Acute pain: How to assess in teens

What causes acute pain in teens?

In teens, common causes of acute pain include:

• routine vaccinations by needle
• dental or orthodontic treatments (such as cavity fillings or tightening braces or retainers)
• injuries from sports (such as bruises, sprains or fractures)
• menstruation
• procedures such as blood work, lumbar punctures, intravenous starts
• surgeries (operations)
• complex health conditions such as cancer or juvenile arthritis

Most teens are well equipped to "self-report" their acute pain (describe it in their own words or rate how bad it is) rather than have a parent or health-care professional speak for them. At this age, teens can also easily distinguish between acute physical pain and emotional distresses (for instance feeling scared or anxious).

Assessing acute pain at home

Aside from self-reports, you may know when your teen is in pain through changes in their behaviour. For example, your teen may:

• be more irritable
• display stronger and quicker changes in mood than normal
• have difficulty moving normally
• withdraw from socializing

Assessing acute pain in medical settings

In the hospital, your teen's health-care team may use pain measurement scales that use words or numbers.

All professionals agree that a teen's self-report of pain takes priority over observation by others. In other words, even if a teen can laugh or sleep or otherwise does not look like they are in pain, if they say they are in pain it must be taken seriously.

Most teens can rate the severity (level) of their pain using the same pain scales that adults use. One common tool is a numeric rating scale that allows patients to verbally rate their pain from 0 to 10, where 0 is 'no pain' and 10 is the worst or strongest pain they can imagine.

When this tool is used with a teen for the first time, they may be asked to point to a number from 0 to 10 on paper. This encourages them to limit their rating to whole numbers on the scale. With repeated use, the numeric rating scale can reveal if pain is changing (getting better or worse) over time.

Factors affecting pain assessment

A developmental disability or intellectual disability may make it difficult for your teen to express their pain in words. In this case, their health-care team will use standard pain assessment tools to look at their behaviour. One such tool is the NCCPC, which helps make caregivers more aware if a teen's behaviour may be different than usual due to pain.

Gender can have affect how teens express pain and how accurately their pain might be assessed. Teenage boys may put a lot of effort into making sure they do not cry, especially if others are around. On the other hand, teen girls may cry more because this behaviour is deemed more acceptable in some cultures. Or the reverse may be true.

Cultural differences can also account for a wide variety of reactions to situations. Some cultures may express themselves freely, but others may repress their emotions or respond to pain in unexpected ways. Some teens may adopt the role of a "good patient" and behave the way they believe health-care professionals want them to behave rather than express how they are feeling.

How you can help health-care professionals understand your teen's pain

Help your teen feel confident to express exactly how much pain they are feeling and make sure their health-care team hear and understand your teen's pain reports. Your teen's self-report is essential for health-care providers to give the most accurate assessment and recommend the most appropriate treatment.

If your teen cannot speak for themselves, it is also important that you tell the health-care team how you know if your teen is in pain.

Websites

Managing your child's pain from braces
https://1stfamilydental.com/reducing-braces-pain/

Managing your child's pain from sports injuries
http://www.stanfordchildrens.org/en/topic/default?id=tackling-kids-sports-injuries-1-4288

Preparing your child with cancer for painful procedures
http://www.cancer.net/navigating-cancer-care/children/preparing-your-child-medical-procedures

Videos

Pain management at SickKids (2 mins 49 secs)
https://www.youtube.com/watch?v=_9_OQFo2APA

Reducing the pain of vaccination in children (Centre for Pediatric Pain Research) (2 mins 18 secs)
https://www.youtube.com/watch?v=KgBwVSYqfps

Reducing the pain of vaccination in children (Dr. Taddio) (20 mins 52 secs)
https://www.youtube.com/watch?time_continue=2&v=TGGDLhmqH8I

Learning how to manage pain from medical procedures (Stanford Children's Health) (12 mins 58 secs)
https://youtu.be/UbK9FFoAcvs

Content developed by Rebecca Pillai Riddell, PhD, CPsych, OUCH Lab, York University, Toronto, in collaboration with:
Lorraine Bird, MScN, CNS, Fiona Campbell, BSc, MD, FRCA, Bonnie Stevens, RN, PhD, FAAN, FCAHS, Anna Taddio, BScPhm, PhD
Hospital for Sick Children

References

Gold, J.I., Mahrer, N.E. (2017) Is Virtual Reality Ready for Prime Time in the Medical Space? A Randomized Control Trial of Pediatric Virtual Reality for Acute Procedural Pain Management. Journal of Pediatric Psychology, 2017 https://doi.org/10.1093/jpepsy/jsx129

Henderson, E.M., Eccleston, C. (2015). An online adolescent message board discussion about the internet: Use for pain Journal of Child Health Care 2015, Vol. 19(3) 412–418

McMurtry, C.M., Chambers, C.T., McGrath, P.J., & Asp, E. (2010). When "don't worry" communicates fear: Children's perceptions of parental reassurance and distraction during a painful medical procedure. Pain, 150(1), 52-58.

Taddio, A., McMurtry, C.M., Shah, V., Pillai Riddell. R. et al. Reducing pain during vaccine injections: clinical practice guideline. CMAJ 2015. https://doi.org/10.1503/cmaj.150391

Uman, L.S., Birnie, K.A., Noel, M., Parker, J.A., Chambers, C.T., McGrath, P.J., Kisely, S.R. (2013) Psychological interventions for needle-related procedural pain and distress in children and adolescents. Cochrane Database of Systematic Reviews https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD005179.pub3/full 

von Baeyer, C.L. (2009). Children's self-report of pain intensity: what we know, where we are headed. Pain Research and Management, 14(1), 39-45.