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Purpose: Pain is a multifaceted experience shaped by various factors including context of pain, previous life events, and ongoing ethnocultural circumstances. Moreover, the definition of pain is inconsistent across cultures. Western medicine views physical pain (e.g., associated with a bone fracture) and nonphysical mental pain (e.g., depression) as two distinct conditions. Indigenous perspectives are often more wholistic, encompassing mental, spiritual, emotional, and physical hurt. The subjective nature of pain invites ample opportunity for discrimination in both its assessment and management. As such, it is important to consider Indigenous perspectives of pain in research and clinical practice. To investigate which aspects of Indigenous pain knowledge are currently considered by Western research, we conducted a scoping review of the literature on pain in Indigenous Peoples of Canada. Source: In June 2021, we searched nine databases and downloaded 8,220 papers after removal of duplicates. Two independent reviewers screened abstracts and full-text articles. Principle findings: Seventy-seven papers were included in the analysis. Using grounded theory, five themes emerged: pain measures/scales (n= 7), interventions (n= 13), pharmaceuticals (n= 17), pain expression/experiences (n= 45), and pain conditions (n= 70). Conclusion: This scoping review shows that there is a paucity of research on pain measurement in Indigenous Peoples of Canada. This finding is concerning in light of numerous studies reporting that Indigenous Peoples experience their pain as ignored, minimized, or disbelieved. Furthermore, a clear disconnect emerged between pain expression in Indigenous Peoples and assessment in medical professionals. We hope that this scoping review will serve to translate current knowledge to other non-Indigenous academics and to initiate meaningful collaboration with Indigenous partners. Future research led by Indigenous academics and community partners is critically needed to better address pain needs in Canada.

Despite wide endorsement of a biopsychosocial framework for pain, socialaspects of pain remain rarely addressed in the context of pain prevention and management. In this review, we aim to 1) examine the broad scope of social determinants and consequences of pain and their interactions across multiple levels of organization, and 2) provide a framework synthesizing existing concepts and potential areas for future work on social aspects of pain, drawing upon socioecological, intersectional, and life course approaches. Integrating interdisciplinary theory and evidence, we outline pathways through which multilevel social factors and pain may affect each other over time. We also provide a brief summary of intrapersonal aspects of pain, which are thought to operate at the interface between individuals and the social context. Progressing from micro- to macrolevel factors, we illustrate how social determinants of pain can directly or indirectly contribute to pain experiences, expression, risk, prognosis, and impact across populations. We consider 1) at the interpersonal level, the roles of social comparison, social relatedness, social support, social exclusion, empathy, and interpersonal conflict; 2) at the group or community level, the roles of intimacy groups, task groups, social categories, and loose associations; and 3) at the societal level, the roles of political, economic, and cultural systems, as well as their policies and practices. We present examples of multilevel consequences of pain across these levels and discuss opportunities to reduce the burden and inequities of pain by expanding multilevel social approaches in pain research and practice.

ABSTRACTAlbuquerque/Bernalillo County, New Mexico, is currently in attainment of the 2015 National Ambient Air Quality Standard (NAAQS) for ozone (70 ppb), but its ozone design values have increased in recent years. Air quality and source apportionment modeling with the Comprehensive Air Quality Model with Extensions (CAMx) was conducted for Albuquerque/Bernalillo County to develop a refined understanding of ozone source apportionment in the region, estimate ozone concentrations in the year 2025 based on projected changes in anthropogenic emissions, and evaluate the sensitivity of future ozone concentrations to various changes in local and non-local emissions. The study focused on two ozone episodes during June and July 2017 when 8-hr average ozone concentrations were greater than 70 ppb. Based on the modeling results, ozone during the June 2017 episode was found to be driven largely by contributions from non-local and regional emissions, whereas ozone during the July 2017 episode was driven more strongly by local emissions from within Albuquerque/Bernalillo County. On high ozone days, anthropogenic emissions from within Albuquerque/Bernalillo County contributed between 8% and 19% (6–14 ppb) of total ozone. Half of this local ozone contribution was from on-road mobile sources. Fire emissions contributed as much as 2 ppb of ozone on a given day. Contributions from large power plants in New Mexico were as large as 1 ppb on a given day but less than 0.5 ppb on most days. Modeled ozone concentrations in Albuquerque/Bernalillo County were also sensitive to emissions from oil and gas emissions in New Mexico. If projected emission reductions by 2025 materialize, these reductions could reduce future peak 8-hr average ozone concentrations by as much as 3–4% compared to 2017 values.Implications:The results of this study have important implications for air quality management in Albuquerque/Bernalillo County. Ozone in Albuquerque/Bernalillo County is the result of local and non-local emissions, is impacted by wildfires, and is sensitive to statewide oil and gas emissions. The magnitude of modeled contributions from anthropogenic emissions within Albuquerque/Bernalillo County is strongly influenced by meteorological conditions, transport pathways, and the presence of wildfire. This modeling is important for understanding the potential effectiveness of local emission controls in Albuquerque/Bernalillo County, and can serve as a basis for testing future regional and local emission control options.

