Pain Neuroscience Education for Children: Difference between revisions

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== Pain ==
== Pain ==
Pain is a sensation and emotion in response to multiple stimuli created by the conscious brain which is then perceived as threatening. Pain is not a measure of tissue damage but rather the brains response to the threat. Therefore, pain is not only physical but an emotional event for the person.<ref name=":0">Prowse, T.  Pain Neuroscience Education Course. Physioplus.. 2022</ref> Pain is always an unpleasant sensation to the body and can be a challenge to define because it is subjective and ranges in quality, intensity and duration. <ref>Raja SN, Carr DB, Cohen M, Finnerup NB, Flor H, Gibson S, Keefe F, Mogil JS, Ringkamp M, Sluka KA, Song XJ. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7680716/ The revised IASP definition of pain: Concepts, challenges, and compromises]. Pain. 2020 Sep 1;161(9):1976.</ref>
Pain is a sensation and an emotional response to multiple stimuli created by the conscious brain which is then perceived as threatening.<ref>Li W, Liu P, Hu Y, Meng J. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7680868/pdf/fpsyg-11-595987.pdf Pain Modulates Responses to Emotional Stimuli.] Front Psychol. 2020 Nov 9;11:595987.</ref> Pain is not a measure of tissue damage, but rather the brain's response to the threat. Therefore, pain is not only physical but an emotional event for the person.<ref name=":0">Prowse, T.  Pain Neuroscience Education Course. Plus.. 2022</ref> Pain is always an unpleasant body sensation, but it can be a challenge to define because it is subjective and ranges in quality, intensity and duration.<ref>Raja SN, Carr DB, Cohen M, Finnerup NB, Flor H, Gibson S, Keefe F, Mogil JS, Ringkamp M, Sluka KA, Song XJ. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7680716/ The revised IASP definition of pain: Concepts, challenges, and compromises]. Pain. 2020 Sep 1;161(9):1976.</ref>


See the video below on the Mysterious Science of Pain
See the following videos by Joshua Pate on the science of pain and phantom limb pain:  
{{#ev:youtube|eakyDiXX6Uc}}


=== Chronic Pain in Children ===
<div class="row">
Thirty per cent of the pediatric population suffers from chronic pain, with a higher incidence in girls.<ref name=":1" /> Chronic pain is defined as pain lasting for more than three months either continuously or intermittently.<ref>Koechlin H, Coakley R, Schechter N, Werner C, Kossowsky J. [https://www.sciencedirect.com/science/article/abs/pii/S0022399917309613 The role of emotion regulation in chronic pain: A systematic literature review.] Journal of psychosomatic research. 2018 Apr 1;107:38-45.</ref> Children suffering from chronic pain have associated negative impacts on their quality of life such as emotional distress, increased school absences, lower reading scores and a higher chance of having chronic pain as an adult. The most commons chronic pain complaints from children are headache, musculoskeletal pain and abdominal pain.<ref name=":1">Pate JW, Hush JM, Hancock MJ, Moseley GL, Butler DS, Simons LE, Pacey V. [https://www.mdpi.com/2227-9067/5/1/12/htm A child’s concept of pain: an international survey of pediatric pain experts]. Children. 2018 Jan;5(1):12.</ref>
  <div class="col-md-6"> {{#ev:youtube|eakyDiXX6Uc|250}} <div class="text-right"><ref>TED-Ed. The mysterious science of pain - Joshua W. Pate. Available from: https://www.youtube.com/watch?v=eakyDiXX6Uc [last accessed 9/5/2022]</ref></div></div>
  <div class="col-md-6"> {{#ev:youtube|KdihphPp1Q0|250}} <div class="text-right"><ref>TED-Ed. The fascinating science behind phantom limbs - Joshua W. Pate. Available from: https://www.youtube.com/watch?v=KdihphPp1Q0 [last accessed 9/5/2022]</ref></div></div>
</div>


