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The Pain Research Unit

Introducing The Pain Research Unit

Our Pain Research Unit at Sydney Children's Hospital (SCH) began 20 years ago with studies in self-report and behavioural measures of pain intensity and what health professionals were responding to when making global assessments based on children's behavioural responses. The Faces Pain Scale was developed by Daiva Bieri from research involving several hundred children. The articles introducing this scale and its widely recommended and researched derivative, The Faces Pain Scale-Revised, are more frequently cited than articles about any other pain scale for children. We have used needle pain and postoperative pain models for subsequent research into the child and parental influences on favourable and adverse outcomes. We have shown that parental influences on pain related distress is evident as early as 4 to 6 months of age, and that brief guidance can improve outcomes.

In recent years we have moved on from pain measurement studies, although our work was recently acknowledged at the international conference on pain measurement and assessment in Nova Scotia, to more diverse research into pain in children and adolescents. In 2003 we hosted the Sixth International Symposium on Paediatric Pain in Sydney. Dr Tiina Jaaniste is currently the secretary of Pain in Childhood, a Special Interest Group of the International Association for the Study of Pain. She was also recently invited, and has accepted, to serve as an International Collaborator with the Strategic Training Initiative in Health Research on Pain in Child Health 2 (Principal Investigator: Dr Patrick McGrath). This is a 6 year program funded by the Canadian Institutes of Health Research (CIHR), with its primary goal to increase capacity and cross-disciplinary of health research on pain in childhood.

Role of the pain research team

The Pain Research Unit was autonomous, and was funded through grants, donations and a fund raising committee, over 20 years until two years ago. The Pain Research Unit no longer exists as an autonomous entity having been incorporated into the Department of Pain and Palliative Care Services and the Department of Anaesthesia and Pain Medicine, facilitated by the Gold Dinner of the SCH Foundation and State Government supplementary funding in 2007. The integration process has been an important factor in the recent and proposed augmentation of the research role. Additionally we continue to acquire donations and will soon be in a strong position to compete successfully for further research grants. Another source of supplementary funding is from the University of NSW administered through the School of Women's and Children's health for supervision of Independent Learning Project and BSc Med medical students. The pain research team's roles include:

  1. Provision of a service to answer clinical questions by literature review.
  2. Provision electronically of important articles on pain medicine from continual literature review.
  3. Development and maintenance of an email discussion service.
  4. Participation in educational activities to pain and palliative care members, Sydney Children's Hospital staff, postgraduate clinical meetings, and to patients and parents.
  5. Assistance with research design, research ethics applications, and analysis of data for studies relevant to pain medicine and palliative care.
  6. Supervision of and collaboration with students/candidates for Independent Learning Projects and other undergraduate studies, Honours theses, and Postgraduate Degrees.
  7. Collaboration with members of the acute and chronic pain service, the palliative care service, and the anaesthetic team, including allied health professionals such as play therapists, in developing studies which address clinical questions which are important to them and to their patients. We have also established collaboration with other SCH Departments such as Surgery, Sleep Medicine, Physiotherapy, Genetics, Pathology/blood collection, and Haematology Oncology (for 2010), with Prince of Wales Hospital and the Royal Hospital for Women, and with our counterparts at the Royal Children's Hospital, Melbourne. Our genetic studies are being conducted in collaboration with Prof John Hopper and Prof Sam Berkovic at the University of Melbourne.
  8. Initiation of pain research and related studies by the pain research team, and conduct of such research, into clinically relevant questions in paediatric pain medicine.
  9. Advocacy for greater awareness of and response to all aspects of pain medicine in infants, children and adolescents with a view to improved experiences and outcomes for these young patients, improved parental guidance, and thus eventually a reduced burden of pain in adults.

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Team Profile

Pain Research Unit Team Members

  • David Champion (MB, BS, MD, FRACP, FFPMANZCA)

    Founder and Director, Pain Research Unit, Departments of Anaesthesia and Pain Medicine, Sydney Children's Hospital, Randwick
    Visiting (Consultant) Physician, Paediatric Rheumatology, Sydney Children's Hospital, Randwick
    Conjoint Associate Professor University of New South Wales

    David Champion

    David has a longstanding commitment to paediatric pain research, being the founder of the team in 1988. He has served as Councillor for Pain in Childhood, a Special Interest Group of the International Association for the Study of Pain (1990-94), and was a member of the Scientific Program Committee for the Third International Symposium on Paediatric Pain (1994). David also represented paediatrics and musculoskeletal medicine on the Scientific Program Committee for the Eighth World Congress of Pain (1993-96). He was Co-convener, and Chairman of the Scientific Program Committee, Sixth International Symposium on Paediatric Pain, Sydney 2003.


  • Tiina Jaaniste (nee Piira) (B.Sc.(Psychol), M.Psychol.(Clinical), PhD)

    Hospital Scientist (Pain Research), Pain Research Unit, Departments of Anaesthesia and Pain Medicine, and Pain and Palliative Care, Sydney Children's Hospital, Randwick

    Tiina Jaaniste

    Tiina is a research scientist with a background in clinical psychology. She has over 30 peer reviewed journal publications, mainly in the field of paediatric pain. Tiina was Secretary of the Steering Committee of the 6th International Symposium on Paediatric Pain, Sydney 2003. She was also a member of the Scientific Program Committee for the 7th International Symposium on Paediatric Pain, Vancouver, 2006. She is currently Secretary of the Pain in Childhood Special Interest Group, International Association for the Study of Pain. She was an International Trainee with the Pain in Child Health (PICH) Strategic Training Program and was awarded a Pain in Child Health (PICH) Mayday Fellowship. Tiina completed her PhD through the School of Psychology at the University of New South Wales in 2009. Her thesis title was "Attentional coping strategies in the management of pain in children." She will be on leave until July 2011.


