Acute and postoperative pain in children is often undertreated, with effects on patient comfort and postoperative recovery. Extended reality (XR) interventions offer non-pharmacological pain management by distracting patients from discomfort. While effective for procedural pain, its impact on prolonged pain episodes remains underexplored. To systematically review and meta-analyze findings from previous studies on the efficacy of XR interventions in managing acute and postoperative pain in children, compared to standard care. Studies involving children (≤ 18 years) with acute or postoperative pain were included if they compared XR interventions to standard care. Studies focusing on procedural or chronic pain were excluded. A systematic search was conducted on January 23, 2025, in MEDLINE, EMBASE, Web of Science, CINAHL, and PsycINFO for studies evaluating XR interventions for acute and postoperative pain in children, using validated pain measures. Pain outcomes were extracted for an exploratory meta-analysis, with self-report as the primary and observer-report as the secondary outcome. Two reviewers independently extracted data and assessed study quality using CONSORT and TREND. From 1793 records, nine studies were included, all evaluating virtual reality (VR) interventions. Seven focused on postoperative pain, two on acute pain. The primary meta-analysis (n = 6) showed a moderate but nonsignificant effect in self-reported pain (SMD = -0.61; 95% CI, -1.58 to 0.36). The secondary meta-analysis (n = 6) for observer-reported pain showed a large but nonsignificant effect (SMD = -1.04; 95% CI, -2.18 to 0.11). This meta-analysis found no significant analgesic effect of VR on acute or postoperative pain in children. However, moderate effect sizes were observed, but the lack of statistical significance indicates that XR interventions require further investigation in pediatric pain management. Future research should prioritize pain as a primary endpoint and assess the effects of VR type, timing, and age on acute pain using validated measures.

Why primary caregivers fail to report pediatric pain: A qualitative study.

Healthcare professionals (HCPs) play a key role in improving pain outcomes in hospitalized children. Knowledge gaps can significantly hinder the ability of HCPs to provide optimal pain care. Developing targeted educational interventions to address these gaps requires a clear understanding of priority areas for training on essential pain-related topics. Against this background, this study aimed to establish consensus on topics for a pediatric pain educational program (PPEP) for continuing professional education among HCPs. A two-stage modified e-Delphi study was conducted among experts in pediatric care, health education, and pain research. The researchers developed 35 topics by reviewing the Core Content of the Pediatric Pain PRN Curriculum. In the first and second rounds, experts rated the topics and suggested additional topics. Ratings were done on a four-point Likert scale with options ranging from 1 (not important at all) to 4 (very important). The outcomes from both rounds were analyzed based on the level of consensus. Consensus on a topic was set at a threshold of ≥ 70. A response rate of 88% (n = 22/25) and 100% (n = 22/22) was achieved for the first and second rounds, respectively. Experts rated 35 topics and 5 topics (the topic that failed to achieve consensus in the first round and four new ones generated from expert comments) in the first and second rounds, respectively. In the first round, experts agreed on 34 of the 35 topics (72.7%-90.9%) while all five topics achieved consensus (90.9%-100%) in the second round. Thus, 39 topics under the domains of pain theories, pediatric chronic pain, pain assessment, opioid risk evaluation and mitigation strategies (REMS), biobehavioural strategies, procedural pain, acute pain management and reorientation were agreed on for inclusion in the PPEP. A high level of consensus was achieved among a multidisciplinary panel of experts on the content of the PPEP. This can serve as a valuable resource for interprofessional pain continuing education in low-resource settings. The topics can also be integrated into curricula for preregistration healthcare professionals in such settings.