==== Signs of Pain ====
== Chronic Pain in Children ==
Children in pain can exhibit different signs of pain based on their age, previous experiences, beliefs and expectations.<ref name=":0" /> The following chart by [https://www.childrensmn.org/educationmaterials/childrensmn/article/15380/pain-in-children-and-teens/ Children's Minnesota]<ref name=":2">https://www.childrensmn.org/educationmaterials/childrensmn/article/15380/pain-in-children-and-teens/</ref> lists clues of pain by various ages of childhood and adolescents:
It is estimated that thirty percent of children experience chronic pain, with a higher incidence in girls.<ref name=":1" /> Chronic pain is defined as intermittent or continuous pain that has lasted for more than three months.<ref>Koechlin H, Coakley R, Schechter N, Werner C, Kossowsky J. [https://www.sciencedirect.com/science/article/abs/pii/S0022399917309613 The role of emotion regulation in chronic pain: A systematic literature review.] Journal of psychosomatic research. 2018 Apr 1;107:38-45.</ref> The quality of life of children who have chronic pain is often affected, and they may experience emotional distress, increased school absences, lower reading scores and will be more likely to have chronic pain as an adult. The most common chronic pain complaints from children are headache, musculoskeletal pain and abdominal pain.<ref name=":1">Pate JW, Hush JM, Hancock MJ, Moseley GL, Butler DS, Simons LE, Pacey V. [https://www.mdpi.com/2227-9067/5/1/12/htm A child’s concept of pain: an international survey of pediatric pain experts]. Children. 2018 Jan;5(1):12.</ref>


Toddlers (1-3 years) may:
== Signs of Pain in Children ==
Children in pain can exhibit different signs of pain based on their age, previous experiences, beliefs and expectations.<ref name=":0" /> The following chart by [https://www.childrensmn.org/educationmaterials/childrensmn/article/15380/pain-in-children-and-teens/ Children's Minnesota]<ref name=":2">Children's Minnesota. Pain in children and teens. Available from: https://www.childrensmn.org/educationmaterials/childrensmn/article/15380/pain-in-children-and-teens/ (accessed 15 November 2022). </ref> lists clues of pain by various ages of childhood and adolescents:


* describe the pain
Children aged 1-3 years (toddlers) may:
* cry or whine
* show facial grimacing
* keep their body rigid, refuse to crawl or walk
* be more easily frustrated
* be aggressive
* be restless or unable to sleep
* have poor appetite<ref name=":2" />


* Be able to describe the pain
* Cry / whine
* Grimace
* Hold their body rigid, refuse to crawl or walk
* Become frustrated more quickly
* Display aggressive behaviour
* Appear restless or be unable to sleep
* Have a poor appetite<ref name=":2" />


Preschool children (4-5 years) may:


* describe the pain
Children aged 4-5 years (preschool) may:
* show facial grimacing
* keep body rigid or refuse to move
* not want the area touched
* cry or whine
* be restless or irritable
* have nightmares
* have poor appetite
* not report pain if they think they are being punished, or fear the treatment<ref name=":2" />


* Be able to describe the pain
* Grimace
* Hold their body rigid / refuse to move
* Not like the painful area to be touched
* Cry / whine
* Appear restless or irritable
* Have nightmares
* Have a poor appetite
* Not mention their pain if they believe they are being punished, or are fearful of treatment<ref name=":2" />


School-age children (6-12 years) can talk more directly about the cause, type, and amount of pain. Common behaviors may include:


* holding still or guarding the area that hurts
Children aged 6-12 years (school-age) are able to talk more directly about pain, including the cause of pain, type, and amount. Common behaviours might include:
* flat-faced expression
* facial grimacing or crying
* emotional withdrawal
* irritability
* restlessness, thrashing
* disrupted sleep
* poor appetite
* nightmares
* not report pain if they fear the treatment<ref name=":2" />


* Keeping still / guarding the painful area
* Grimacing / crying
* Withdrawing emotionally
* Irritability
* Restlessness / thrashing around
* Disrupted sleep
* Poor appetite
* Having nightmares
* Not mentioning pain if they are fearful of treatment<ref name=":2" />


Teens (13-18 years) may show a combination of adult and childlike behavior. Look for:


* change in activity level
Children aged 13-18 years (teenagers) may demonstrate both adult and childlike behaviour. There may be:
* decreased cooperation or participation
* change in eating or sleeping patterns
* irritability, restlessness
* inability to focus or concentrate
* anger or withdrawal<ref name=":2" />


