The Pain Research Unit - Highlights and Insights
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Highlights and Insights
The Pain Research Unit has been involved in a wide range of projects over recent years. These have included: experimental studies of children's use of attentional coping strategies, a meta-analysis invesigating the efficacy and safety of ibuprofen compared with paracetamol (acetaminophen) for children's pain and fever, a series of studies investigating factors influencing infants' responses to pain, investigating the school functioning of children with pain problems, a systematic review investigating the role of parents during children's medical procedures, and a number of studies investigating the measurement of pain in children. A selection of highlights follow:
6th International Symposium on Paediatric Pain, Sydney, 15-19 June 2003
The Pain Research Unit was privileged to host the triannual conference of the International Association for the Study of Pain, the 6th International Symposium on Paediatric Pain, in June 2003. The conference program considered "The Big Questions" of Pain in Childhood, reflecting the importance of nociception and pain factors in all stages of childhood up to and including adolescence. The conference was attended by over 400 delegates from 32 countries. This was the first time that the conference was hosted in the Southern Hemisphere. Keynote speakers included: Adrian Bosenberg (South Africa), Heather Buchan (Australia), Tomasz Dangel (Poland), Christopher Eccleston (UK), Stephen Hunt (UK), Marja Mikkelsson (Finland), Isabelle Murat (France), John Taplin (Australia), and John van den Anker (The Netherlands / US).
Involvement in Pain in Child Health (PICH) Strategic Training Program
In September 2003 Tiina Piira became an International Trainee with the PICH Program. This program, sponsored by the Canadian Institute of Health Research (CIHR), aims to develop a community of scholars in pediatric pain by providing young researchers with mentorship and training through annual training institutes, lab meetings, web-based presentations distance tools, opportunties for lab visits, and web-based courses in pain. Tiina has participated in monthly web-based meetings enabling live discussion with other researchers in the field. This has included an online presentation of her own PhD work at the June 2004 meeting. Tiina received an Education and Research Scholarship from the New South Wales Psychologists' Registration Board, enabling her to attend the PICH May 2004 training institute as well as the American Pain Society and Canadian Pain Society meeting, where she gave a presentation of some of her PhD research. Whilst in Canada she also presented at paediatric pain research units in Saskatoon and Halifax. More recently Tiina has received a PICH Mayday Fellowship which will enable her to attend the PICH October 2004 training institute and the International Forum on Paediatric Pain, Nova Scotia, Canada.
The Faces Pain Scale - Revised (FPS-R)
In 1990, the Pain Research Unit published the original Faces Pain Scale (Bieri, Reeve, Champion, Addicoat & Ziegler, 1990) for use by children to measure pain intensity. Since then, the Faces Pain Scale-Revised (FPS-R) was developed by Carl von Baeyer and his students at the University of Saskatchewan, Canada, in collaboration with the Pain Research Unit. The FPS-R retains many of the features of the FPS, such as a neutral face as the "no pain" anchor. However, an important advantage of the FPS-R is that with six faces rather than seven, the measure is compatible in scoring with other self-rating and observational scales which use a common metric (0-to-5 or 0-to-10), whilst still maintaining strong psychometric properties. Many units, both local and international, are now using the FPS-R clinically and for research purposes.
The Faces Pain Scale - Revised (FPS-R) is now available with instructions in 15 languages. The FPS-R, together with instructions for administration, are freely available for non-commercial clinical and research use from www.painsourcebook.ca. For all other uses, including republication, permission should be sought from the IASP: kathyh@iasp-pain.org
Hicks, CL, von Baeyer, CL, Spafford, PA, van Korlaar, I & Goodenough, B. (2001). The Faces Pain Scale - Revised: Toward a common metric in pediatric pain measurement. Pain, 93, 173-183.
Bieri D, Reeve R, Champion GD, Addicoat L & Ziegler JB. (1990).The Faces Pain Scale for the self-assessment of the severity of pain experienced by children: development, initial validation, preliminary investigation for ratio scale properties. Pain, 41, 139-150.
Children's attentional coping strategies
Tiina Piira, Brett Hayes, Belinda Goodenough, Carl von Baeyer
Does distraction always work? What makes it more or less helpful? Is distraction more helpful for some children than for others? Is it sometimes more useful to focus on painful sensations than to be distracted? These are just some of the questions currently being explored in a series of experimental studies which Tiina Piira is working on for her PhD through the School of Psychology, University of New South Wales, under the supervision of Drs Brett Hayes and Belinda Goodenough, and in collaboration with Prof Carl von Baeyer, University of Saskatchewan, Canada.
Predictors of infant pain responses
Tiina Piira, David Champion, Kei Lui, Theona Bustos
Our first study investigating the determinants of infant pain responses found the role of parent behaviour in the treatment room to be an important factor in influencing how babies responded to their immunisation injections. Theona Bustos, who was a research assistant for part of this project, is now following up this finding with a brief parent intervention study as part of her master's project in Clinical Psychology under the supervision of Dr Karen Salmon and Tiina Piira.
Over-the-counter analgesics
David Perrott, Tiina Piira, Belinda Goodenough & David Champion (Funded by Boots Healthcare Australia Pty Ltd)
Perrott, D.A., Piira, T., Goodenough, B. & Champion, G.D. (2004).The safety and efficacy of acetaminophen versus ibuprofen for treating children's pain and fever: a meta-analysis. Archives of Child and Adolescent Medicine, 158, 521-526.
A meta-analysis was conducted to assess the relative safety and efficacy of ibuprofen and paracetamol (acetaminophen) for children's pain and fever. In children, single doses of ibuprofen (4-10mg/kg) and paracetamol (7-15 mg/kg) were found to have similar efficacy for relieving moderate to severe pain. In the studies reviewed, single doses of ibuprofen (5-10mg/kg) were found to be more effective as an antipyretic than single doses of acetaminophen (10-15mg/kg) at 2, 4, and 6 hours post-treatment. The researchers identified areas where more research is needed:
- There has been little research with children younger than 2 years, especially infants younger than 6 months.
- There is a need for the relative efficacy of ibuprofen and acetaminophen to be studied across a range of children's pain conditions for which these drugs are used, e.g., headache, cold and flu pain, muscular aches, and menstrual cramps.
- The published research in this field currently includes primarily single-dose trials. More multi-dose trials are needed.
- Researchers are also encouraged to provide sufficient detail regarding outcome measures to allow for subsequent data synthesis and meta-analysis.
Pain Research | Team Profile | Highlights & Insights | Education | Publications | Funding | links