  • Cindy Chapman (B.Psychology (Hons))

    Hospital scientist (Pain Research), Pain Research Unit, Departments of Anaesthesia and Pain Medicine, and Pain and Palliative Care, Sydney Children's Hospital, Randwick


    Cindy completed her Bachelor of Psychology (Honours) at the University of New South Wales in 2010. She is passionate about paediatric research and working with children. Cindy is a temporary full-time hospital scientist in the Pain Research team.


Members of the Acute and Chronic Pain service, Department of Anaesthesia and Pain Medicine

There is extensive collaboration between the above members of the Pain Research Unit and the clinical service team members. Particular acknowledgements should be made to the contributions by Dr Matthew Crawford (Clinical Director of the Pain Service), Dr Simon Cohen (Pain Fellow), Dr Maline Glogauer (Clinical psychologist), Dr Meg Goodison Farnsworth (Clinical psychologist), Megan James and David Anderson (Clinical nurse consultants), Marianne McCormick (Physiotherapist), Jessica Dawber (Occupational therapist), Michelle Perrin (Play therapist), Louise Dolahenty (Social Worker).

Acknowledgements

  • Belinda Goodenough (PhD)

    A glance at our publication list will provide some insight into the major role played by Dr Goodenough in our paediatric pain research over many years. She is a critical and innovative thinker and her presentation at functions and conferences had a widely admired star quality. She was a Co-convener of the Sixth International Symposium on Paediatric Pain, Sydney 2003.


  • Carl von Baeyer (PhD, RDPsych)

    Professor von Baeyer, Professor Emeritus of Psychology and associate member in Paediatrics, University of Saskatchewan, has a special place in the history of the Pain Research Unit. His roles have included visiting professor on sabbatical visits, mentor, co-author, philosopher, reviewer of pain management and pain research programs, and kindly friend. One of his major initiatives was to foresee the importance of modification of the Faces Pain Scale to a common metric (thus conforming to a 0-10 scale), resulting in the development, validation, and subsequent international promotion of the Faces Pain Scale-Revised (see Highlights and Insights).


  • Carol Yap (PhD)

    Carol with a strong neuroscience and psychology background provided invaluable research expertise to the Pain Research Unit. She was a part-time hospital scientist during 2009


  • Wen Qiu (B.Sc Hons1 (Biochemistry), PhD)

    Wen was a temporary part-time hospital scientist in the Pain Research team in 2010. Wen completed her PhD through the Department of Biochemistry at the University of Melbourne. Her PhD project was on the genetic and molecular characterisation of a cell type called fibroblasts in breast and ovarian cancers.



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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 investigating 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. More recently our studies have diversified into genetics of functional pain disorders; research into the nature of growing pains, its neurobiology and genetic links to restless legs syndrome; appendicitis; the influence of disgust on needle pain; a trial of brief instruction to parents to reduce needle pain distress in children; a parent education program to assist children with chronic pain; and the survey of experiences, attitudes and management concerning procedural pain in Sydney Children's Hospital. A selection of highlights follows:

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 Jaaniste 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 paediatric 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 participated in monthly web-based meetings enabling live discussion with other researchers in the field. This included an online presentation of her 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. Tiina received a PICH Mayday Fellowship which enabled 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 our 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. These Faces Pain Scales have been considered a significant advance in paediatric pain medicine, and FPS-R is currently international standard especially for children aged 5-12 years. As of August 2010 the number of citations for the FPS (Bieri et al. 1990) was 492 and for the FPS-R (Hicks et al. 2001) was 308.

The Faces Pain Scale - Revised (FPS-R) is now available with instructions in 45 languages. The FPS-R, together with instructions for administration, are freely available for non-commercial clinical and research use from www.usask.ca/childpain/fpsr/. For all other uses, including republication, permission should be sought from the IASP via www.iasp-pain.org/permissions/. The FPS-R now has its own permanent home on the wesite of the International Association for the Study of Pain at www.iasp-pain.org/FPSR.

Faces Pain Scale and Faces Pain Scale - Revised

This figure has been reproduced with permission of the International Association for the Study of Pain® (IASP®).
The figure may not be reproduced for any other purpose without permission.


References:

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.

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.


Children's attentional coping strategies

Tiina Jaaniste, 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 which were explored in a series of experimental studies which Tiina Jaaniste completed 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.

A review on the use of distraction in the management of children's pain, Piira, Hayes & Goodenough (2002).

Predictors of infant pain responses

Tiina Jaaniste, 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, followed 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 Jaaniste.

Over-the-counter analgesics

David Perrott, Tiina Jaaniste, 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.

Studies using needle pain as a model

Infants and children are subject to many needle procedures. It is critical to examine the situational and personal vulnerability factors in the pain experiences, which can be the genesis of needle phobia. Needle size, volume injection, and other technical factors related to the intensity of the nociceptive stimulus are early important considerations. From our work, the most significant influence on pain reaction in infants and young children are the catastrophising tendencies and coping promoting behaviour of the parent, usually the mother. These factors tend to override other contextual factors such as nurse behaviour. When children are capable of self-report, the highest pain intensity has been found in children up to 7 years. In this group, the observed behaviour, especially facial reaction, correlates with self-report. We have found that individual factors in more intense pain and pain-related experiences have included birth order, body surface area, expectation, catastrophising, anxiety, and fear. Further, unpleasantness ratings have shown no principal age effect, but girls' ratings have been significantly higher than boys' ratings, particularly in 8-year-olds and older children. Current research has shown that disgust propensity is another predictor of pain. Disgust may also be important because of it's relation to feelings of faintness. We have found that parents' estimates of children's reactions to other painful events have been found to be a predictor of self-reported pain intensity. The child at most risk of high pain and related behaviour is young, with relatively small body size, having bad memories, who expects severe pain, is disgusted by the experience, fears the worst, and whose parents tend to catastrophise and to exhibit negative coping strategies such as inappropriate explanation and reassurance. It is important to consider these variables when selecting and tailoring distress management approaches.