=== Pain Education ===
* An alteration in activity level
When working with children who have chronic pain, it is important to educate them and their parents on the concept of pain: how they understand pain, what function it serves and what biological processes are thought to increase it.<ref name=":1" /> Practitioners explaining these concepts should use easy to understand terminology for children and more in-depth language for parents<ref name=":0" />  Having the child learn and understand pain concepts provides an opportunity for them to become an active participant in managing and treating their pain while the therapist acts as a coach. <ref name=":3">Hogans BB, Watt-Watson J, Wilkinson P, Carr EC, Gordon DB. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6106863/ Perspective: update on pain education. Pain]. 2018 Sep;159(9):1681.</ref> <ref name=":0" />  The therapist works more as a coach with the child leading Encouraging the child to be an involved team member can alleviate barriers to treatment and provides more positive outcomes.<ref name=":3" />(
* Decreased cooperation / participation
* Changes in eating / sleeping patterns
* Irritability / restlessness
* Change in ability to focus / concentrate
* Anger / withdrawal<ref name=":2" />


==== Pain education in parents ====
===== The video below by Live Active Chiropractic provides a good summary of pain and strategies to help with pain =====
Parents who have a child with chronic pain often are enduring increased stress themselves. Being conscious of how they manage their stress is important because their coping skills are commonly modelled and emulated by their children. Parents who adopt self-care techniques can handle chronic stress with less negative outcomes and are better able to assist with family needs. Alternatively, parents who catastrophize have increased stress, anxiety and are less able to support their children. Studies show 50% of parents of children with chronic pain have pain themselves. Parents with chronic pain themselves may bring in their own biases regarding pain and the support they can provide for their child. <ref>Guite JW, Russell BS, Homan KJ, Tepe RM, Williams SE. [https://www.mdpi.com/2227-9067/5/12/161/htm Parenting in the context of children’s chronic pain: balancing care and burden]. Children. 2018 Dec;5(12):161.</ref>
{{#ev:youtube|C_3phB93rvI}}


How to help a child in pain
== Pain Education ==
It is estimated that chronic pain in paediatric populations reaches 46%. <ref>Miró J, Roman-Juan J, Sánchez-Rodríguez E, Solé E, Castarlenas E, Jensen MP. [https://reader.elsevier.com/reader/sd/pii/S1526590022004758?token=B61753B9767042B305BCAF937AF6BB0C9DF1293C1A078CA8FB5E9BC6F7A6AFD72876A60DACFF5A27AB365B88B8199027&originRegion=eu-west-1&originCreation=20230122190715 Chronic pain and high impact chronic pain in children and adolescents: a cross-sectional study.] The Journal of Pain. 2022 Dec 25.</ref> When working with children who have chronic pain, it is important to educate them and their parents on the concept of pain: how they understand pain, what function it serves and what biological processes are thought to increase it.<ref name=":1" /> <ref>Koechlin H, Locher C, Prchal A. [https://www.mdpi.com/853266 Talking to Children and Families about Chronic Pain: The Importance of Pain Education—An Introduction for Pediatricians and Other Health Care Providers.] Children. 2020 Oct 12;7(10):179.</ref> Practitioners explaining these concepts should use easy to understand terminology for children and more in-depth language for parents<ref name=":0" /> Having the child learn and understand pain concepts provides an opportunity for them to become an active participant in managing and treating their pain while the therapist acts as a coach.<ref name=":3">Hogans BB, Watt-Watson J, Wilkinson P, Carr EC, Gordon DB. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6106863/ Perspective: update on pain education. Pain]. 2018 Sep;159(9):1681.</ref> <ref name=":0" /> Thus, the therapist works more as a coach while the child leads. Encouraging the child to be an involved team member can alleviate barriers to treatment and result in more positive outcomes.<ref name=":3" />


[https://health.ucdavis.edu/children/patients_family_resources/Patient_and_Family_Education_A_to_Z/How-to-Help-a-Child-in-Pain.html UC Davis Health]<ref name=":4">https://health.ucdavis.edu/children/patients_family_resources/Patient_and_Family_Education_A_to_Z/How-to-Help-a-Child-in-Pain.html</ref> has provided a list of suggestions for how parents can help their child in pain:
=== Pain Education for Parents ===
Parents who have a child with chronic pain will often experience increased stress themselves. Being conscious of how they manage their stress is important because their coping skills are commonly modelled and emulated by their children. Parents who adopt self-care techniques can handle chronic stress with less negative outcomes and are better able to assist with family needs. Alternatively, parents who catastrophise, and have increased stress, and anxiety are less able to support their children. Studies show that 50 percent of parents of children with chronic pain have pain themselves. <ref>Skarstein S, Bergem AK, Helseth S. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7298795/pdf/40359_2020_Article_430.pdf How do mothers of adolescents with chronic pain experience their own quality of life?] BMC Psychol. 2020 Jun 16;8(1):64.</ref> Parents with chronic pain themselves may bring in their own biases regarding pain and the support they can provide for their child.<ref>Guite JW, Russell BS, Homan KJ, Tepe RM, Williams SE. [https://www.mdpi.com/2227-9067/5/12/161/htm Parenting in the context of children’s chronic pain: balancing care and burden]. Children. 2018 Dec;5(12):161.</ref>


