Exploring the concept of pain of Australian children with and without pain: qualitative study

Joshua W Pate, Tim Noblet, Julia M Hush, Mark J Hancock, Renee Sandells, Meg Pounder, Verity Pacey, Joshua W Pate, Tim Noblet, Julia M Hush, Mark J Hancock, Renee Sandells, Meg Pounder, Verity Pacey

Abstract

Objective: A person's concept of pain can be defined as how they understand what pain actually is, what function it serves and what biological processes are thought to underpin it. This study aimed to explore the concept of pain in children with and without persistent pain.

Design: In-depth, face-to-face interviews with drawing tasks were conducted with 16 children (aged 8-12 years) in New South Wales, Australia. Thematic analysis was used to analyse and synthesise the data.

Setting: Children with persistent pain were identified from a pain clinic waiting list in Australia, and children without pain were identified through advertising flyers and email bulletins at a university and hospital.

Participants: Eight children had persistent pain and eight children were pain free.

Results: Four themes emerged from the data: 'my pain-related knowledge', 'pain in the world around me', 'pain in me' and 'communicating my concept of pain'. A conceptual framework of the potential interactions between the themes resulting from the analysis is proposed. The concept of pain of Australian children aged 8-12 years varied depending on their knowledge, experiences and literacy levels. For example, when undertaking a drawing task, children with persistent pain tended to draw emotional elements to describe pain, whereas children who were pain free did not.

Conclusions: Gaining an in-depth understanding of a child's previous pain-related experiences and knowledge is important to facilitate clear and meaningful pain science education. The use of age-appropriate language, in combination with appropriate assessment and education tasks such as drawing and discussing vignettes, allowed children to communicate their individual concept of pain.

Keywords: concept of pain; drawing task; paediatric pain; pain science education; qualitative interviews.

Conflict of interest statement

Competing interests: None declared.

© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

Figures

Figure 1
Figure 1
Examples of drawings by children when asked to draw whatever the word ‘pain’ makes them think of. Panels (a) and (b) represent how children who were pain-free drew injuries (9 years, girl; 10-year girl). Panels (c) and (d) are examples of how children with persistent pain drew more emotional elements such as hearts and tears (11 years, boy; 10 years, girl).
Figure 2
Figure 2
Eight examples of labelled diagrams of the brain, spinal cord and nerves by children aged 8–12 years. The top row shows drawings of children who were pain free (8 years, boy; 8 years, boy; 10 years, girl; 11 years, boy) and the bottom row shows drawings of children with persistent pain (8 years, boy; 12 years, boy; 9 years, girl; 11 years, boy). No differences between children with and without persistent pain were identified in this drawing task.
Figure 3
Figure 3
A proposed conceptual framework of the potential interactions between the themes resulting from the analysis and a child’s concept of pain.

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Source: PubMed

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