The nature and heritability of growing pains

Several recent studies into the nature and heritability of growing pains have been conducted since 2007. The results have been presented at national and international conferences and currently submitted for publications. We have shown that the growing pain disorder is a neurobiologically determined condition, and shares genetic determinants with the restless legs syndrome. Based on these characteristics and other features including comorbidities, growing pains belongs to the category of functional pain disorders as currently defined. Growing pains has been shown in our twin studies to be more strongly genetically influenced than other primary pain syndromes. More details are available under the section "Current Projects". The pedigree shown below illustrates the strong genetic relationship between growing pains and restless legs syndrome. Mother has the restless legs syndrome and had growing pains as a child. One of the monozygous (identical) twin daughters has the growing pains and the other has the restless legs syndrome while their non-twin sister has the restless legs syndrome.

Pedigree

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Education

Maintaining effective pain management clinical practices relies on health professionals keeping abreast of the latest research and evidence-based guidelines. Members of the Pain Research Unit facilitate the integration of research and clinical practice through regular meetings with the pain service team, integrated projects with diverse hospital departments, responses to questions on evidence-based information, and the provision of important current publications to the pain service team.

Recent student projects

Current and recent students doing research projects through the Pain Research Unit:

  • Overseas students and postgraduate researchers
    • Inge van den Brand (the Netherlands) 2008 Somatosensory and psychosocial correlates of pain outcomes in children with chronic regional pain disorders.
    • Lotte W. de Groot (the Netherlands) 2009 Retrospective survey of outcomes for children presenting at Sydney Children's Hospital with suspected acute appendicitis
    • Alies Coenders (the Netherlands) 2010-2011 Clinical case-control and twin family survey studies on functional pain syndromes.
    • Evelyne de Kluiver (the Netherlands) 2011. Sedation practices in children in Australian nuclear medicine departments and twin study on genetics of needle pain and its influences.
  • Medical students, Faculty of Medicine, University of New South Wales
    • Honours Students
      • Shanthi Pathirana BSc(Med) Hons 1, 2007 An investigation into the nature of growing pains.
    • Independent Learning Project
      • Emily Yu 2007 A behavioural guidance sheet for parents to reduce pain and distress in infants and preschool children receiving immunization: a randomized controlled trial.
      • Siyao Du 2008 The differential impact of parental disgust and fear in venipuncture procedures in children: an observational study.
      • Jessica Bispham 2009-2010 The impact of parent-child interaction and coping in adolescent chronic pain.
      • Jananie Balendran 2009-2010 A common sleep disorder in pregnancy: Restless legs syndrome and its predictors.
      • Patricia Hannaford 2009-2010 The influence of early childhood and familial factors in adolescent chronic pain: a case-control study.
      • Carla Flynn 2009-2010 What is this malady called "growing pains"? Genes, Environment and the RLS connection.
      • Amelia Taylor 2009-2010 The heritability of growing pains.
      • Nivethigha Chandramohan 2010 The differentiate impact of disgust and fear in venipuncture procedures in adolescents and adults: an observational study.
      • Paridhi Garg 2010 Enhancing the procedural experiences of children, families and staff - a quality review of practices to minimise pain and distress in children having procedures
      • Peiwen Lim 2010 Parent education in the paediatric chronic pain clinic.
      • ManWai Wong 2010/2011 Twin family case control study on growing pains and functional pain disorders.
      • Kate Findeisen 2010/2011 Twin family case control study on migraine, non-migraine headaches and associated disorders.