* Provide your child with as many reasonable choices as possible and give them some control over treatment.
=====  The Ted Talk video below by Lorimer Moseley explains Why Things Hurt: =====
* Provide your child with honest, accurate, and age appropriate information in regards to their hospital experiences. Some of a child’s anxiety and fear can be subsided when they are properly informed.
{{#ev:youtube|gwd-wLdIHjs}}
* Give your child the opportunity to ask questions and express their feelings.
 
* Ask your child about their fears and clear up misconceptions they may have. If their fear is based on prior experience, talk through that experience and discuss how you can work together to help to make the next experience a better one.
==== How to Help a Child in Pain ====
* Do your best to reduce the extra stimulation and anxiety in the room. Children pick up on the emotions of adults (especially parents), so create a calm environment with those people that can remain relaxed and supportive.
The following list from [https://health.ucdavis.edu/children/patients_family_resources/Patient_and_Family_Education_A_to_Z/How-to-Help-a-Child-in-Pain.html UC Davis Health]<ref name=":4">https://health.ucdavis.edu/children/patients_family_resources/Patient_and_Family_Education_A_to_Z/How-to-Help-a-Child-in-Pain.html</ref> offers suggestions for how parents can help their child in pain:
* Encourage your child to practice deep breathing. Breathing creates a sense of relaxation. Bubbles and pinwheels are a great tool.
 
* Provide your child with items for distraction. Re-focus their attention onto something they enjoy such as playing a game.
* Provide children with as many reasonable choices as possible and give them some control over treatment
* Encourage your child to use their imagination and focus their attention onto telling a story.
* Provide children with honest, accurate, and age-appropriate information about hospital experiences - this can help to alleviate fear and anxiety in children
* Provide opportunities for comforting touch such as holding and cuddling.
* Allow children the opportunity to ask any questions they may have and express their feelings
* Remain close to your child. Children often feel more secure when their parents are close by<ref name=":4" />
* Ask children about any fears they have and clear up any misconceptions
** If a child's fear is related to a past experience, it is important to discuss this experience and explore ways to work together to ensure the next experience (i.e. treatment / hospital stay) goes better
* It is important to reduce any extra stimulation and anxiety in the room
** Because children can pick up on their parents and other adults' emotions, it is beneficial to create a calm environment "with those people that can remain relaxed and supportive"
* Encourage children to practise deep breathing to help with relaxation
** Tools to assist can include bubbles and pinwheels
* Provide children with items to distract them - re-focus their attention on something they enjoy (e.g. a game, activity)
* Encourage children to use their imagination and focus their attention on telling a story
* Provide opportunities for comforting touch (e.g. holding, cuddling)
* Encourage parents to remain close to their child as this can help a child feel more secure<ref name=":4" />


== Resources ==
== Resources ==
Line 90: Line 101:
* [https://www.amazon.com/When-Your-Child-Hurts-Strategies/dp/0300204655 When Your Child Hurts]
* [https://www.amazon.com/When-Your-Child-Hurts-Strategies/dp/0300204655 When Your Child Hurts]
* [https://www.yumpu.com/en/document/view/61002254/a-journey-to-learn-about-pain A Journey to Learn About Pain]
* [https://www.yumpu.com/en/document/view/61002254/a-journey-to-learn-about-pain A Journey to Learn About Pain]
* [https://www.retrainpain.org/ Retrain Pain Foundation]
* [[Pain in Children: Assessment and Questionnaire|Pain in Children Assessment and Questionnaire]]


== References ==
== References ==
<references />
<references />
[[Category:Rehabilitation]]
[[Category:Rehabilitation]]
[[Category:ReLAB Content Development Project]]
[[Category:ReLAB-HS Course Page]]
[[Category:Course Pages]]
[[Category:Course Pages]]
[[Category:Pain]]
[[Category:Pain]]
[[Category:Paediatrics]]
[[Category:Paediatrics]]