In particulate matter (PM) nonattainment and maintenance areas, quantitative hot-spot analyses are required to assess air quality impacts of transportation projects that are identified as projects of local air quality concern (POAQC). In its 2006 rulemaking, the U.S. Environmental Protection Agency identified sample projects that would likely be POAQCs, including a new highway project with annual average daily traffic (AADT) greater than 125,000 and at least 8% diesel truck traffic. The objective of this study was to identify project characteristics that could reasonably exclude the project from consideration as a POAQC. Scenario analyses were performed for a hypothetical project that featured a new freeway with four mixed-flow lanes and baseline traffic activity of 125,000 AADT and 8% diesel truck traffic. The MO Vehicle Emission Simulator and the Emission FACtors models were used to quantify PM10and PM2.5emissions for a 2006 analysis and to evaluate the impact of fleet turnover and truck percentages on project-level emissions from 2006 to 2035. Fleet turnover effects sharply reduce project-level PM2.5emissions over time. For an analysis year of 2015, impacts from a highway project with 125,000 AADT and 8% trucks are approximately 50% less than impacts from such a project in 2006. In contrast, fleet turnover effects do not substantially reduce PM10emissions, since re-entrained road dust emissions and tire wear and brake wear emissions increasingly dominate project-level inventories over time, and these emissions vary little by analysis year.

We were invited by a small charity called Friends in the West to visit Rwanda to advise on a training programme for those dealing with the victims of violence. The [...]

ABSTRACTThe main objective of this study was to investigate the capabilities of the receptor-oriented inverse mode Lagrangian Stochastic Particle Dispersion Model (LSPDM) with the 12-km resolution Mesoscale Model 5 (MM5) wind field input for the assessment of source identification from seven regions impacting two receptors located in the eastern United States. The LSPDM analysis was compared with a standard version of the Hybrid Single-Particle Lagrangian Integrated Trajectory (HYSPLIT) single-particle backward-trajectory analysis using inputs from MM5 and the Eta Data Assimilation System (EDAS) with horizontal grid resolutions of 12 and 80 km, respectively. The analysis included four 7-day summertime events in 2002; residence times in the modeling domain were computed from the inverse LSPDM runs and HYPSLIT-simulated backward trajectories started from receptor-source heights of 100, 500, 1000, 1500, and 3000 m. Statistics were derived using normalized values of LSPDM- and HYSPLIT-predicted residence times versus Community Multiscale Air Quality model-predicted sulfate concentrations used as baseline information. From 40 cases considered, the LSPDM identified first- and second-ranked emission region influences in 37 cases, whereas HYSPLIT-MM5 (HYSPLIT-EDAS) identified the sources in 21 (16) cases. The LSPDM produced a higher overall correlation coefficient (0.89) compared with HYSPLIT (0.55–0.62). The improvement of using the LSPDM is also seen in the overall normalized root mean square error values of 0.17 for LSPDM compared with 0.30–0.32 for HYSPLIT. The HYSPLIT backward trajectories generally tend to underestimate near-receptor sources because of a lack of stochastic dispersion of the backward trajectories and to overestimate distant sources because of a lack of treatment of dispersion. Additionally, the HYSPLIT backward trajectories showed a lack of consistency in the results obtained from different single vertical levels for starting the backward trajectories. To alleviate problems due to selection of a backward-trajectory starting level within a large complex set of 3-dimensional winds, turbulence, and dispersion, results were averaged from all heights, which yielded uniform improvement against all individual cases.IMPLICATIONSBackward-trajectory analysis is one of the standard procedures for determining the spatial locations of possible emission sources affecting given receptors, and it is frequently used to enhance receptor modeling results. This analysis simplifies some of the relevant processes such as pollutant dispersion, and additional methods have been used to improve receptor-source relationships. A methodology of inverse Lagrangian stochastic particle dispersion modeling was used in this study to complement and improve standard backward-trajectory analysis. The results show that inverse dispersion modeling can identify regional sources of haze in national parks and other regions of interest.