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Publications

Representative Publications

  • Bieri D, Reeve R, Champion GD, Addicoat L & Ziegler JB. 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. 1990; 41: 139-150.
  • Goodenough B, Addicoat L, Champion GD, McInerney M, Young B, Juniper K & Ziegler JB. Pain in 4- to 6-year old children receiving intramuscular injections: a comparison of the Faces Pain Scale with other self-report and behavioural measures. The Clinical Journal of Pain. 1997; 13: 60-73.
  • Goodenough B, Kampel L, Champion GD, Laubreaux L, Nicholas MK, Ziegler JB & McInerney M. An investigation of the placebo effect and other factors in the report of pain severity during venipuncture in children. Pain. 1997: 72(3): 383-491.
  • Goodenough B. Pain in circumcision. Pediatric Pain Letter. Abstracts and commentaries on Pain in Infants, Children, and Adolescents. PJ McGrath & GA Finley (Eds.) Dalhousie University: Nova Scotia, Canada. 1997. Vol 1 (3), 31-33.
  • Champion GD, Goodenough B, von Baeyer CL & Thomas W. Self-report measures of pain in children. In: PJ McGrath, GA Finley (Eds.) Measurement of Pain in Infants and Children. Progress in Pain Research and Management. IASP Press (International Association for the Study of Pain). 1998; 10: 123-160.
  • Goodenough B, Champion GD, Laubreaux L, Tabah L & Kampel L. Needle pain severity in children: does the relationship between self-report and observed behaviour vary as a function of age? Australian Journal of Psychology. 1998; 50(1), 1-9.
  • Goodenough B. Growing pains. Pediatric Pain Letter. Abstracts and commentaries on Pain in Infants, Children, and Adolescents.. PJ McGrath & GA Finley (Eds.) Dalhousie University: Nova Scotia, Canada. 1998. Vol 2 (4), 38-41.
  • Thomas T, Robinson C, Champion D, McKell M & Pell M. Prediction and assessment of the severity of post-operative pain and of satisfaction with management. Pain. 1998; 75: 177-185.
  • Champion GD, Kong JHN & Goodenough B. Medical considerations in the management of chronic pain in children. Pain 1999- An Updated Review. Refresher Course Syllabus, 9th World Pain Congress, International Association for the Study of Pain. Seattle: IASP Press 1999:245-251.
  • Goodenough B, Thomas W, Champion GD, Perrott D, Taplin JE, von Baeyer CL & Ziegler JB. Unravelling age effects and sex differences in needle pain: ratings of sensory intensity and unpleasantness of venipuncture pain by children and their parents. Pain. 1999; 80: 179-190.
  • Goodenough B, van Dongen K, Brouwer N, Abu-Saad HH & Champion GD. A comparison of the Faces Pain Scale and the Facial Affective Scale for children's estimates of the intensity and unpleasantness of needle pain during blood sampling. European Journal of Pain. 1999; 3: 301-315.
  • Taplin JE, Goodenough B, Webb J & Vogl L. Children's understanding of pain. Chapter in M Siegal & C Peterson (Eds) Children's Understanding of Biology and Health. Cambridge University Press. 1999.
  • Champion GD Emerging influences of pain medicine on clinical reasoning (guest editorial). Current Therapeutics 2000; 41, 8-11.
  • Goodenough B, Perrott D & Champion GD, Thomas W. Painful pricks and prickle pains: is there a relationship between children's ratings of venipuncture pain and parental assessments of usual reaction to other pains? Clinical Journal of Pain. 2000; 16: 135-143.
  • Goodenough B, Perrott D, van Dongen K, Brouwer N & Champion GD. Children's response to vaccine fluid injection versus needle puncture pain during routine immunisation. Ambulatory Child Health. 2000; 6: 91-100.
  • Anand KS & Intenational Evidence-Based Group for Neonatal Pain. Consensus statement for the prevention and management of pain in the newborn. Archives of Pediatric & Adolescent Medicine. 2001; 2: 173-180.
  • Hicks CL, von Baeyer CL, Spafford PA, van Korlaar I & Goodenough B. The Faces Pain Scale-Revised: Toward a common metric in pediatric pain measurement. Pain. 2001; 93:173-183.
  • Piira T & von Baeyer C. Parents' behaviour in helping children cope with painful procedures. Pediatric Pain Letter. 2001; 5(2),13-15.
  • Goodenough B, von Baeyer CL & Champion GD. Facial expression and pain in children. In M Katsikis (Ed). The Human Face; Measurement and Meaning. The Netherlands, Kluwer Academic Press (2002).
  • Piira T, Taplin JE, Goodenough B. & von Baeyer CL. Cognitive-behavioural predictors of children's tolerance of a laboratory-induced pain: Implications for clinical assessment and future directions. Behaviour Research and Therapy, 2002; 40: 571-584.
  • Blount R L., Piira T, & Cohen LL. Management of pediatric pain and distress due to medical procedures. In M. C. Roberts (Ed.), Handbook of Pediatric Psychology (3rd ed., pp. 216-233). New York: Guilford, 2003.
  • Spagrud LJ, Piira T & von Baeyer CL. Children's self-report of pain intensity: The Faces Pain Scale - Revised. American Journal of Nursing, 2003; 103(12):62-64.
  • von Baeyer, CL, & Piira, T. The Faces Pain Scale - Revised (FPS-R) around the world: Translation and adaptation for use in many cultures. Abstract, Canadian Pain Society, Toronto. Pain Research and Management, 2003; 8 (Supp.B): 57B.
  • Perrott DA, Goodenough B & Champion GD. Children's ratings of the intensity and unpleasantness of post-operative pain using facial expression scales. European Journal of Pain, 2004; 8: 119-127.
  • Piira T, Sugiura T, Champion GD, Donnelly N & Cole A. The role of parental presence in the context of children's medical procedures: a systematic review. Child: Care, Health and Development. 2005; 31(2):233-43.
  • Blount RL., Piira T, Cohen L. & Cheng P. Pediatric procedural pain. Behavior Modification, 2006; 30(1):24-49.
  • Jaaniste T, Hayes B, von Baeyer CL. Effects of preparatory information and distraction on children`s cold-pressor pain outcomes: a randomized controlled trial. Behaviour Research and Therapy 2007; 45(11): 2789-2799.
  • Jaaniste T, Hayes B, von Baeyer CL. Providing children with information about forthcoming medical procedures: a review and synthesis. Clinical Psychology: Science and Practice 2007; 14(2): 124-143.
  • Piira T, Champion GD, Bustos T, Donnelly N, Lui K. Factors associated with infant pain response following an immunization injection. Early Human Development 2007; 83: 319-326.
  • von Baeyer, CL, & Piira, T. The Faces Pain Scale - Revised around the world: Translation and adaptation for use in many cultures. The Suffering Child. 2003. Special Issue: Proceedings of the International Symposium on Paediatric Pain.
  • Blount, R.L., Simons, L.E., Devine, K.A., Jaaniste, T., Cohen, L.L., Chambers, C. & Hayutin, L.G. Evidence-based assessment of coping and stress in pediatric psychology, Journal of Pediatric Psychology 2008; 33, 1021-1045.
  • Bustos T, Jaaniste T, Salmon K, Champion GD. Evaluation of a brief parent intervention teaching coping-promoting behavior for the infant immunization context. Behavior Modification 2008; 32: 450-467.
  • Du S, Jaaniste T, Champion D, Yap CSL. Theories of fear acquisition: the development of needle phobia in children. Pediatric Pain Letter 2008; 10(2): 13-17.
  • Blount RL, Zempsky WT, Jaaniste T, Evans S, Cohen LL, Devine KA, Zeltzer LK. Management of pain and distress due to medical procedures. In MC Roberts & R Steele (Eds). Handbook of Pediatric Psychology, 4th ed, 2009, New York: Guilford Press, 171-188.
  • von Baeyer, CL & Jaaniste, T. Computer-Animated Faces Pain Scale: Commentary on Fanciullo et al. (2007), Pain Medicine 2009; 10(1), 195-196.
  • Champion D, Flynn C, Taylor A, Jaaniste T. Growing pains shares genetic determinants with the Restless Legs Syndrome. Twin Research and Human Genetics 2011, 13 (3): 250.
  • Gordon BK, Jaaniste T, Bartlett K, Perrin M, Jackson A, Sanstrom A, Charleston R, Sheehan S. Child and parental surveys about pre-hospitalization information provision. Child: Care, health and development, 2010 doi: 10.1111/j.1365-2214.2010.01190.x
  • von Baeyer CL, Champion GD. Multiple pains as functional pain syndromes (Commentary). Journal of Pediatric Psychology Advance Access January 11, 2011 doi.10.1093/jpepsy/jsq123.
  • Balendran J, Champion D, Jaaniste T, Welsh A. A common sleep disorder in pregnancy: Restless legs syndrome and its predictors. Australian and New Zealand journal of Obstetrics and Gynacology 2011 doi: 10.1111/j.1479-828X.2011.01294.x .

