Children’s Behavioral Pain Cues: Implicit Automaticity and Control Dimensions in Observational Measures

Abstract

Some pain behaviors appear to be automatic, reflexive manifestations of pain, whereas others present as voluntarily controlled. This project examined whether this distinction would characterize pain cues used in observational pain measures for children aged 4–12. To develop a comprehensive list of cues, a systematic literature search of studies describing development of children's observational pain assessment tools was conducted using MEDLINE, PsycINFO, and Web of Science. Twenty-one articles satisfied the criteria. A total of 66 nonredundant pain behavior items were identified. To determine whether items would be perceived as automatic or controlled, 277 research participants rated each on multiple scales associated with the distinction. Factor analyses yielded three major factors: the “Automatic” factor included items related to facial expression, paralinguistics, and consolability; the “Controlled” factor included items related to intentional movements, verbalizations, and social actions; and the “Ambiguous” factor included items related to voluntary facial expressions. Pain behaviors in observational pain scales for children can be characterized as automatic, controlled, and ambiguous, supporting a dual-processing, neuroregulatory model of pain expression. These dimensions would be expected to influence judgments of the nature and severity of pain being experienced and the extent to which the child is attempting to control the social environment.

The management of pediatric pain and the perception of the nursing team in light of the Social Communication Model of Pain

“…Pediatric pain management includes pain recognition to the moment when the professional defines which strategies to use to relieve it. For this sequence of events to be carried out properly, the nursing professional needs to understand the importance of his/her role in this process and recognize how prepared he/she is to carry out this management 14 . This preparedness is evidenced in the SCMP as the professional training involved in the professional's intrapersonal factors, which in practice is illustrated as transmitted content, institutional training, and previous knowledge 8 .…”

A Study of Patient’s Pain Assessment Based on Facial Expression: Issues and Challenges

“…In fragile group with advanced stage of dementia (PACSLAC, DOLOPLUS2, PAINAD) [29,32,33,36,39,44,58] and for a cognitive impaired [46,47]. For unconscious patients using observational scales such as (BPS, CPOT, and NVPS) [28,45,48,55,59]. A significant amount of previous knowledge and experience is necessary to adjust the accurately.…”

Automated Pain Detection in Facial Videos of Children Using Human-Assisted Transfer Learning

“…Further, infants, young children, and others with communication/neurological disabilities do not have the ability or capacity to self-report pain levels [3,5,6]. As a result, to evaluate pain in populations with communication limitations, observational tools based on nonverbal indicators associated with pain have been developed [7].…”

“…Of the various modalities of nonverbal expression (e.g., bodily movement, vocal qualities of speech), it has been suggested that facial activity provides the most sensitive, specific, and accessible information about the presence, nature, and severity of pain across the life span, from infancy [8] to advanced age [9]. Moreover, observers largely consider facial activity during painful events to be a relatively spontaneous reaction [7].…”