AbstractThe ability of receptor models to estimate regional contributions to fine particulate matter (PM2.5) was assessed with synthetic, speciated datasets at Brigantine National Wildlife Refuge (BRIG) in New Jersey and Great Smoky Mountains National Park (GRSM) in Tennessee. Synthetic PM2.5chemical concentrations were generated for the summer of 2002 using the Community Multiscale Air Quality (CMAQ) model and chemically speciated PM2.5source profiles from the U.S. Environmental Protection Agency (EPA)’s SPECIATE and Desert Research Institute’s source profile databases. CMAQ estimated the “true” contributions of seven regions in the eastern United States to chemical species concentrations and individual source contributions to primary PM2.5at both sites. A seven-factor solution by the positive matrix factorization (PMF) receptor model explained approximately 99% of the variability in the data at both sites. At BRIG, PMF captured the first four major contributing sources (including a secondary sul-fate factor), although diesel and gasoline vehicle contributions were not separated. However, at GRSM, the resolved factors did not correspond well to major PM2.5sources. There were no correlations between PMF factors and regional contributions to sulfate at either site. Unmix produced five- and seven-factor solutions, including a secondary sulfate factor, at both sites. Some PMF factors were combined or missing in the Unmix factors. The trajectory mass balance regression (TMBR) model apportioned sulfate concentrations to the seven source regions using Hybrid Single-Particle Lagrangian Integrated Trajectory (HYSPLIT) trajectories based on Meteorological Model Version 5 (MM5) and Eta Data Simulation System (EDAS) meteorological input. The largest estimated sulfate contributions at both sites were from the local regions; this agreed qualitatively with the true regional apportionments. Estimated regional contributions depended on the starting elevation of the trajectories and on the meteorological input data.

AbstractTo elucidate the relationship between factors resolved by the positive matrix factorization (PMF) receptor model and actual emission sources and to refine the PMF modeling strategy, speciated PM2.5(particulate matter with aerodynamic diameter <2.5 μm) data generated from a state-of-the-art chemical transport model for two rural sites in the eastern United States are subjected to PMF analysis. In addition to χ-2and R2used to infer the quality of fitting, the interpretability of PMF factors with respect to known primary and secondary sources is evaluated using a root mean square difference analysis. For the most part, factors are found to represent imperfect combinations of sources, and the optimal number of factors should be just adequate to explain the input data (e.g., R2> 0.95). Retaining more factors in the model does not help resolve minor sources, unless temporal resolution of the data is increased, thus allowing more information to be used by the model. If guided with a priori knowledge of source markers and/or special events, rotation of factors leads to more interpretable PMF factors. The choice of uncertainty weighting coefficients greatly influences the PMF modeling results, but it cannot usually be determined for simulated or real-world data. A simple test is recommended to check whether the weighting coefficients are suitable. However, uncertainties in the data divert PMF solutions even when the optimal weighting coefficients and number of factors are in place.