Recent Presentations at Scientific Meetings

The Pain Research Unit endeavours to provide a strong Australian paediatric representation at National national and International international Scientific scientific meetings devoted to the specialist study of pain. Presentations were conducted at the following conferences:

  • Eighth International Symposium on Paediatric Pain, Acapulco, Mexico, 7-11 March 2010
    • Lindsey L. Cohen, Amy Baxter, David Champion. Knowledge from Needles: Lessons from a Decade f Research.
    • David Champion. Contextual and Vulnerability Factors in Adverse Pain Experiences by Children Undergoing Needle Procedures.
    • Emily Yu, Tinna Jaaniste, David Champion, Carol Yap. Randomized Controlled Trial of a Parental Guidance Sheet Aiming to Reduce Pain-Related Distress in Infants and Preschool Children Receiving Immunization Injection.
    • David Champion, Shanthi Pathirana, Angie Soetanto, Rani Sachdev, Millie Taylor, Carla Flynn, Tiina Jaaniste. Growing Pains and the Restless Legs syndrome Connection.
    • SiYao Du, David Champion, Carol Yap. The Relationship Between Parental and Child Anxiety and Disgust to Needle Pain Outcomes.

  • Annual Scientific meeting of the Australian Pain Society, Gold Coast, Australia, 28-31 March 2010
    • Lotte de Groot, Simon Cohen, G. David Champion, Vicent Varjavandi, Carol Yap, Tiina Jaaniste. Retrospective Survey of Outcomes for Children Presenting at Sydney Children's Hospital with Suspected Appendicitis.
    • Carla Flynn, G. David Champion, Tiina Jaaniste, Millie Taylor, Shanthi Pathirana, Rani Sachdev, Carol Yap. What Is This Malady Called "Growing Pains"? Genetic and Environmental Influences.
    • Patricia Hannaford, G. David Champion, Tiina Jaaniste, Amelia Taylor, Carla Flynn, George Chalkiadis. Functional Pain Syndromes of Childhood: Epidemiology, Risk Factors and Outcomes.
    • Siyao Du, David Champion, Carl Yap, Tiina Jaaniste. "Yuck!" The Relationship between Parental and Child Anxiety and Disgust to needle Pain Outcomes.
    • David Anderson, Meg Goodison-Farnsworth, Simon Cohen, Matthew Crawford, Maline Glogauer, Louise Dolahenty, Jessica Dawber, Marianne McCormick, Michelle Perrin and Greg Rowell. Sydney Children's Hospital Chronic Pain Team Treatment and Management.
    • Christopher Holmes, Matthew Crawford, Simon Cohen, Megan James, David Anderson. The Effect of Adding Naloxone to Morphine Patient Controlled Analgesia on the Incidence of Opioid Side effects in Children.

  • Thirteenth International Congress on Twin Studies, Seoul, South Korea, 4-7 June 2010
    • David Champion, Carla Flynn, Amelia Taylor, Tiina Jaaniste. Growing Pains Shares Genetic Determinants with the Restless Legs Syndrome.
  • Twenty Eighth Course in Paediatrics, Sydney Children's Hospital, March 2011.
    • David Champion, Functional Pain Syndromes: New concepts and developments.
  • Abstracts accepted for presentations at the Annual Scientific Meeting of the Australian Pain Society, Darwin, June 2011. Abstracts

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Projects

Projects 2008-2011

  1. Effect of adding low dose naloxone to morphine patient controlled analgesia (PCA) on the incidence of opioid-induced adverse side effects. Holmes C, Cohen S, Crawford M, Anderson D, James M. The addition of naloxone to morphine PCA did not decrease the incidence of nausea, vomiting or pruritis. This was in contrast to favourable results previously reported for children receiving continuous intravenous morphine. The results of this project were presented by poster at the International Symposium on Pediatric Pain, Acapulco, Mexico (presenter: Megan James) and at the Australian Pain Society & New Zealand Pain Society Combined Annual Scientific Meeting, Gold Coast (presenter David Anderson).

