DEFINITIONS AND ASSESSMENTS OF PAIN WITH IMPACT IN CHILDREN AND ADOLESCENTS: A SCOPING REVIEW

Abstract

Background

There is growing recognition that a substantial proportion of children and adolescents are challenged by pain. However, there are inconsistencies as to how pain is defined. There is no consensus on what constitutes pain with sufficient impact to warrant concern for a child or adolescent.

Objectives

The aim of this scoping review is to provide an overview of the descriptors used to define pain with impact on children and adolescents.

Methods

We considered studies on pain in children and adolescents of school age (6 to 19 years). The definitions of pain with impact in children and adolescents were descriptively reported. To analyze the structure of the pain definitions, we grouped the definitions according to the impact of pain and based on 4 main domains: (1) presence of physical complaint, (2) impact of physical complaint, (3) temporal characteristic of the physical complaint, and (4) association with secondary disorders.

Results

Searches identified a total of 52,731 records and based on our inclusion criteria, 436 articles were included in this scoping review. Of these, 352 studies proposed to assess pain as a primary outcome but did not provide information on how pain was defined. In these studies, the most reported painful condition was “chronic pain,” with symptoms over 3 months, and the most used measurement instrument was the Numerical Rating Scale (NRS). Eighty-four studies assessed the impact of pain and provided a definition. For the description of 'symptoms', the most used terms were “pain” or “discomfort”, but few studies mentioned “impact”, the most used terms being “not being able to participate in daily activities” and “functional disability”. The most used assessment instrument was the Numerical Rating Scale (NRS).

Conclusion

Most studies did not propose a detailed definition and there is no standardization of the terms used even to search for the same concept. The lack of consensus on a definition of pain with impact in children and adolescents makes it difficult to compare the findings.

Implications

Although many studies include in their primary data the investigation of pain with impact, there is a lack of descriptions regarding the 'impact' of the condition in children and adolescents. Although the most used tools for assessing pain with impact have been the Numerical Rating Scale (NRS) and the Visual Analog Scale (VAS), these tools are quantitative and may not capture the complexity of the pain or its potential impact on the patient's life.