The impact of appearance-based information on judgments about the psychological functioning of pain patients was investigated. Video-tapes of low back pain patients experiencing pain were used as stimulus materials. Subjects viewed silent video clips and photographs of the patients' faces and made judgments about the functioning of these patients. These judgments were affected both by patient physical attractiveness and gender. Physically attractive patients and male patients were judged to be functioning better than physically unattractive and female patients. The judgments were reasonably described as biased because the perceived differences about patients varying in attractiveness and sex were not associated with measures of actual patient functioning.

The present study compares the self-reported personality characteristics of heroin addict and nonaddict prisoners using the Edwards Personality Preference Schedule (EPPS) which was corrected for social desirability. Seventy pairs of addicted and nonaddicted criminal offenders were matched for age, education, intelligence, and home environment. The addicted offenders were

This article reviews recent investigations that have led to an increase in understanding of children’s pain and to an increase in our ability to measure and treat pediatric pain. It stresses physiologic, cognitive, affective and psychosocial development with regard to understanding children’s pain.

Grain growth, defined as the increase in volume of the average grain, is found, in its steadystate, to be directly proportional to the time of isothermal annealing. During steady-state grain growth the grain corners are found all to be quadruple points, the grain edges all triple lines and the ratio of corners to faces to edges to be 6:7:12. The rate constant for steady-state grain growth is shown to be calculable from first principles and from properties that can be measured independently of the growth observation. It is the product of four individual constants, namely: 1) a dimensionless topological constant ⊝ that is characteristic of steady-state grain growth in any material, 2) the mobility ώ of the average grain boundary in the specific material, 3) the surface tension y of the average grain boundary in the specific material and 4) a dimensionless structural constant σ which expresses the curvature of surface of the grain boundary in the array of grain forms obtaining in the specific specimen of the material and which can be determined metallographically. The topological changes that constitute steady-state growth are shown to exist as a logical sequence of simple events.

It was hypothesized that direct negative reinforcement to observers, solely contingent upon errors in a model's behavior, would facilitate or interfere with the observer's subsequent efforts to learn the task as a function of intensity of punishment (electric shock). 80 Ss were run in a factorial design varying shock intensity, the number of model errors and shock contingency. The task was a complex temporal maze which explicitly required the learning of a series of correct switch selections and implicitly required avoidance of punished switches. The findings indicated that relatively severe noninstrumental punishment disrupted vicarious acquisition of the task insofar as avoidance of punished decisions was concerned. The effects were independent of whether the shock was contingent or noncontingent. Marginal support was found for the contention that mild punishment would facilitate performance beyond the level to which no punishment would influence performance.

GSR reactivity, serving as a physiological measure of affective arousal, was instigated and conditioned when Ss observed a performer consistently failing at a motor task. Experimental groups who were told that shock was contingent upon the performer's failure manifested no more vicarious affective reactions than groups observing failure only. Groups observing failure consistently responded with more GSRs than groups observing task success.

It was hypothesized that allowing Ss to observe a confederate model reporting a constant, nonaversive electric shock as progressively more noxious would elicit reports of pain to this same shock from Ss themselves. Two groups of 10 Ss received nonincremental shocks, with one group observing a model rate the shocks as progressively more painful. Ss concurrently rated shock intensity on a scale varying from undetectable to painful. Ss paired with a progressively less tolerant model matched this behavior. The findings were discussed in the context of vicarious learning theory and social influences on expressions of pain.

The relationship between the personality characteristic of aggression and word associations was investigated. Extreme groups of 20 aggressive (A) and 20 non-aggressive (NA) Ss were selected from a pool of 180 on the basis of their scores on four subscales of the Buss-Durkee Hostility-Guilt Inventory and were subsequently administered a word association test. The test contained neutral stimulus items as well as 12 homonyms, which had both an A and NA meaning. Results showed that A Ss exceeded the NA Ss in the aggressive content of their associations to the homonyms. There was no difference, however, in the aggressive content of the A and NA Ss' responses to the neutral stimuli. The results were interpreted as support for the theoretical position that aggression is a response to specific situational cues.

