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Why Unidimensional Pain Measurement Prevails in the Pediatric Acute Pain Context and What Multidimensional
Tiina Jaaniste1,2, Melanie Noel3,4,5, Renee D Yee1,2
1Department of Pain and Palliative Care, Sydney Children's Hospital, Randwick, NSW 2031, Australia.
Insights
Unidimensional pain assessments in children are insufficient, failing to capture the full pain experience. Multidimensional pain measurement offers a more comprehensive approach for better clinical interventions and identifying risks for chronic pain.
Area of Science:
- Pediatric Pain Management
- Clinical Psychology
- Pain Measurement
Background:
- Pain is recognized as multidimensional, yet unidimensional intensity measures dominate pediatric acute pain assessment.
- Unidimensional assessments provide an incomplete view of a child's pain and inadequately inform clinical practice.
- This review addresses the gap between the recognized multidimensional nature of pain and its common unidimensional measurement in children.
Purpose of the Study:
- To review the literature supporting the multidimensional nature of pediatric acute pain.
- To examine concordance data for sensory, affective, and evaluative pain dimensions in children.
- To discuss the implications of multidimensional pain assessment for clinical practice, education, and research.
Main Methods:
- Systematic review of theoretical and empirical literature on pediatric acute pain.
- Analysis of studies reporting concordance data for distinct pain dimensions (sensory, affective, evaluative).
- Examination of reasons for the prevalence of unidimensional pain assessment protocols.
Main Results:
- Empirical literature supports the distinct nature of sensory, affective, and evaluative pain dimensions in children.
- Multidimensional assessment holds promise for identifying predictors of chronic pain.
- Unidimensional measures are prevalent due to various factors, despite their limitations.
Conclusions:
- Multidimensional pain assessment in children provides a more complete understanding of their pain experience.
- Adopting multidimensional approaches can improve clinical management and identify children at risk for chronicity.
- Further research and education are needed to promote the use of multidimensional pediatric pain assessment.
Abstract:
Although pain is widely recognized to be a multidimensional experience and defined as such, unidimensional pain measurement focusing on pain intensity prevails in the pediatric acute pain context. Unidimensional assessments fail to provide a comprehensive picture of a child's pain experience and commonly do little to shape clinical interventions. The current review paper overviews the theoretical and empirical literature supporting the multidimensional nature of pediatric acute pain. Literature reporting concordance data for children's self-reported sensory, affective and evaluative pain scores in the acute pain context has been reviewed and supports the distinct nature of these dimensions. Multidimensional acute pain measurement holds particular promise for identifying predictive markers of chronicity and may provide the basis for tailoring clinical management. The current paper has described key reasons contributing to the widespread use of unidimensional, rather than multidimensional, acute pediatric pain assessment protocols. Implications for clinical practice, education and future research are considered.
