many complications at the infusion site. Nerve endings on the venous walls may be affected during antibiotic drug infusion, depending on the drug molecule, which results in pain. PurposeThis study aims to assess the effect of cold application on relieving drug infusion-related pain (lincosamide class clindamycin phosphate) in children. Design & methodsThis study included 120 pediatric patients (40 in the experimental, 40 in the placebo, and 40 in the control groups) aged 6 to 18 and hospitalized in a pediatric hospital. In the experimental group, a cold pack kept in the refrigerator was applied to the area above the IV catheter before drug infusion, while a cold pack kept at room temperature was applied in the placebo group. In the control group, drug infusion was routinely administered. ResultsThe experimental, placebo and control groups' 5th minute mean VAS scores were 0.98 ± 2.17, 3.95 ± 4.08, and 4.73 ± 3.89, respectively (p < 0.001), being higher in the control and placebo groups compared to the experimental group. No difference was found between the groups based on the VAS measurements at the 10th minute (p = 0.053). A difference was found between the groups based on the VAS measurements at the 15th minute (p=0.026). The VAS score of control group was higher than that of the placebo group (p = 0.032). ConclusionCold application was effective in relieving drug infusion-related pain. Implications for practiceThis method may be recommended for general use in clinics since it is easy-to-use and economic. This method can ease the treatment process between nurses and children and increase patient satisfaction.

Perceived Injustice Is Associated With Pain-related Function and Mood in Youth With Acute Musculoskeletal Pain.

Perceived injustice (PI), which is one's appraisal of justice or fairness regarding the pain experience, is an emerging area of interest in pediatric pain research. No previous studies have investigated PI in youth with acute pain. To fill this gap, this study examined (1) associations among PI, pain-related function, and psychological function in treatment-seeking youth with acute musculoskeletal (MSK) pain, and (2) the impact of parent-child PI discordance on children's pain and psychosocial function. Participants were youth (aged 11 to 17, 55% male) with acute pain (onset <1 mo) recruited from emergency departments or outpatient clinics and participating parents (102 parent-child dyads). Dyads completed study questionnaires within 1 month of the child's pain onset. Youth-reported PI was significantly correlated with poorer physical and psychosocial quality of life, higher pain catastrophizing, higher fear of pain, increased pain-related disability, and greater depression and anxiety. Furthermore, PI was significantly associated with the physical quality of life, psychosocial quality of life, and pain-related disability. Moreover, discordance in youth and parent ratings of PI was associated with children's psychological and pain-related function. Specifically, compared with Concordant dyads, youth in the Discordant dyads (youth high PI/parent low PI) reported significantly poorer physical quality of life, psychosocial quality of life, higher pain-related disability, depression, anxiety, and pain catastrophizing. These findings reveal that PI in youth with acute MSK pain is associated with quality of life and pain-related disability. Furthermore, results highlight the importance of discordance between youth and parent reports of PI on pain-related functioning.

General dental practitioners' knowledge and attitudes on children's pain and pain management-A questionnaire survey.

The aim was to study general dental practitioners’ knowledge and attitudes on pain and pain management in children and adolescents, using a multidimensional questionnaire. There is little information on dentists’ views on pain in children. The research question was how attitudes and knowledge may correlate to the dentists’ age, sex, years of professional experience, the proportion of working time devoted to treating children and adolescents, as well as being a parent. At the time of the study, 387 general dentists working for the Public Dental Service participated in a web‐based, multidimensional validated questionnaire holding the categories (A) views on the care of children in pain, (B) physiology, (C) pain alleviation, (D) medication, (E) sociology/psychology, (F) Pain assessment instruments and methods, (G) non‐medication methods of pain alleviation, and (H) documentation of pain management. The age categories were given as; below 25, 25‐35, 36‐45, 46‐55 years, and older than 55 years of age. 71% of the responders were female. The dentists’ age cohort, as well as the years of professional experience, tended to make a difference as to the pain interventions in children and adolescents (P < 0.03). The female dentists, in comparison to the male dentists, conveyed different pain treatment strategies (P < 0.03). The proportion of working time devoted to treating children and adolescents, as well as being a parent, did not show significant differences regarding pain strategies. Associations were observed between the age of the dentists studied, the number of years as professionals and the knowledge and attitudes that benefit children's pain treatment. Being a parent was not significant. In this studied group, female dentists displayed significantly more care regarding pain management, than did their male colleagues. Furthermore, the study highlighted the need for a short questionnaire, user‐friendly yet with retained multidimensionality.

Perception of Pain in Children With Covid-19 Using DWT (Drawing, Writing And Tell) at Hospital For Emergency Covid-19 Management Athlet College Kemayoran

One of the most common symptoms that children with COVID-19 experience was pain. Pain perception in children was influenced by the level of understanding and how to communicate. Draw, write and tell Method (DWT) was a method used to assess pain in children. This study used a qualitative method with a descriptive phenomenology approach. The study participants consisted of six children aged 4-10 years who were treated with COVID-19 who could draw or like to draw and were able to write and tell the results they drew. Data analysis used the analysis stage according to Colaizzi. The findings of this study included (1) The physical changes felt by children before being confirmed by COVID-19. (2) The discomfort felt by the child when the swab is examined. (3) Child psychological impact. (4) Child Social Impact

What is pain: Are cognitive and social features core components?

Pain is a universal experience, but it has been challenging to adequately define. The revised definition of pain recently published by the International Association for the Study of Pain addressed important shortcomings of the previous version; however, it remains narrow in its focus on sensory and emotional features of pain, failing to capture the substantial roles of cognitive and social core components of the experience and their importance to advances in pain management. This paper reviews evidence and theoretical models for the significant role social and cognitive factors play in pain experience and we argue that without explicit recognition of these core components in the definition, significant nuances are lost at a cost to understanding and clinical management of pain. A focus on sensory and emotional features perpetuates biomedical interventions and research, whereas recognition of cognitive and social features supports a multidimensional model of pain, advances in interdisciplinary care, and the benefits of cognitive behavioral therapy and self‐management interventions. We also explore the six Key Notes that accompany the new definition of pain, discuss their application to the understanding of pain in childhood, and, in doing so, further explore social and cognitive implications. Considerations are also described for assessment and treatment of pain in pediatric populations.

End-of-life decision making in critical illness: Perspectives of Asian parents

To explore parents' perspectives regarding end-of-life (EOL) decisions, factors and possible barriers that influence the EOL decision making process, and to understand parental preferences for communication about EOL care in an Asian population. A prospective questionnaire cohort study conducted in a university-based tertiary care hospital. 30 parents of children who had been admitted to general pediatric wards for acute ailments and/or were being followed up in general pediatric outpatient clinics after inpatient admissions or emergency department visits completed 30 interviewer-administered questionnaires. With the first 10 completed questionnaires, we sought feedback on the design of the four case vignettes and related questions. Responses to specific questions related to each case vignette were rated on a Likert scale. The majority of parents were able to comprehend and identify with the issues in the case vignettes, which allowed them to respond appropriately. Parents tended to avoid active withdrawal or withholding of life-sustaining treatment. The top three priorities for parents making EOL decisions for their children were: the chance of improvement, the presence of pain or discomfort, and information provided by healthcare staff. Parents reported that they would prefer to know immediately if their child is at risk of dying; they also preferred to get as much information as possible from the healthcare team and thought that meeting with the healthcare team before making EOL decisions was pivotal. Parents place highest priorities on their child's likelihood of improvement, perception of their child's pain, and information provided by healthcare professionals in making EOL decisions.