Some pain behaviors appear to be automatic, reflexive manifestations of pain, whereas others present as voluntarily controlled. This project examined whether this distinction would characterize pain cues used in observational pain measures for children aged 4–12. To develop a comprehensive list of cues, a systematic literature search of studies describing development of children’s observational pain assessment tools was conducted using MEDLINE, PsycINFO, and Web of Science. Twenty-one articles satisfied the criteria. A total of 66 nonredundant pain behavior items were identified. To determine whether items would be perceived as automatic or controlled, 277 research participants rated each on multiple scales associated with the distinction. Factor analyses yielded three major factors: the “Automatic” factor included items related to facial expression, paralinguistics, and consolability; the “Controlled” factor included items related to intentional movements, verbalizations, and social actions; and the “Ambiguous” factor included items related to voluntary facial expressions. Pain behaviors in observational pain scales for children can be characterized as automatic, controlled, and ambiguous, supporting a dual-processing, neuroregulatory model of pain expression. These dimensions would be expected to influence judgments of the nature and severity of pain being experienced and the extent to which the child is attempting to control the social environment.

A standard for carbon dioxide emissions from power plants in the United States, known as the Clean Power Plan, has been finalized by the Environmental Protection Agency. Decreases in carbon dioxide emissions from fossil fuel combustion have the potential cobenefit of reductions in emissions of oxides of nitrogen, which contribute to the formation of ground-level ozone. Emissions of ozone precursors may result in elevated ozone concentrations nearby or downwind. Chronic exposure of sensitive vegetation to tropospheric ozone reduces its potential productivity. To evaluate the cobenefits of the Clean Power Plan to sensitive vegetation, we estimate ozone concentrations in the continental U.S. in 2020 with a chemical transport model in accordance with reference and alternative Clean Power Plan policy scenarios, which represent a range of possible approaches to reducing carbon dioxide emissions from power plants. The reductions in biomass, or the potential productivity losses, due to the exposure of 4 crops and 11 tree species to ozone are as large as 1.9% and 32%, respectively, in the reference scenario. The least stringent policy scenario reduces these losses by less than 3% for any given species; however, the scenarios consistent with policies resulting in more rigorous nitrogen oxide reductions produce potential productivity losses lower than the reference scenario by as much as 16% and 13% for individual crops or tree species, respectively. This analysis affords the opportunity to consider public welfare cobenefits of a regulation that is designed to reduce carbon dioxide emissions from power plants. Policies to control carbon dioxide emissions from power plants also decrease ground-level ozoneDecreases in ground-level ozone can mitigate potential productivity losses to crops and treesDecreases in potential productivity losses of crops and trees vary spatially across the U.S.

BACKGROUND AND OBJECTIVES: Pain in Child Health (PICH) is a transdisciplinary, international research training consortium. PICH has been funded since 2002 as a Strategic Training Initiative in Health Research of the Canadian Institutes of Health Research, with contributions from other funding partners and the founding participation of five Canadian universities. The goal of PICH has been to create a community of scholars in pediatric pain to improve child health outcomes.METHODS: Quantitative analyses enumerated PICH faculty, trainees, training activities and scientific outputs. Interviews with PICH stakeholders were analyzed using qualitative methods capturing perceptions of the program’s strengths, limitations, and opportunities for development and sustainability.RESULTS: PICH has supported 218 trainee members from 2002 through 2013, from 14 countries and more than 16 disciplines. The faculty at the end of 2013 comprised nine co-principal investigators, 14 Canadian coinvestigators, and 28 Canadian and international collaborators. Trainee members published 697 peer-reviewed journal articles on pediatric pain through 2013, among other research dissemination activities including conference presentations and webinars. Networks have been established between new and established researchers across Canada and in 13 other countries. Perceptions from stakeholders commended PICH for its positive impact on the development of pediatric pain researchers. Stakeholders emphasized skills and abilities gained through PICH, the perceived impact of PICH training on this research field, and considerations for future training in developing researchers in pediatric pain.CONCLUSIONS: PICH has been successfully developing highly qualified health research personnel within a Canadian and international community of pediatric pain scholarship.

The article announces the recipients of the 2009 Awards for Access to Innovative Psychological Services, including Child Care Resources in the Sudbury/Manitoulin District of Northern Ontario, the University of Calgary Applied Psychological and Educational Services and the University of Regina Centre on Aging and Health.

