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Accuracy of pain recall in children
Ashish Chogle1, Marcelo Sztainberg, Lee Bass
1Division of Gastroenterology, Hepatology and Nutrition, Children's Memorial Hospital, Chicago, IL, USA.
Insights
Children often inaccurately recall chronic abdominal pain (AP) episodes, reporting fewer days than documented in diaries. Younger children demonstrate better recall of AP symptoms than adolescents.
Area of Science:
- Pediatric Gastroenterology
- Clinical Pain Research
- Child Psychology
Background:
- Chronic abdominal pain (AP) is a prevalent condition in children, impacting daily life and healthcare utilization.
- Accurate symptom recall is crucial for clinical management, treatment assessment, and research outcomes in pediatric AP.
- Existing data on the accuracy of AP recall in pediatric populations are limited.
Purpose of the Study:
- To evaluate the accuracy of children's recall of chronic abdominal pain episodes.
- To compare prospective diary-recorded pain data with retrospective recall of pain frequency and intensity.
Main Methods:
- Secondary analysis of a randomized, placebo-controlled trial involving children (8-17 years) with functional gastrointestinal disorders.
- Participants maintained daily AP diaries for one month, recording presence, frequency, and intensity.
- Retrospective recall of AP days in the previous month was compared with diary data using Spearman rank correlations.
Main Results:
- Only 16% of children demonstrated perfect agreement between recalled and diary-documented AP days.
- Children recalled fewer AP episodes, with an average of 17.7 days/month versus 23.5 days/month in diaries (P=0.001).
- Recall accuracy was higher in younger children (≤11 years, r=0.59) compared to older children (>11 years, r=0.26), with no correlation to pain intensity.
Conclusions:
- Children frequently underestimate the frequency of their chronic abdominal pain episodes when recalling past symptoms.
- The accuracy of AP recall is limited in children, particularly in adolescents.
- Prospective symptom diaries are more reliable than retrospective recall for assessing AP frequency in pediatric populations.
Background And Aim:
Chronic abdominal pain (AP) is common in children. Recall of symptoms is used clinically to determine management, to assess treatment progress, and in drug studies to assess outcomes. Limited data exist on accuracy of AP recall in children. The aim of the present study was to assess ability to accurately recall AP in children.
Methods:
The study was a secondary analysis of data obtained from a double-blind, randomized, placebo-controlled trial, evaluating amitriptyline in children with functional gastrointestinal disorders. Children ages 8 to 17 years with AP predominant functional gastrointestinal disorders based on Rome II criteria were recruited from 6 centers. Those with evidence of organic disease were excluded. Patients maintained AP diary daily for 1 month (presence, frequency, and intensity). At the end of the study, patients reported the number of days of AP during previous month. Agreement between daily pain reports and recalled pain was assessed. Univariate analysis was conducted with Spearman rank correlations.
Results:
We recruited 63 children (45 girls, mean age 12.8 years). Sixteen percent children had perfect agreement on number of days of AP. Fifty-four percent of children recalled fewer episodes of pain. The average number of days with AP by recall was 17.7/month, whereas by diary it was 23.5/month (P = 0.001). Correlation between patient recall of the last week of symptoms (r = 0.47) was no better than correlation between recall of the last 30 days of symptoms (r = 0.48). On comparing AP recall versus various pain intensities, reported AP did not reflect only AP of greater severity. Higher correlation of recall of symptoms was seen in children 11 years or younger (r = 0.59) as compared with children older than 11 years (r = 0.26).
Conclusions:
Few children can accurately recall the episodes of AP. Children commonly recall a lower frequency of AP than that assessed by prospective diary reports. Reported recall does not reflect a shorter recollection period. Recall is not related to intensity of pain. Adolescents have worse recall of symptoms.