  2. Randomised controlled trial of paracoxib in children undergoing tonsillectomy. Davidson G, Crawford M et al. This trial has been funded but requires research ethics clearance before commencing.

  3. Behavioural guidance sheet for parents to reduce pain and distress in infants and preschool children receiving immunization: a randomized controlled trial. Yu E, Jaaniste T, Yap C, Champion GD. This study, soon to be submitted for publication, showed that provision of information to parents improved their positive coping promoting behaviour. However the parents did not respond to the guidance to reduce negative influences and it was these which correlated with the infant`s and children`s pain outcomes. Thus the children did not benefit. Future studies will focus on guidance to parents to overcome negative influences such as inappropriate reassurance.

  4. Growing pains program. Growing pains (benign nocturnal limb pain syndrome) is important, not so much because it is second only to headache in prevalence in young children nor because the nature of the disorder hitherto has been unknown, but because it appears to be a genetic marker for risk of later life pain vulnerability. Growing pains (GP) was the subject of Shanthi Pathirana`s BSc(Med) Honours thesis (awarded first class honours). Our projects to date, some of which have been presented at international conferences and are in preparation for publication, have shown:
    • GP was associated with mild widespread disorder of somatosensory processing. Taken together with lack of somatic pathology and no evidence for a peripheral neuropathic disorder, GP is likely to be a primary neurobiological disorder.
    • GP was moderately strongly influenced by genetic factors (monozygous twin concordance 75%, dizygous twin concordance 25%).
    • GP shares genetic determinants with the restless legs syndrome (RLS). Carla Flenn presented data from a combined study with Amelia Taylor at the annual scientific meeting of the Australian Pain Society, Broadbeach march 2010. This study was also presented at the 13th International Twin Research Congress, Seoul, June 2010.
    • The restless legs syndrome prevalence (RLS) is increased in pregnancy and in our case-control study this condition in 22.5% of women in their third trimester. Having a history of childhood GP conferred a 42% risk of restless legs during pregnancy.
    • GP has features of a sleep disorder and a retrospective review of sleep studies in children showed an association with periodic limb movements in sleep >5/hour. A prospective study has been commenced.
    • GP was found in a twin family case control study to be associated not only with Restless Legs Syndrome, but also with migraine and non-migraine headaches. Abstract

  5. In search of genetic vulnerability to pain: This plan will follow directly on from the twin studies. We have no expectation that there will be a single gene coferring risk of growing pains, but more likely will be advances in gene knowledge from these studies bearing in mind that growing pains appears to be more heritable than almost all other primary idiopathic pain disorders. This encourages us to initiate a research program in paediatric pain genetics, a field that has not been developed.

  6. Idiopathic/functional pain syndrome studies: This is another flow on effect of our growing pains research. We are in the process of confirming that growing pains, recurrent headaches and recurrent abdominal pain syndromes are the 3 prevalent spontaneously occurring or easily provoked pain disorders of early childhood. By adolescence headaches and recurrent abdominal pains are still prevalent, but additionally neck and back pains, widespread chronic pains and other idiopathic/functional syndromes contribute substantially to population prevalence of chronic/recurrent pain disorders of the order of 15%. We are currently undertaking a systematic review of the idiopathic/functional pain disorders of children and adolescents, focusing on age-related prevalence, comorbidities, and their role as risk factors for later life adverse pain experiences. The latter point is being tested in a case control study (below, item 7). This has been another greatly neglected are of paediatric pain research, notwithstanding the importance, prevalence, and continuing unfavourable associations and influences of such disorders in adult life. Our timing of research interest in the functional pain syndromes is ideal in view of current neurobiological, psychological and genetic progress in the adult literature in this field.
    A current project is a twin family case-control study collaborating with the Australian Twin Registry directed at functional pain syndromes, their heritabilities and comorbidities, with particular focus on GP, RLS, migraine and anxiety/depression. Abstract Final Student Report

  7. Risk factors for chronic pain in children and adolescents: a case-control study. This study was commenced by Patricia Hannaford, medical student in her 2009-2010 ILP project. The data from cases and controls analysed during her tenure were presented at the annual scientific meeting of the Australian Pain Society, Broadbeach march 2010. Cases from hospital clinics and healthy controls are being surveyed for risk factors including prematurity, illness and injury, psychosocial factors, and personal and family history of idiopathic pain disorders, notably including growing pains. Interstate collaboration is being explored. This study has been continued by Alies Coenders. The results show that chronic pain in adolescents was associated with, and might be predicted by, migraine, non-migraine headaches and recurrent abdominal pain by multiple logistic regression analysis. Further, chronic pain was associated with parental recurrent abdominal pain and depression. Final Student Report

  8. The impact of parent-child interaction and coping in adolescent chronic Pain: This was an ILP project for 2009-2010 by Jessica Bispham, medical student, being supervised by Carol Yap, Tiina Jaaniste and David Champion. The design was cross-sectional and involved adolescent patients from the Chronic Pain Clinic in collaboration with the attending psychologists. This is a potentially important direction in psychosocial assessment in the context of chronic pain in adolescents. Jessica presented some of her work as part of a workshop at the Australasian Physiotherapy conference earlier this year. A current study concerns the impact of a parent education program on the outcome of children and adolescents attending the chronic pain clinic. This has been conducted by Peiwen (Jane) Lim in collaboration with the chronic pain clinic team. This study has shown important associations between parental psychological variables and functional pain outcomes in the adolescents. Final Student Report