Procedural pain and distress in children can result in severe short- and long-term consequences, including post-traumatic stress syndrome and needle phobia. While distraction techniques (e.g., toys, music) have been widely used, virtual reality (VR) offers a novel, immersive form of distraction. Despite the rapid development of VR technologies, there is a lack of comprehensive evidence regarding which paediatric patients and procedures benefit most from VR interventions. We conducted a scoping review following the PRISMA-ScR guidelines. A systematic search across PubMed, Embase, Web of Science, Cochrane Library and Chinese databases (CNKI, Wanfang, VIP, SinoMed) identified studies from January 1, 2000 to November 15, 2025. Inclusion criteria were randomized controlled trials (RCTs) or quasi-experimental designs assessing VR for pain/anxiety management during medical procedures in paediatric patients, with outcomes including pain intensity, distress, feasibility, satisfaction or safety. Of the 5458 original database citations, 201 were eligible for full-text evaluation. Of these articles, a total of 22 were included in the scoping review. RCTs comprised 81.8% (n = 18). The majority (86.4%) employed immersive VR and 27.3% utilized cost-effective smartphone-based systems. Procedures targeted included venipuncture, needle-related interventions, intravenous access, surgery and burn wound care. Approximately 86.4% of studies reported VR's superiority over standard care in reducing procedural pain and distress. VR is an effective, non-pharmacological tool for managing procedural pain and distress in paediatric clinical settings, showing promise for integration into routine care. However, existing studies exhibit methodological heterogeneity and focus primarily on short-term outcomes. Future research should prioritize large-scale, rigorously designed RCTs with long-term follow-up, and focus on developing standardized, evidence-based VR protocols for diverse paediatric populations. No patient or public contribution was required for this scoping review, as it only synthesized existing published literature without primary data collection.

Comprehensive pain management in children requires a specialized skillset, with a limited number of clinicians possessing the level of expertise required to successfully navigate the complexities of holistic care. The emergence of pediatric anesthesia fellowship programs in sub-Saharan Africa presents an opportunity to embed a pediatric pain curriculum for trainees, improving the availability of specialist skill and knowledge in the field. Existing pain curricula fall short in addressing the sociocultural aspects of pediatric pain identified through research as being unique to the African context, and do not include elements of leadership and advocacy training required to navigate the complexities of resource-constrained healthcare settings. A Delphi survey including literature review, iterative rounds of surveys and expert consensus was used to establish a pediatric pain curriculum for pediatric anesthesia fellows undertaking advanced training in sub-Saharan Africa. The 22-member expert panel included anesthetists, nurses, surgeons, pharmacists, pediatricians, a physiotherapist and a patient-caregiver dyad with a lived experience of pain. After completing three rounds of surveys, a steering committee of five members was assembled to resolve outstanding items to achieve the final curriculum. The process yielded a curriculum containing 20 knowledge items and 23 skills items. Attitudes are a key component of the curriculum and were grouped into six themes. A further aspect of the process was the identification of foundational knowledge with which trainees should enter a fellowship training program. This was termed the foundational curriculum. Using a Delphi method, consensus has been achieved on a pediatric pain curriculum for pediatric anesthesia fellows in sub-Saharan Africa with potential to meet the identified need for transformative pain care in this patient population.

Emerging work characterizing youth with chronic pain increasingly recognizes a large cohort of youth with co-occurring chronic pain and autism. This development has prompted questions about how to adapt Intensive Interdisciplinary Pediatric Pain Treatment (IIPTs) and the group-based treatments commonly used in these settings to improve accessibility, acceptability, and utility for autistic participants. There is a need for clinically oriented literature that IIPT programs and clinical trialists can use to guide adaptation efforts. Given long-term risks of inadequately treated pediatric pain, we argue it is clinically and ethically important to identify reasonable autism-informed adjustments within existing IIPT frameworks, even as more empirical work unfolds to inform nuance. In this narrative review, we synthesize evidence from pediatric pain psychology and autism intervention literatures to identify overlapping mechanisms and opportunities for adaptation, with a specific focus on group-based CBT/ACT-oriented treatments delivered in IIPTs. We summarize emerging clinical characteristics of autistic adolescents enrolled in IIPTs, bridge autism and pediatric pain group treatment literature, map that literature onto pediatric pain targets and autism-informed IIPT group design considerations and provide practical examples of IIPT group modifications extended from the existing data and the authors' clinical experience delivering group-based pain psychology services to autistic youth in IIPTs. We also highlight constraints of group formats for autistic youth and emphasize flexible pathways of care.