Latest revision as of 21:06, 22 January 2023

Original Editor - Robin Tacchetti based on the course by Tracy Prowse
Top Contributors - Robin Tacchetti, Jess Bell, Kim Jackson and Ewa Jaraczewska


Pain[edit | edit source]

Pain is a sensation and an emotional response to multiple stimuli created by the conscious brain which is then perceived as threatening.[1] Pain is not a measure of tissue damage, but rather the brain's response to the threat. Therefore, pain is not only physical but an emotional event for the person.[2] Pain is always an unpleasant body sensation, but it can be a challenge to define because it is subjective and ranges in quality, intensity and duration.[3]

See the following videos by Joshua Pate on the science of pain and phantom limb pain:

[4]
[5]

Chronic Pain in Children[edit | edit source]

It is estimated that thirty percent of children experience chronic pain, with a higher incidence in girls.[6] Chronic pain is defined as intermittent or continuous pain that has lasted for more than three months.[7] The quality of life of children who have chronic pain is often affected, and they may experience emotional distress, increased school absences, lower reading scores and will be more likely to have chronic pain as an adult. The most common chronic pain complaints from children are headache, musculoskeletal pain and abdominal pain.[6]

Signs of Pain in Children[edit | edit source]

Children in pain can exhibit different signs of pain based on their age, previous experiences, beliefs and expectations.[2] The following chart by Children's Minnesota[8] lists clues of pain by various ages of childhood and adolescents:

Children aged 1-3 years (toddlers) may:

  • Be able to describe the pain
  • Cry / whine
  • Grimace
  • Hold their body rigid, refuse to crawl or walk
  • Become frustrated more quickly
  • Display aggressive behaviour
  • Appear restless or be unable to sleep
  • Have a poor appetite[8]


Children aged 4-5 years (preschool) may:

  • Be able to describe the pain
  • Grimace
  • Hold their body rigid / refuse to move
  • Not like the painful area to be touched
  • Cry / whine
  • Appear restless or irritable
  • Have nightmares
  • Have a poor appetite
  • Not mention their pain if they believe they are being punished, or are fearful of treatment[8]


Children aged 6-12 years (school-age) are able to talk more directly about pain, including the cause of pain, type, and amount. Common behaviours might include:

  • Keeping still / guarding the painful area
  • Grimacing / crying
  • Withdrawing emotionally
  • Irritability
  • Restlessness / thrashing around
  • Disrupted sleep
  • Poor appetite
  • Having nightmares
  • Not mentioning pain if they are fearful of treatment[8]


Children aged 13-18 years (teenagers) may demonstrate both adult and childlike behaviour. There may be:

  • An alteration in activity level
  • Decreased cooperation / participation
  • Changes in eating / sleeping patterns
  • Irritability / restlessness
  • Change in ability to focus / concentrate
  • Anger / withdrawal[8]
The video below by Live Active Chiropractic provides a good summary of pain and strategies to help with pain[edit | edit source]

Pain Education[edit | edit source]

It is estimated that chronic pain in paediatric populations reaches 46%. [9] When working with children who have chronic pain, it is important to educate them and their parents on the concept of pain: how they understand pain, what function it serves and what biological processes are thought to increase it.[6] [10] Practitioners explaining these concepts should use easy to understand terminology for children and more in-depth language for parents[2] Having the child learn and understand pain concepts provides an opportunity for them to become an active participant in managing and treating their pain while the therapist acts as a coach.[11] [2] Thus, the therapist works more as a coach while the child leads. Encouraging the child to be an involved team member can alleviate barriers to treatment and result in more positive outcomes.[11]

Pain Education for Parents[edit | edit source]

Parents who have a child with chronic pain will often experience increased stress themselves. Being conscious of how they manage their stress is important because their coping skills are commonly modelled and emulated by their children. Parents who adopt self-care techniques can handle chronic stress with less negative outcomes and are better able to assist with family needs. Alternatively, parents who catastrophise, and have increased stress, and anxiety are less able to support their children. Studies show that 50 percent of parents of children with chronic pain have pain themselves. [12] Parents with chronic pain themselves may bring in their own biases regarding pain and the support they can provide for their child.[13]

The Ted Talk video below by Lorimer Moseley explains Why Things Hurt:[edit | edit source]

How to Help a Child in Pain[edit | edit source]

