Pain and development: interacting phenomena

For decades, clinicians and researchers have observed bidirectional relationships between child development and the pain experience in childhood. Pain in childhood is an inherently developmental phenomenon, embedded in an iterative, time-dependent process that reflects individual biological, behavioral, social, psychological, and environmental characteristics that unfold across the early life span. Childhood pain can have wide ranging effects on brain development in ways that contribute-for better and worse-to social, emotional, and cognitive well-being in childhood and on into adulthood. Atypical trajectories of development in the context of disorders such as autism, cerebral palsy, ADHD, and mood/anxiety disorders also contribute to unique childhood pain experiences. In this paper, pain will be considered as a determinant of development, and conversely development will be considered as a key determinant of a child's pain experience. We will discuss how intersectional identities (eg, gender, race, socioeconomic status) and associated social, structural, systemic, and physical environments influence the relationship between development and pain. Finally, we will identify what might be needed to think "developmentally" in ways that extend from the "bench side" in the lab to the "curb side" in the community, integrating a developmental perspective into research and clinical practice to achieve health accessibility and equity in pain care for all children across the developmental spectrum.