This audit aimed to assess compliance with British Orthopaedic Association Standards for Trauma (BOAST) for paediatric forearm and wrist fractures across UK NHS hospitals and identify targets for improvement locally and nationally. This was a prospective, multicentre observational audit of BOAST standards for the Early Management of the Paediatric Forearm Fracture guideline. Consecutive patients aged under 16 years presenting with a forearm or distal radius fracture over a two-month period were included with follow-up to eight weeks post injury. Data were collected to assess each of the BOAST standards for practice. Percentage compliance with all standards was calculated for each hospital. Data from 1,699 patients across 53 hospitals were included. The mean age was 9.7 years (SD 3.6), and 37% (n = 636) were female. Overall, 60% of fractures (n = 1,023) were metaphyseal distal radius fractures. A total of 577 patients (34%) underwent manipulation with the majority initially reduced in the Emergency Department (ED) (n = 423, 73%); 89 (21%) required subsequent theatre manipulation. The median time to first manipulation in the ED was two hours 43 minutes (IQR 1 hr 43 mins to 4 hrs 4 mins) and 18 hours 47 minutes (IQR 13 hrs 48 mins to 24 hrs 2 mins) when first manipulation was performed in theatre. Overall compliance with BOAST standards was 63%, with 20% of patients (n = 85) having pain scores documented, 51% (n = 217) having a complete neurovascular assessment, and 23% (n = 95) receiving analgesia and a patient information leaflet on discharge. This study highlights variability in managing paediatric fractures despite established standards. In line with recommendations, a high proportion of reductions are now being performed in EDs. Particular areas requiring improvement are the management of paediatric pain, documented assessment of neurovascular status, and the provision of patient information. We recommend that hospitals review their current practice and ensure that local protocols are in place to promote the provision of optimal care for this patient group, and to minimize the impact on operating theatre capacity.

Many children and adolescents suffer from high-impact chronic pain. While preliminary evidence suggests that intensive interdisciplinary pain treatment is effective, there is limited post-treatment support. Individualized support through a pain management app may help close this gap. We conducted a multicenter randomized controlled trial with N = 453 youths with chronic pain aged 8-17 and their caregivers. Participants had access to the app MyBrainCity from admission until six months following discharge. Immediately after discharge, participants had access to either (1) app usage statistics (reference group), (2) plus push notifications and suggestions, (3) plus on-demand chat communication with a psychologist, or (4) plus psychologist-initiated chat communication. Data were collected up to nine months after discharge. Outcomes included the functional disability inventory, the Revised Anxiety and Depression Scale, and numeric rating scales to assess pain intensity. The primary analysis showed no significant differences in functional impairment between groups nine months post-discharge (χ2(3)=6.122, p=.106). Secondary analyses revealed that patients in Groups 3 and 4 showed significantly greater improvements in functional impairment compared to the reference group (-1.13 points, p<.001). Only patients in Group 4 demonstrated additional improvements in emotional burden (anxiety: -0.91 points, p<.001; depression: -0.72 points, p=.012). Patients in Group 2 had significantly greater reductions in both average (-0.24 points, p=.007) and maximum pain intensity (-0.33 points, p=.001) compared to the reference group. Pediatric pain management apps may be most effective when designed to include individualized, personal support. Patients especially benefit from clinician-delivered feedback following discharge.