The following list from UC Davis Health[14] offers suggestions for how parents can help their child in pain:

  • Provide children with as many reasonable choices as possible and give them some control over treatment
  • Provide children with honest, accurate, and age-appropriate information about hospital experiences - this can help to alleviate fear and anxiety in children
  • Allow children the opportunity to ask any questions they may have and express their feelings
  • Ask children about any fears they have and clear up any misconceptions
    • If a child's fear is related to a past experience, it is important to discuss this experience and explore ways to work together to ensure the next experience (i.e. treatment / hospital stay) goes better
  • It is important to reduce any extra stimulation and anxiety in the room
    • Because children can pick up on their parents and other adults' emotions, it is beneficial to create a calm environment "with those people that can remain relaxed and supportive"
  • Encourage children to practise deep breathing to help with relaxation
    • Tools to assist can include bubbles and pinwheels
  • Provide children with items to distract them - re-focus their attention on something they enjoy (e.g. a game, activity)
  • Encourage children to use their imagination and focus their attention on telling a story
  • Provide opportunities for comforting touch (e.g. holding, cuddling)
  • Encourage parents to remain close to their child as this can help a child feel more secure[14]

Resources[edit | edit source]

References[edit | edit source]

  1. ↑ Li W, Liu P, Hu Y, Meng J. Pain Modulates Responses to Emotional Stimuli. Front Psychol. 2020 Nov 9;11:595987.
  2. ↑ 2.0 2.1 2.2 2.3 Prowse, T. Pain Neuroscience Education Course. Plus.. 2022
  3. ↑ Raja SN, Carr DB, Cohen M, Finnerup NB, Flor H, Gibson S, Keefe F, Mogil JS, Ringkamp M, Sluka KA, Song XJ. The revised IASP definition of pain: Concepts, challenges, and compromises. Pain. 2020 Sep 1;161(9):1976.
  4. ↑ TED-Ed. The mysterious science of pain - Joshua W. Pate. Available from: https://www.youtube.com/watch?v=eakyDiXX6Uc [last accessed 9/5/2022]
  5. ↑ TED-Ed. The fascinating science behind phantom limbs - Joshua W. Pate. Available from: https://www.youtube.com/watch?v=KdihphPp1Q0 [last accessed 9/5/2022]
  6. ↑ 6.0 6.1 6.2 Pate JW, Hush JM, Hancock MJ, Moseley GL, Butler DS, Simons LE, Pacey V. A child’s concept of pain: an international survey of pediatric pain experts. Children. 2018 Jan;5(1):12.
  7. ↑ Koechlin H, Coakley R, Schechter N, Werner C, Kossowsky J. The role of emotion regulation in chronic pain: A systematic literature review. Journal of psychosomatic research. 2018 Apr 1;107:38-45.
  8. ↑ 8.0 8.1 8.2 8.3 8.4 Children's Minnesota. Pain in children and teens. Available from: https://www.childrensmn.org/educationmaterials/childrensmn/article/15380/pain-in-children-and-teens/ (accessed 15 November 2022).
  9. ↑ Miró J, Roman-Juan J, Sánchez-Rodríguez E, Solé E, Castarlenas E, Jensen MP. Chronic pain and high impact chronic pain in children and adolescents: a cross-sectional study. The Journal of Pain. 2022 Dec 25.
  10. ↑ Koechlin H, Locher C, Prchal A. Talking to Children and Families about Chronic Pain: The Importance of Pain Education—An Introduction for Pediatricians and Other Health Care Providers. Children. 2020 Oct 12;7(10):179.
  11. ↑ 11.0 11.1 Hogans BB, Watt-Watson J, Wilkinson P, Carr EC, Gordon DB. Perspective: update on pain education. Pain. 2018 Sep;159(9):1681.
  12. ↑ Skarstein S, Bergem AK, Helseth S. How do mothers of adolescents with chronic pain experience their own quality of life? BMC Psychol. 2020 Jun 16;8(1):64.
  13. ↑ Guite JW, Russell BS, Homan KJ, Tepe RM, Williams SE. Parenting in the context of children’s chronic pain: balancing care and burden. Children. 2018 Dec;5(12):161.
  14. ↑ 14.0 14.1 https://health.ucdavis.edu/children/patients_family_resources/Patient_and_Family_Education_A_to_Z/How-to-Help-a-Child-in-Pain.html
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