• Lynn M Breau, Carol S Camfield, Patrick J McGrath, and G Allen Finley.
• Pediatric Pain Research Laboratory, IWK Health Centre, Halifax, Nova Scotia, Canada. lbreau@ns.sympatico.ca
• Arch Pediat Adol Med. 2003 Dec 1; 157 (12): 1219-26.

BackgroundChildren with severe cognitive impairments are believed to suffer pain frequently.ObjectiveTo document the frequency, duration, and intensity of pain experienced by children with severe cognitive impairments.DesignCohort study using surveys during 1 year.SettingTertiary-care pediatric center for 3 provinces in eastern Canada.ParticipantsCaregivers of 94 children and adolescents with moderate to profound mental retardation, aged 3 to 18 years (mean age, 10.1 years [SD, 4.3 years]). Forty-four children had cerebral palsy and 59 had a seizure disorder; 83 lived with family, and 11 in group homes. Main Outcome Measure Caregivers completed 4 semistructured telephone surveys, reporting the cause, duration (in minutes), and intensity (on a scale of 0-10) of children's pain during the previous week.ResultsA total of 406 episodes of pain occurred. During a 4-week period, 73 children (78%) experienced pain at least once, and 58 (62%) had nonaccidental pain. Accidental pain was most frequent (n = 28 [30%]), followed by gastrointestinal tract (n = 21 [22%]), infection (n = 19 [20%]), and musculoskeletal (n = 18 [19%]) pain. Each week, 33 to 49 children (35%-52%) had pain. Mean pain duration was longer than 9 hours per week (SD, 1.7-2.4 hours). Mean intensity was 6.1 (SD, 2.2) for nonaccidental pain and 3.8 (SD, 2.1) for accidental pain. Children with the fewest abilities had more nonaccidental pain (F4,89 = 3.7; P =.007), and children with greater motor abilities had more accidental pain (F4,89 = 2.8; P =.03). Pain did not vary with demographic characteristics.ConclusionsChildren with severe cognitive impairments experience pain frequently, mostly not due to accidental injury. Children with the fewest abilities experience the most pain.

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