Pediatric patient-reported outcome measures (PROMs) are essential in pain intervention research, yet their changes often lack clear clinical significance. The authors estimated minimally important differences (MIDs) for commonly used and freely available PROMs in pediatric pain intervention research. Using data from a longitudinal multicenter study (N = 453) on children and adolescents aged 8 to 17 years with chronic pain in Germany, the authors applied equipercentile linking to align pre-post intervention changes in PROMs with global ratings of change. The MID for improvement in the Functional Disability Inventory (FDI) is 4.96 points (8.27% of the instrument range, Hedges g = 0.47). In the Revised Children's Anxiety and Depression Scale (RCADS), the MID for anxiety is 3.32 points (2.99% of subscale range, g = 0.17) and 1.38 points (4.60%, g = 0.24) for depression. A reduction of 0.64 points (g = 0.32) on an 11-point pain intensity scale indicates meaningful improvement. For pain self-efficacy (Scale for Pain Self-Efficacy), an increase of 3.72 points (8.46% of instrument range, g = 0.44) constitutes an MID. This is the first study to estimate detailed anchor-based thresholds using equipercentile linking for widely used pediatric PROMs based on patient perspectives, distinguishing clinical from statistical significance. Although primarily applicable to pediatric chronic pain, these patient-centered thresholds may extend to broader pediatric populations.

Taking social determinants of health seriously: pediatric pain in migrant youth.

ABSTRACTNurses play a vital role in pediatric pain assessment and management. However, nurses' limited competencies in pain management have been identified as one of the barriers to optimal pediatric pain care. Therefore, this study aimed to implement and evaluate an educational program and changes in nurses' pediatric pain assessment knowledge and attitudes (PPAKA), self‐efficacy, and the program's acceptability. Guided by Kirkpatrick's model of evaluation, a one‐group pre‐post study was conducted among 20 nurses working at the children's unit of the Kwame Nkrumah University of Science and Technology (KNUST) Hospital in Ghana. The pediatric pain assessment educational program (PPAEP) was delivered to the nurses by a pediatric pain nurse researcher in a one‐time training session. Participants' pediatric pain assessment knowledge, attitudes, and self‐efficacy were assessed before and after the educational program, whereas the program's acceptability was assessed only after the training session. Wilcoxon signed‐rank test was performed to evaluate changes in knowledge, attitudes, and self‐efficacy following the educational program. Acceptability was presented using descriptive statistics. A Wilcoxon signed‐rank test revealed that nurses' PPAKA scores significantly increased after participating in the educational program (z = −2.514, p = 0.012). The standard PPAKA score increased from 63 at pre‐test to 78 at post‐test. Participants' self‐reported efficacy in assessing pediatric pain was also significantly higher at post‐test than at pre‐test (z = −3.967, p < 0.001). The standard self‐efficacy score increased from 58.6 at pre‐test to 87.7 at post‐test. Participants were satisfied and gave positive feedback on the program. A brief PPAEP is acceptable among nurses in a resource‐constrained setting and is associated with improvement in pediatric pain assessment knowledge, attitudes, and self‐efficacy. Future multi‐site studies using larger samples and more rigorous designs, such as randomized controlled trials, are needed to evaluate the program's effectiveness.

Burnout is a concern among healthcare providers, linked to suboptimal patient care. Working as part of an integrated team has been identified as a mitigator and exacerbator of burnout, however, this relationship is not well understood in pediatric chronic pain care. This study assessed levels of burnout and perceptions of teamwork in a multidisciplinary group of pediatric chronic pain providers. A cross-sectional survey consisting of the Copenhagen Burnout Inventory and team functioning measures (i.e., communication/information sharing, team support, team effectiveness) was completed by N=195 providers. Pearson correlations were conducted to evaluate the association between burnout and teamwork. A K-means cluster analysis was used to group providers according to their level of burnout, and groupwise comparisons were conducted to examine differences in team functioning perceptions across established groups. Rates of personal (M=39.91, SD=16.97) and work-related (M=39.67, SD=17.75) burnout exceeded established norms. Team functioning ratings were generally positive; however, variability existed with poorer ratings in areas such as team coordination and productivity. Increased burnout was associated with poorer perceptions of team effectiveness and higher perceived room for improvement. K-means clustering identified three distinct provider groups: high, moderate, and low burnout, with significant differences in perceived team functioning across these groups. Elevated rates of burnout exist among multidisciplinary pediatric pain providers and are related to perceptions of team functioning. Research should explore directionality and causality of this relationship as well as provider experiences to support development of interventions to address team functioning and burnout and thus improve patient care.