The article presents an update on the activities of the Canadian Psychological Association Foundation (CPAF) as of October 2009.

BACKGROUND: Research suggests that caregivers’ beliefs pertaining to infant pain and which infant pain cues are perceived to be important play an integral role in pediatric pain assessment and management.OBJECTIVES: Following a recent quasi-experimental study reporting on caregiver background and age differences in actual infant pain judgments, the present study clarified these findings by analyzing caregivers’ pain beliefs and the cues they use to make pain assessments, and by examining how the wording of belief questions influenced caregivers’ responses.METHODS: After making pain judgments based on video footage of infants between two and 18 months of age receiving immunizations, parents, nurses and pediatricians were required to respond to questionnaires regarding pain beliefs and importance of cues.RESULTS: Parents generally differed from pediatricians. Parents tended to have less optimal beliefs regarding medicating the youngest infants, were more influenced by question wording, and reported using many more cues when judging older infants than other caregiver groups. In terms of beliefs, influence of question wording and cue use, nurses tended to fall in between both groups; they displayed similarities to both parents and pediatricians.CONCLUSIONS: Paralleling the original findings on pain judgments, these findings suggest that parents differ from pediatricians in their pain beliefs and the cues they use to make pain judgments. Moreover, some similarities were found between parents and nurses, and between nurses and pediatricians. Finally, caution must be taken when interpreting research pertaining to beliefs about infant pain because question wording appears to influence interpretation.

Research in the field of pediatric pain has largely ignored the role of fathers in their children’s pain experiences. The first objective of the present study was to examine the effect of the presence of mothers versus fathers on children’s subjective ratings, facial expressions and physiological responses to acute pain. The second objective was to examine whether child and parent sex influence parents’ proxy ratings of their children’s pain. The final objective was to compare levels of agreement between mothers’ and fathers’ assessments of their children’s pain. Participants included 73 children (37 boys, 36 girls), four to 12 years of age, along with 32 fathers and 41 mothers. Children undertook the cold pressor pain task while observed by one of their parents. During the task, the children’s heart rates and facial expressions were recorded. Children provided self-reports and parents provided proxy reports of child pain intensity using the seven-point Faces Pain Scale. Neither child nor parent sex had a significant impact on children’s subjective reports, facial expressions or heart rates in response to acute pain. Fathers gave their sons higher pain ratings than their daughters, whereas mothers’ ratings of their sons’ and daughters’ pain did not differ. Kappa statistics and t tests revealed that fathers tended to be more accurate judges of their children’s pain than mothers. Overall, this research highlights the importance of examining both parent and child sex differences in pediatric pain research.

BACKGROUND: Despite blatant indications, such as behavioural and contextual cues, infant pain is often undermanaged by adult caretakers. The belief that infants are limited in their abilities to comprehend the meaning of an experience or recall that experience has been used to minimize or deny the need for intervention in this vulnerable population.OBJECTIVES: This investigation explored parental beliefs regarding the impact of infant cognitive capabilities, behavioural cues and contextual cues to their pain judgments. Particular interest was focused on their beliefs regarding the general cognitive capabilities of infants of different ages.METHODS: Forty-nine parents viewed videotapes of healthy infants, aged two, four, six, 12 and 18 months, receiving routine immunization injections and provided judgements of the severity of pain on a 100 mm Visual Analogue Scale. Upon completion of their pain judgements for each of the five age groups (two infants per age group; 10 infants total), parents completed questionnaires regarding their beliefs about the capabilities of infants in that age group and then reported the importance of the various cues utilized to formulate their pain judgements.RESULTS: Parents attributed substantial pain to infants in all age groups, almost twice the amount they hypothesized an adult undergoing a similar injection would experience. The cues rated as most important for judgements were similar for infants of varying ages. Overall, facial expressions, sounds and body movements were consistently reported to be most important. Parents acknowledged the development of memory and understanding of pain throughout infancy. However, these beliefs were not deemed by parents as important to their pain ratings, nor were their importance ratings directly related to the pain ratings.CONCLUSION: Parents judged that infants undergoing a routine immunization were experiencing clinically significant levels of pain. However, despite generally acknowledging a developing trajectory for memory and understanding across the five age groups, parents did not indicate that a child's ability to remember and understand pain were essential features of their pain judgements. The results indicated that memory and understanding did not influence parental judgements of infant pain demonstrating the validity of the parents' self-assessments.

