Pain is not Over when the Needle Ends: A Review and Preliminary Model of Acute Pain Memory Development in Childhood

Abstract

SUMMARY Over the past several decades, the field of pediatric pain has made impressive advances in our understanding of the pain experience of the developing child, as well as the devastating impact of inadequately managed pain early in life. It is now well recognized that, from infancy, children are capable of developing implicit memories of pain that can influence their subsequent reactions to pain. The present review provides a synthesis of selected studies that made a significant impact on this field of inquiry, with particular emphasis on recent clinical and laboratory-based experimental research examining children‘s explicit autobiographical memories for acute pain. Research has begun to move towards improving the precision with which children at risk for developing negatively estimated pain memories can be identified, given the adverse influence these memories can have on subsequent pain experiences. As such, several fear- and anxiety-related child and parent variables implicated in this process are discussed, and avenues for future research and clinical intervention are identified throughout. Finally, a preliminary empirically and theoretically derived model of acute pain memory development in childhood is presented to parsimoniously summarize the evidence accumulated to date and guide future investigation in this area.

Acknowledgements

Parts of this review paper are derived from unpublished portions of the first author‘s doctoral dissertation entitled, ‘Children‘s memory for pain: experimental investigations of the role of anxiety in children‘s pain memories and the influence of pain memories on subsequent pain experience‘. The authors greatly appreciate the generosity of the anonymous reviewer who made important contributions to the development of the preliminary model. The authors would also like to thank K Birnie and K Boerner for their valuable insights into the model. Finally, the authors would like to sincerely thank the children and families who took part in this dissertation research and inspired these ideas and writing.

Financial & competing interests disclosure

M Noel and M Petter are Killam Scholars and are supported by Frederick Banting and Charles Best Canada Graduate Scholarships Doctoral Awards from the Canadian Institutes of Health Research (CIHR). At the time that this work was completed, M Noel was also supported by a CIHR Team in Children‘s Pain Fellowship. M Noel‘s dissertation research was supported by a Marion and Donald Routh Student Research Grant from the Society of Pediatric Psychology (Division 54, American Psychological Association), a Canadian Pain Society Trainee Research Award from the Canadian Pain Society, and a Category A Research Grant from the IWK Health Centre awarded to M Noel. Funding for this research was also provided by an operating grant from the CIHR and infrastructure funding from the Canada Foundation for Innovation awarded to CT Chambers. M Noel and M Petter are trainee members of Pain in Child Health, a Strategic Training Initiative in Health Research of CIHR. CT Chambers and PJ McGrath are supported by Canada Research Chairs. SH Stewart was supported through a Killam Research Professorship from the Dalhousie University Faculty of Science at the time this research was conducted. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.

Ethical conduct of research

The authors state that they have obtained appropriate institutional review board approval or have followed the principles outlined in the Declaration of Helsinki for all human or animal experimental investigations that they conducted themselves. In addition, for investigations involving human subjects that they themselves conducted, informed consent has been obtained from the participants involved.

Additional information

Funding

M Noel and M Petter are Killam Scholars and are supported by Frederick Banting and Charles Best Canada Graduate Scholarships Doctoral Awards from the Canadian Institutes of Health Research (CIHR). At the time that this work was completed, M Noel was also supported by a CIHR Team in Children‘s Pain Fellowship. M Noel‘s dissertation research was supported by a Marion and Donald Routh Student Research Grant from the Society of Pediatric Psychology (Division 54, American Psychological Association), a Canadian Pain Society Trainee Research Award from the Canadian Pain Society, and a Category A Research Grant from the IWK Health Centre awarded to M Noel. Funding for this research was also provided by an operating grant from the CIHR and infrastructure funding from the Canada Foundation for Innovation awarded to CT Chambers. M Noel and M Petter are trainee members of Pain in Child Health, a Strategic Training Initiative in Health Research of CIHR. CT Chambers and PJ McGrath are supported by Canada Research Chairs. SH Stewart was supported through a Killam Research Professorship from the Dalhousie University Faculty of Science at the time this research was conducted. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed. No writing assistance was utilized in the production of this manuscript.