To describe the youngest and second ever reported patient with real-time point-of-care ultrasound (POCUS) visualization of motile Enterobius vermicularis within the appendix and to demonstrate how real-time intraluminal motion aids in distinguishing parasitic infestation from typical obstructive appendicitis. We present the clinical course, ultrasound findings, and management of a 23-month-old girl with acute intermittent abdominal pain. POCUS revealed a dilated, noncompressible appendix containing multiple linear echogenic structures demonstrating serpiginous, independent motion-highly suggestive of E. vermicularis . Mild periappendiceal echogenicity suggested early acute appendicitis. The patient was successfully managed nonoperatively with albendazole and intravenous antibiotics, experiencing complete symptom resolution within 24 hours. This represents the youngest and second-ever reported patient in whom real-time sonographic visualization of live appendiceal parasites has been reported. True intraluminal motility is a critical sonographic discriminator of parasitic infestation and can fundamentally alter management decisions. In this case, early identification of E. vermicularis supported a safe, nonoperative strategy for early appendicitis. Incorporating POCUS early in the evaluation of atypical pediatric abdominal pain may prevent unnecessary surgical intervention.

Long-term predictive validity of the pediatric pain screening tool for chronic postsurgical pain and pain-related quality of life impairment: Associations with risk stratification groups in Spain.

Although pediatric pain can impede healthy development throughout adulthood, the prevalence of chronic pain among US children with developmental disabilities remains unclear. To evaluate parent-reported chronic pain prevalence and the association between developmental disabilities and chronic pain in US children and adolescents (hereinafter, children). This national survey study included 263 168 children aged 3 to 17 years who participated in the 2016-2023 National Survey of Children's Health (NSCH). Data were analyzed from June 2025 to August 2025. Reporting any of the 10 developmental disabilities included in the NSCH: seizure, cerebral palsy, autism, attention-deficit/hyperactivity disorder, vision, hearing, and/or speech delay, intellectual and/or learning disability, and developmental delay. The weighted prevalence of parent-reported chronic pain in children with or without any of these 10 disabilities was calculated across the study period and by year. Logistic regression models were applied to examine the association between various categories of developmental disabilities and pain among US children as well as potential health disparities. This study included a weighted sample of 224 467 664 children; of them, 135 848 (51.1%) were male with a mean (SD) age of 10.2 (4.5) years. Approximately 18.7% of children reported having at least 1 disability. The weighted prevalence of parent-reported chronic pain was higher in children with at least 1 developmental disability compared to peers without a disability (13.2% vs 5.5%) over the study period. Adjusted analyses revealed significant associations between any of the disabilities and parent-reported chronic pain, with an odds ratio of 2.31 (95% CI, 2.14-2.49). Similar positive associations were also observed for all disability categories, particularly seizure and cerebral palsy. Moreover, higher odds of parent-reported chronic pain were associated with lower levels of parental education and family income, or more adverse childhood experiences. The findings in this study indicate that children with diverse developmental disabilities were more likely to have parent-reported chronic pain, and this likelihood was associated with several socioeconomic factors. These findings provide important insights into targeted screening and interventions for pain in pediatric populations with developmental disabilities.