BACKGROUND: Despite recent progress in understanding memory of pain in adults, the validity of the assumption that these findings extend to children has not been established. Because treatment often is evaluated on the basis of pain recall, it is crucial that the accuracy of pain memories in children be established.OBJECTIVES: To examine children's ability to recall pain intensity and contextual details associated with a novel painful experience. Furthermore, children's memories were compared with those of their parents.SUBJECTS AND METHODS: Twenty-three parent-child dyads were recruited from a sample participating in an earlier study investigating children's responses to the cold pressor test and parents' characterization of the children's responses. Children (age five to 12 years) and parents independently had rated the child's pain using a seven-point Faces Pain Scale. Approximately one year later, they were asked to recall the experience and rate the pain again. Memory for contextual details associated with the event also was assessed through a series of open-ended questions.RESULTS: A 2 (rater) × 2 (time period) repeated measures ANOVA examined the reliability of ratings and differences between parent and child ratings of pain, both recorded at the time of the cold pressor and recalled one year later. There were no significant differences in ratings over time or between parent and child.CONCLUSIONS: The findings indicate that children's memories of a novel painful experience can be consistent over a long interval. Moreover, parents' ratings also reflect good recall and can be in agreement with those of their children.

BACKGROUND: Objectively coded facial activity provides a useful index of pain among elders who have difficulty in reporting pain because of cognitive impairments. However, limitations of previous research include no direct assessment of participants' level of cognitive impairment; no comparison of the reactions of elders with cognitive impairments with those of nonimpaired elders; observers' expectations about pain levels could have influenced judgements about the severity of pain experienced when global rather than objectively coded measures were used because the painful medical procedure was visible on film.OBJECTIVE: To extend previous findings by incorporating improvements in design and methodology in response to the aforementioned limitations.PARTICIPANTS: Fifty-nine in-patients with a mean age of 73 years.METHODS: Facial reactions were filmed during routine blood tests and coded objectively using the Facial Action Coding System (FACS). Observer ratings of pain were also obtained.RESULTS: FACS indexes revealed substantial changes from baseline to venepuncture indiscriminate of whether elders were cognitively impaired. Furthermore, these changes were apparent to both nurse and student observers although the nurses rated the pain displayed by the patients as being lower.CONCLUSION: After addressing limitations of previous work in this area, the validity of nonverbal indexes of pain in the assessment of elders with cognitive impairments was demonstrated. Such indexes are uniquely suited as outcome measures within the context of clinical trial methodology.

Judgements of the nature and severity of pain others may be experiencing are heavily influenced by an observer's preconceptions about the nature of the experience. Our personal sense of conscious experience dictates a search for consciousness characterized by the state of awareness found in competent adults, including constructive memories and thoughts, images and feelings. People incapable of verbally articulating experiences akin to those reported by competent older children and adults are at risk of having other evidence of pain denied, minimized or ignored. Despite substantial behavioural evidence for pain in the neonate and infant, and findings indicating destructive immediate and long term consequences if pain is not controlled, pain in infants and children often continues to be discounted. An alternative perspective on infant consciousness of pain focusing upon sensory and emotional components is presented. The current prominent definition of pain supports the prejudice favouring adult conceptions of consciousness by emphasizing the importance of self-report in assessing pain. Explanatory notes accompanying this definition also perpetrate the misguided belief that the experience of pain emerges as a product of early life experiences. The case for using nonverbal as well as verbal expression in the process of inferring states of pain is presented. As well, the proposition is supported that there should be explicit recognition that the experience of pain is an inherent quality of life present in all viable newborns, with the nature of the experience and its expression changing in the course of maturation and as a result of exposure to life experiences related to tissue injury.