Table 1 Overview of pain education material applied to children and youth
From: Spreading the word: pediatric pain education from treatment to prevention
Interactivea pain education material | |||||||
Author, year | Covered topics | Learning objectives (according to Leake et al. [44])b | Education material | Tool(s) (e.g., metaphors, illustrations) for transferring concepts | Delivery method(s) | Educator(s) | Target(ed) audience |
■ PNE4Kids is divided in 3 sections: ‣■ The pain system and its function (i.e., nervous system anatomy, from nociception to pain, modulation of nociceptive information) ‣■ Bioplasticity and persistent pain ‣■ Therapeutic strategies to ease pain with application to the child’s own situation / daily life | (1)–(6) | PNE4Kids toolbox consisting of: ■ A game board ■ 5 privates ■ 1 lieutenant ■ 1 general ■ 5 cubes/messages ■ 5 computers ■ 1 brain ■ 1 spinal cord ■ PNE4Kids instructions for educator Currently available in English, Dutch, and Danish via http://www.paininmotion.be/pne4kids | ■ Allegory of the military ■ Metaphors for brain, spinal cord, peripheral nerves and (danger) messages ■ Examples ■ Storytelling | ■ Interactive session(s) with the PNE4Kids toolbox that stimulates children to come up with personal examples and to demonstrate and explain pain themselves. ■ 2 session of ±30 min [6] ■ 1 session of ±60 min [28] | Physiotherapist | ■ Healthy children between 6 and 12 years old (and their parents/caregivers) [6] ■ Children between 6 and 12 years old with a diagnosis of functional abdominal pain disorder (and their parents/caregivers) [28] | |
Non-interactivea pain education material | |||||||
Author, year | Covered topics | Learning objectives (according to Leake et al. [44])b | Education material | Tool(s) (e.g., metaphors, illustrations) for transferring concepts | Delivery method(s) | Educator(s) | Target(ed) audience |
Selhorst et al. (2020) [29] | ■ Pain-related fear and pain catastrophizing using the “Common Sense Model of Self-Regulation” framework ■ Information on how the body processes nociception, experiences pain ■ The concept that pain does not always mean tissues are being damaged | Not specifically reported but derived by the authors of this masterclass from the reported topics covered: (1), (3)–(5) | ■ Psychologically-informed video including pain neuroscience education created by a physical therapist and clinical psychologist using a narrator | Not specifically reported. The article states that adults pain neuroscience education was modified for the adolescent population according to Robins et al. (2016) [45] and tailored to patellofemoral pain | ■ Video with a duration of 8 minutes and 30 seconds ■ The video was shown once | Not mentioned | Adolescents with patellofemoral pain between 12 and 17 years old (mean (±SD) age: 14.1 (2.4) years) |
Rheel et al. (2021) [36] | ■ The pain system and its function: ■ Nervous system anatomy ■ From nociception to pain ■ Modulation of nociceptive information | (1), (3)–(5) | ■ Engaging video based on PNE4Kids [6] ■ Children are invited to use the materials from the PNE4Kids toolbox while watching the video | ■ Allegory of the military ■ Metaphors for brain, spinal cord, peripheral nerves and (danger) messages ■ Examples ■ Storytelling | ■ 15-minute engaging video ■ The video was shown once | Physiotherapist | Children/adolescents between 8 and 15 years old (mean (±SD) age: 12.02 (1.87) years) |
Reis et al. (2021) [46] | ■ Characterization of pain as the alarm system of the body ■ Pain neurophysiology (neurons, nociceptive system, nociceptive pathways, up- and down-regulation of the nervous system, peripheral and central sensitization) ■ Cognitive, emotional, and behavioral factors that might contribute to pain ■ A summary of the most important concepts in the book ■ True or false quiz consisting of affirmative statements about pain | (1)–(5) | A comic book “A journey to learn about pain”. Currently available in pdf, flipbook, and e-book in English, Portuguese and German via http://pesquisaemdor.com.br/?page_id=84 | ■ Sequence of illustrations with accompanying speech bubbles ■ Story with different characters ■ Metaphors ■ Examples | ■ 40 page comic book ■ Children may read the book themselves or let someone else read it for them (e.g., parent, healthcare professional, …) | N/A | Children between 8 and 12 years old (and their parents/caregivers) |
Louw et al. (2020) [41] | ■ Peripheral sensitization ■ Central sensitization ■ Bio-psycho-social factors associated with pain ■ Threat appraisal of the brain ■ Nociception, stress, and endocrine responses in pain ■ Various therapeutic endogenous strategies to ease pain | Not specifically reported but derived by the authors of this masterclass from the reported topics covered: (1)–(7) | ■ PowerPoint presentation with encouragement to ask questions afterwards ■ 2 follow-up video-presentations | ■ Illustrations ■ Metaphors ■ Examples | ■ 30-minute, 32-slide PowerPoint presentation delivered in a classroom setting with room for asking questions after the presentation ■ 2 booster sessions at 2 and 4 months follow-up via video-presentation (± 10 min each) | Physiotherapist or occupational therapist | Children of grade 7 in the USA education system (mean age: 12.2 years) |