Functional abdominal pain (FAP) and irritable bowel syndrome (IBS) are associated with anxiety, depression, school absenteeism and reduced quality of life in children. In secondary care, hypnotherapy is often available. To determine the effectiveness of home-based guided hypnotherapy for children with FAP or IBS in primary care. A pragmatic randomised controlled trial in Dutch primary care with a follow-up of 12 months. Children aged 7-17 years with FAP or IBS diagnosed by a general practitioner were included. The intervention group received home-based guided hypnotherapy via a website for 3 months in addition to care as usual. The control group received care as usual only. The primary outcome was adequate relief of abdominal pain and/or discomfort at 12 months. Adjusted odds ratios (aOR) and 90% confidence intervals (90%CI) are reported. In total, 152 children were included. No significant differences were observed in adequate relief at 12 months (79.5% in the intervention group (58/73 children) versus 74.3% in the control group (52/70 children); aOR 1.47, 90%CI 0.74-2.93), but more children in the intervention group had adequate relief compared to the control group at 3 months (aOR 2.74, 90%CI 1.22-6.13) and 6 months (aOR 4.26, 90%CI 1.81-10.04). The intervention group also showed reductions in abdominal pain severity, intensity, frequency, and threat, and higher proportions of fast sleep onset. While adequate relief after 12 months is high in both groups, adding hypnotherapy to care as usual may help achieve earlier relief and reduce pain.

ABSTRACTBackgroundCross‐sectional studies have reported associations between pain catastrophizing and pain medication use in youth with chronic pain; however, the factors underlying this association remain unclear. Guided by the paediatric Fear‐Avoidance model, this cohort study examined whether pain interference played a role in the longitudinal association between pain catastrophizing and subsequent pain medication use.MethodsParticipants were drawn from the EPIDOL project and included 180 adolescents (mean age = 13.56 years; 78% female) with chronic pain at both first assessment (T1) and 12‐month follow‐up (T2). Self‐report measures assessed demographics (birth sex and age), pain characteristics (location, extent, and intensity), pain interference, pain catastrophizing, and pain medication use. Generalized structural equation models tested theory‐guided autoregressive and cross‐lagged panel specifications. Models adjusted for age, birth sex, and pain intensity and accounted for temporal stability.ResultsPain catastrophizing and pain medication use showed moderate to high temporal stability. No significant association was observed between pain catastrophizing at T1 and pain medication use at T2. In contrast, pain interference at T1 was significantly associated with pain medication use at T2, even when controlling for pain catastrophizing at T1. Findings were consistent across model specifications.ConclusionsThe findings suggest that pain interference may represent a functional factor prospectively associated with subsequent pain medication use. Future research should examine its potential role in linking pain catastrophizing and pain medication use when such associations are observed. Overall, the results support assessing both cognitive and functional dimensions when evaluating pain‐related management patterns in youth with chronic pain.Significance StatementThis longitudinal study found that the association between pain catastrophizing and pain medication use inadolescents with chronic pain was accounted for indirectly by pain interference. These findings highlight theimportance of addressing both functional interference and pain‐related cognitions in paediatric pain management.

This study aimed to assess pediatric nurses' knowledge and skills in pain management and examine the factors influencing their proficiency in this area. A cross-sectional study was carried out to assess the knowledge of pediatric nurses in Greece. Data were collected from six public pediatric hospitals using a convenience sampling method, yielding a sample of 154 nurses. The Demographic Information Questionnaire and the Knowledge and Attitudes Survey Regarding Pain (KASRP) were utilized. Statistical analysis was performed using Statistical Product and Service Solutions (SPSS) software. The study found that pediatric nurses had a mean score of 51.98% on the pain management knowledge questionnaire, highlighting significant gaps in understanding, particularly regarding opioid use and pain intensity indicators. Scenario-based decision-making revealed that only a small percentage of participants correctly identified the appropriate dosage for pediatric pain management. Key areas for improvement were identified, especially in the proper use of opioids and pain assessment scales. The findings of this study highlight the need for targeted educational interventions and training programs to enhance pediatric nurses' competencies in pain management. Improving nurses' knowledge and clinical decision-making could contribute to more effective pain relief and higher-quality care for pediatric patients.

This review outlines current interventional radiology literature for managing pediatric musculoskeletal conditions-specifically bone cysts, bone tumors, and pain management. With the advancements in regenerative bone grafts, ablative techniques and increased awareness from referring physicians, there has been a gradual shift from open surgical techniques to minimally invasive, image-guided procedures in the management of certain pediatric musculoskeletal conditions.

Consensus, divergence, and challenges in pediatric pain management practices: a qualitative study from a multi-stakeholder perspective