  9. Somatosensory testing studies. The first of these was in growing pains, mentioned above. The rationale is that this psychophysical process involving responses to physical stimuli to the skin and to deep somatic tissue, obtains insight into the neurobiology of pain disorders. The methods assist in evaluation and diagnosis of peripheral neuropathic pain syndromes and, more effectively than bedside neurological examination, reveal clinical correlates of central sensory dysfunction, notably central sensitisation of nociception. The methods and rationale are available in a document entitled "Somatosensory testing in the context of chronic pain disorders in children and adolescents". A recent and a proposed study are:
    • Psychological evaluation and sensory testing for the diagnosis and assessment of regional pain disorders. This study was conducted by Inge van den Brand, medical student from The Netherlands, supervised by David Champion, Matthew Crawford and Carol Yap, involving patients attending the Chronic Pain and Rheumatology Clinics. Somatosensory findings and psychological measures were evaluated in correlation analyses with pain outcomes in a cross sectional study. The application of the measures to the diagnostic assessment of individual cases was also undertaken. Her thesis was well received by her Netherlands` supervisors.
    • Somatosensory testing is to be incorporated into the workup of children attending the Chronic Pain Clinic. Correlation will be made with clinical, psychological and pain function outcome data to explore the practicality and interpretation of somatosensory testing in this context.

  10. Acute appendicitis studies: The Pain Research Unit responded to observations by the acute pain team, Simon Cohen in particular who has become a lead investigator on the projects, that post-appendicectomy there seemed to be frequent reports of normal appendicies and pain responses varied considerably and unpredictably. In collaboration with Dr Vincent Varjavandi, surgeon, it was decided to conduct a prospective study to identify associations as potential predictors of non-appendicitis and of adverse pain outcomes. It was considered prudent firstly to conduct a retrospective survey, a chart review of the most recent 18 months of appendicectomy cases. Lotte de Groot, Dutch medical student, was assigned to this audit/survey. She is currently analyzing the data in conjunction with our Research Scientists. In the 352 appendicectomy cases, there were 17.4% with histologically normal appendicies. The data indicate that the best scoring systems, particularly the Inflammatory Response Score which she calculated from the file entries, effectively predicted non-appendicitis and could be applied with diagnostic advantage. Potential predictors of bad pain outcomes were limited mainly to age, sex, pain intensity and non-appendicitis. This background forms the basis for a potential prospective cohort study with our surgeons and ED staff. The proposed aim is to test that the addition of psychological measures, irritable bowel syndrome screening and somatosensory testing to the currently known and revealed best assessments will enhance prediction for the 2 principal research questions.

  11. Hospital staff survey of procedural experiences and prospective being conducted by Megan James (CNC) and Paridhi Garg (ILP student). The procedures will be compared with international best practice with a view to quality improvement.
    This study was presented as a poster presentation at Women's Hospitals Australasia & Children's Hospitals Australasia Annual Conference 2010 8 - 10 November Hilton on the Park, Melbourne, Australia. Final Student Report

  12. Disgust and needle pains Siyao (Sienna) Du conducted an ILP project in 2008-2009 investigating disgust reaction to needle pain in children. Her data showed that disgust was associated, as an independent predictor (which did not correlate with anxiety) of worse pain outcomes. The study was presented by poster at a national conference and an international pain conference. In 2010, Niv Chandramohans as her her ILP project, has extended this study into adolescents and adults. Preliminary multivariate analyses are showing again that disgust is a significant predictor of worse pain outcomes. Abstract Final Student Report

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Resources

Online Questionnaires

We are conducting a survey study by questionnaire to learn about child and family conditions which may predict a chronic pain in an older child or adolescent. You may have been invited to participate in this study through your school. Please follow the links below to answer the questionnaires for you and your parents.

Online Resources

Following is a list of website that we have found useful. As these websites may constantly be changing, we cannot guarantee the accuracy of all the information they report.

  • www.pediatric-pain.ca
    Pediatric Pain: Science Helping Children Pediatric Pain Research Lab located in the IWK Grace Health Centre and the Psychology Department of Dalhousie University in Halifax, Nova Scotia, Canada
  • www.apsoc.org.au
    Australian Pain Society
  • www.iasp-pain.org
    International Association for the Study of Pain
  • www.ampainsoc.org/advocacy/pediatric.htm
    Background, policy, and extensive references concerning multidisciplinary assessment and treatment of chronic pain in children and adolescents
  • www.aboutkidshealth.ca
    The About Kids Health Online is the website of the Hospital for Sick Children. It provides information such as "About Pain", "Myths about Pain", "Pain relief: Comfort Kit", "Complementary and Alternative Therapies for Pain Management", "Pain: How to talk to kids about their pain", "How do I Know that My Child Has Pain?", "Ten ways parents can help ease pain in children" and "Pain Resources".
  • www.childpain.org
    This is a website provided by International Association for the Study of Pain: Special Interest Group on Pain in Childhood. You can access New Publications on Pediatric Pain which provides summaries and sometimes links to full articles on the latest scientific publications on pain in children and adolescents.
  • www.childpain.org/ppl
    Pediatric Pain Letter (PPL) provides free, open-access, peer-reviewed commentaries on pain in infants, children and adolescents.
  • www.talkinghealth.org/uploads/Pain Toolkit Booklet May 2010.pdf
    This is an appealing presentation of a wide range of tactics to manage persistent pain which can be applied to children and adolescents.
  • www.med.umich.edu/yourchild/topics/pain.htm
    University of Michigan Health system: Your Child website adds to the usual evidence-based information, interesting complementary and alternative ways of helping extending to humour, meditation and music.
  • www.chronicpainaustralia.org
    Chronic Pain Australia organisation provides wide ranging help and information for people with chronic pain. It mainly deals with adults but can be very helpful responding to questions about chronic pain in children and adults.
  • www.thecochranelibrary.com
    This very authoritative and important website (The Cochrane Library) provides free public access to the best medical evidence about diagnosis and treatment and includes reviews covering pain in children and adolescents.
  • www.ncbi.nlm.nih.gov/pubmed
    This well-known public access website (Pubmed) enables searches into all aspects of medicine and psychology. You can apply keywords such as "chronic pain adolescent". If you wish to limit the search to review articles, add "review". The immediate access is to abstract (summary) but sometimes you can obtain the full article by clicking on "free article".
  • www.painmanagement.org.au
    Australian Pain Management Association Self-Help.
  • www.paintoolkit.org
    The Pain Toolkit offers tips and skills in self-managing persistent pain.
  • www.iasp-pain.org/FPSR
    This page for the Faces Pain Scale-Revised contains links to download the scale and instructions, references, translations of the instructions into 40+ languages, and permission to reproduce the scale.

