Author(s): Fernandes, Ananda Maria ; Batalha, Luís Manuel da Cunha ; Campos, Diana Catarina Ferreira de ; Oliveira, Armando Luis Dinis Mónica ; oliveira, miguel
Date: 2012
Origin: Repositório Científico da Escola Superior de Enfermagem de Coimbra
Subject(s): Children; cancer; pain; nursing
Background Age and gender differences regarding pain perception have been described. Cognitive development modulates children's ability to express their pain, with older children having a more complete understanding of pain experiences. Boys are said to be more stoic and girls more expressive. Previous pain experience may also influence the choice of words to describe pain. Although much has been investigated about age and gender differences regarding pain sensitivity, the role of these variables as well as health condition on pain language is not well understood among paediatric population. Aim This study compared the use of pain descriptors by children and adolescents of different age groups, gender and health condition. Methods As part of a larger study, 67 pain descriptors from Adolescent Pediatric Pain Tool were presented to two groups of children (8-12 years old) and adolescents (13-17 years old): healthy and diagnosed with cancer (n=48). In each group, 24 subjects were included at random: 6 boys and 6 girls. Following Q-sort procedure, children were asked to recall their pain experiences and allocate each descriptor to one of three categories: a) words that I know and use to describe pain; b) words that I know but don't use to describe pain; c) words that I don't know. For each subject, the percentage of words that are used within the number of words that are known was calculated and used as dependant variable in stepwise regression analysis. Results Findings show that cancer subjects use fewer words to describe their pain compared to healthy subjects. Although there were no age and gender related differences, in sub-analysis in the cancer group, adolescents use more words to describe their pain than children and girls use more descriptors than boys. In stepwise regression analysis only health condition and age group were retained as predictors. These two variables explain 25% of the variance in the amount of words that children and adolescents use to describe their pain experiences. Conclusions Although many internal and external factors underlie the way in which pain is described, our results suggest that the choice of words to describe pain during the course of development is shaped by the experience of repeated pain such as in children and adolescents with cancer. The use by cancer subjects of a smaller number of descriptors among those that are known to them may be the result of a more precise and complex representation of pain. In this group, the wider spectrum used by adolescents compared to children, may reflect a broader understanding of the pain experience and its impact as well as more verbal skills. The role of gender together with chronic pain experience in pain descriptions deserves to be further explored. Implications Even though these conclusions require replication, the results offer some direction in the choice of pain assessment tools for cancer children. Health professionals should be aware of age and gender related differences in pain language to avoid underestimating the experience of less communicative groups.