Louw et al. (2019a) [47] | ■ Sensitization of the nervous system during a pain experience leading to decreased pain thresholds for movement, emotions and activity ■ Strategies to dampen down a sensitive nervous system | Not specifically reported but derived by the authors of this masterclass from the reported topics covered: (1)–(7) | PNE was delivered via a virtual reality system, including a headset and earphones | ■ Illustrations ■ Metaphors ■ Sound | ■ 3 sessions delivered 1 week apart ■ Time per session: session 1 (15 min), session 2 (22 min), session 3 (26 min) | Not mentioned | 18-year-old high school girl who developed chronic neck pain following a motor vehicle collision 10 months ago |
Louw et al. (2018) [38] (2019b) [39] (2020) [41] Podolak et al. (2019) [40] | ■ Peripheral sensitization ■ Central sensitization ■ Bio-psycho-social factors associated with pain ■ Threat appraisal of the brain ■ Nociception, stress, and endocrine responses in pain ■ Various therapeutic endogenous strategies to ease pain | Not specifically reported but derived by the authors of this masterclass from the reported topics covered: (1)–(7) | PowerPoint presentation with encouragement to ask questions afterwards | ■ Illustrations ■ Metaphors ■ Examples | ■ 30-minute, 32-slide PowerPoint presentation delivered in a classroom setting with rooms for asking questions after the presentation [38,39,40,41] ■ Class size < 30 students [38, 40] ■ Mean class size = 34 students [39] | ■ Children of grades 5–8 in the USA education system (mean (±SD) age: 12.74 (1.13) years) [38] system (mean (±SD) age: 12.8 (1.1) years) [40] ■ Children of grade 7 in the USA education system (mean age: 12.3 years) [39, 41] | |
Crandall et al. (2008) [35] | ■ An introduction describing how each person experiences pain differently ■ Definition of pain and associated feelings ■ Questions the nurses and doctors would ask about their pain (i.e., is there pain, how much, location and were the medicines helping), ■ A review of a 0—10 pain intensity scale ■ Expected location and duration of pain ■ Available pain medications, their helpfulness and side effects ■ Non-pharmacologic pain management strategies (e.g., resting, use of distraction, and the importance of drinking including the drinking of cold liquids and food) ■ To take the pain medicine every 4 h if pain occurs ■ To tell their parents, nurse or doctor if the pain medicine is not working. | Not specifically reported but derived by the authors of this masterclass from the reported topics covered: (5) | Not specifically reported: at least a booklet containing textual information | Not specifically reported | ■ During the pre-operative clinic visit with the parent(s) present, children were given the option to either read the booklet themselves or have the researcher read it ■ The booklet was sent to the child’s home afterwards | No educator or a researcher (professional background of researcher was not reported) | Children between 7 and 13 years scheduled for tonsillectomy with or without adenoidectomy (mean (±SD) age: 10.1 (2.2) years) |
Wager et al. (2018) [42] Kisling et al. (2021) [43] | The video is divided into three parts: ■ General knowledge on pain (i.e., biological facts on pain) ■ Chronic pain development and maintenance (i.e., how pain is caused and processed by the brain, as well as how chronic pain originates, including examples of psychosocial factors that can contribute to pain) ■ Strategies for the management of chronic pain | (1)–(7) | A 10 min video available on Youtube https://www.youtube.com/watch?v=eJ8THITj_2Y | ■ Simple language and catchy illustrations and hand-painted scenes drawn on a white-board. ■ Story is told by a teenage girl ■ Pictures of a male and female character are equally embedded + a sex-neutral character – a ‘brain’ with arms and legs – is included as well | ■ Children watched the video once in groups of 15 to 20 [42]. ■ Children watched the video at least 1 time and received a QR-code which allowed them to watch it again if they wanted to [43]. | N/A | Children of grades 5–7 in the German education system (age range 10–15 years) ■ (mean (±SD) age: 11.7 (1.1) years) [42] ■ (mean (±SD) age intervention group: 11.21 (0.93) years) [43] |
Mixed (interactive and non-interactive)a pain education material | |||||||
Author, year | Covered topics | Learning objectives (according to Leake et al. [44])b | Education material | Tool(s) (e.g., metaphors, illustrations) for transferring concepts | Delivery method(s) | Educator(s) | Target(ed) audience |
Andias et al. (2018) [27] | ■ The neurophysiology of pain ■ Transition from acute to chronic pain ■ The nervous system’s ability to modulate the pain experience. | Not specifically reported but derived by the authors of this masterclass from the reported topics covered: (1)–(4) | ■ Pictures and diagrams (based on Butler & Moseley [48] and Louw & Puentedura [49]) ■ A booklet for use between sessions | Not specifically reported | ■ 4 group sessions ■ Groups of 4 to 7 adolescents ■ Time allocated to pain science education decreased from session 1 (45 min) to session 4 (15 min) | Physiotherapists | Adolescents from a secondary school in Portugal (mean (±SD) age intervention group: 17.4 (1.4) years) |