Book Resources

Some books are focused on the management of chronic pains in children and adolescents and below is the list of books the Pain Research Unit used in the Parent Education Program.

  • Conquering Your Child's Chronic Pain: A Pediatrician's Guide for Reclaiming a Normal Childhood.
    (2005) Lonnie Zeltzer, MD, & Christina Blackett Schlank. Harper Collins.
    Although a few years old, the authors are first class and the principles are essentially the same. Lonnie Zeltzer is the highly esteemed President of the Pain in Childhood Special Interest Group of the International Association for the Study of Pain.
  • Relieve Your Child's Chronic Pain: A Doctor's Program for Easing Headaches, Abdominal Pain, Fibromyalgia, Juvenile Rheumatoid Arthritis, and More.
    (2005) Elliott Krane, KD & Deborah Mitchell. New York: Fireside also Lynn Sonberg Books.
    The authors are authoritative. The focus is a little more disease/condition specific, such as headaches, abdominal pain and so on.
  • Be the Boss of Your Pain: Self-Care for Kids
    (2007) Timothy Culbert, MD, and Rebecca Kajander, CPNP, MPh. Minneapolis, MN: Free Spirit Publishing.
    We have not read the content, but this book directed primarily at children looks very appealing with lots of funny pictures.
  • A Child in Pain: How to Help, What to Do
    (1996) Leora Kuttner, PhD. Crown House Publishing.
    This is a highly recommended book written by a very experienced and authoritative clinical and research psychologist who has specialised in pain management. This book was first published in 1996 and reprinted in 2004, 2005, 2006.
  • A Child in Pain: What Health Professional Can Do to Help
    (2010) Leora Kuttner, PhD. Crown House Publishing Company LLC.
    This book is directed primarily to health professionals but is very accessible to the general reader and has much that is of high value to parents and adolescents. It is a blend of sensitive, practical and interesting information and guidance with evidence.
  • Managing Pain in Children: A Clinical Guide
    (2009) Twycross, A., Dowde, S.J., Bruce, E. Oxford: Wiley-Blackwell.
    Although written for healthcare professionals, many parents will find the information of practical value and can lead to useful questions to present to the pain management team.
  • The Brain That Changes Itself: personal triumph from the frontiers of brain science
    (2010) Norman Doidge. Scribe Publications.
    This book is not about pain but provides encouragement about ways and means unwanted brain activities (which include pain) can be diminished or overcome.
  • Managing persistent pain in adolescents: A handbook for therapists
    (2008) Rogers, R. Oxford & New York: Radcliffe.
    Another book written for healthcare professionals with information also useful for parents and adolescents.
  • Explain Pain
    (2003) David S. Butler and G. Lorimer Moseley. Noigroup Publications, Adelaide, Australia.
    This book is now seven years old but provides excellent and still valid understanding of the nature of pain and is quirky, appealing and fun to read.

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Funding

The Pain Research Unit receives financial support from Sydney Children's Hospital, particularly since 2007 from Sydney Children's Hospital Foundation Gold Dinner Fund. We have taken advantage in recent years of availability with some financial support of medical students from University of New South Wales through the Independent Learning Project and Bachelor of Science (Medical) Honours schemes. We also rely on private donations, and short-term grants from corporate, government and charitable organisations. We are grateful to all those who have supported our research over the years. We are particularly grateful for annual donations from BBM. Ltd. (Formerly Big Brother Movement)

We wish to acknowledge with deep gratitude the members of our fund raising committee who provided remarkable financial support until 2007 when we benefited from the Gold Dinner Fund of the Sydney Children's Hospital Foundation. The Chair was Gay Windeyer, and the committee members were June Buckingham, Judith Bull, Caroline Champion, Christine Cole, Claire Dixon, Susan James and Helen Wright.

Donations

Donations may be made to:

Pain Research Unit, Sydney Children's Hospital

In Writing

C/O- Associate Professor David Champion
Pain Research Unit, Department of Anesthesia and Pain Medicine
Level 1 Campus Centre
Sydney Children's Hospital
High Street
Randwick NSW 2031
Australia

Telephone

  • Tel: 61 2 9382 1585
  • Fax: 61 2 9382 1008

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Contact Details

Telephone

  • Tel: 61 2 9382 1585
  • Fax: 61 2 9382 1008

Postal Address:

C/O- Associate Professor David Champion, Cindy Chapman
Pain Research Unit
Level 1 Campus Centre
Sydney Children's Hospital
High Street
Randwick NSW 2031
Australia

Email Contacts:


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