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Getting pain science education ‘right’ for kids – Part 1 of 2

Paediatric pain researcher and resources developer, Joshua W. Pate, shares with Noigroup a passion for making learning more accessible for all – kids included! Enjoy part one of his insight here, delivered with a genuine enthusiasm that makes collaborating with Josh an absolute delight. (And when we say ‘collaboration’… watch this space!)

Part 1 of 2: Identifying and addressing conceptual ‘gaps’ and misconceptions

Do you think everyone challenged by pain should learn a ‘one-size-fits-all’ curriculum of education about the science of pain? I’m guessing you answered ‘no’. I also have a hunch that you have found it hard at times to know where to start… I sure have.

My PhD studies focussed on understanding how children think about pain and how that variable can be assessed. I dreamed, ‘If we can get pain science education ‘right’ for kids, surely that’ll help us with educating adults too?”.

Working as part of an international team of researchers, we developed the Concept of Pain Inventory (COPI), and published research on it in 2020.

A quick side note about developing and testing a questionnaire – it’s a huge process! We surveyed experts, interviewed kids, piloted, ran it past an expert panel, more piloting, and THEN we did the ‘initial’ validation study linked above. This paper covers the factor analysis, internal consistency, test-retest-reliability, agreement, smallest detectable change, and criterion validity – these psychometric properties were analysed ONLY for 8-12 year old’s seeking care for pain – and future research is needed to test if the findings are similar in other settings and populations. For example, a paper with adults data is under review, a paper on physiotherapy students is coming soon, and a range of cross-cultural translations are on their way!

Back to my little story about the COPI…

A key purpose of the questionnaire is to better target education in a clinical setting. Let’s use an example to think more about this:

Introducing 12-year old Norah with 2 years of persisting back pain. Imagine she had filled out the COPI prior to the assessment that you conducted. Would this completed questionnaire change your assessment and/or treatment? My answer would be ‘yes’ to both questions. Here’s why:

  1. Pick an item with an ‘Unsure’ response (you can repeat these steps for any item!)
  2. Ask the patient why they responded that way, then
  3. Listen intently and actively and go from there.

For example:

You: So Norah, why did you tick ‘Unsure’ for the sentence: ‘Learning about pain can help you to feel less pain?’.
Norah: Because I have never really learnt about pain. I mean, I’ve got pain, but no one has ever taught me anything about it. What is there to learn anyway?

Now you have a perfect opportunity to start teaching Norah about the science of pain, in a personalised way, where she is open to learning. Maybe you’ll start by discussing one of these TED-Ed videos I wrote (Phantom limbs, The mysterious science of pain), or Tame the Beast. [It’s a good time to mention that we have a series of targeted children’s books developed with Josh coming very soon! –Ed.]

You could then address the other ‘Disagree’/‘Unsure’ ticks, and also encourage Norah on her ‘Agree’ ticks. Does that process make sense?

Rewind and let’s go again:

You: So Norah, why did you tick ‘Unsure’ for the sentence: Learning about pain can help you to feel less pain?
Norah: I just don’t know. And I don’t really want to know. I just want to get on with it, not chit chat.

In this opposite situation, you realise that Norah may not be open to learning about the science of pain right now. So, my very biased view is that the COPI may help you identify patients with this attitude too.

A few other things I really like about the COPI:

  1. It uses a 5-point agreement scale, so as a clinician you can unpack ‘how much’ a particular conceptualisation is held to (unlike a ‘knowledge’ quiz, it means we can understand more about a patient’s beliefs too!)
  2. The language is simple, because it was designed using the language of an 8-year old.
  3. It’s brief. Fourteen questions (or 13 for the adult version coming soon!) only takes an average of 1 to 3 minutes to complete.

Anyway, I don’t want this to come across like a sales pitch, but rather a potentially handy tool for you to go and use today in your clinical practice.

You can give the COPI a quick go:

Or you can email me if you want a printable hard copy version. I’d love to hear any feedback you have or any research suggestions. Thank you for taking a moment out of your day to sit (probably) and think hard about how we can all best enable tailored learning about the science of pain.

–Joshua W. Pate
Lecturer in Physiotherapy at the University of Technology Sydney (UTS)

You can follow Josh on Instagram or Twitter

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