The communication of pain in Paediatric Dentistry

  • J. VerslootEmail author
  • K. D. Craig


AIM: In this paper the communication model of pain is reviewed and the information then applied to understanding the acute pain experience of children in dentistry, with attention directed to improving the process of pain assessment. BACKGROUND: Expression of pain in children is of great importance as it enables them to engage others who may provide care. The experience of pain, however, is inherently private and not directly accessible to others. Therefore, it requires judgment and skill on the part of observers if pain is to be assessed accurately. In addition, there are striking individual differences in how people react to pain, which makes the assessment of pain in others an even greater challenge. Craig and colleagues [2008] have proposed the use of the social communication model of pain that gives priority to understanding the numerous social factors that affect whether children are successful in communicating painful distress. CONCLUSION: When children’s pain is underestimated or a child’s self-report is not seen as credible, there is a considerable risk of failure to deliver needed dental care.

Key words

socio-communication model pain children dentistry 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. Anand KJS, Craig KD. New perspectives on the definition of pain. Pain 1996;67:3–6.PubMedCrossRefGoogle Scholar
  2. Anand KJS, Grunau RVE, Oberlander TF. Developmental character and long-term consequences of pain in infants and children. Child Adolesc Psychiatr Clin N Am 1997;6:703–724.Google Scholar
  3. Bennett-Branson SM, Craig KD. Postoperative pain in children: Development and family influences on spontaneous coping strategies. Can J Behav Sci 1993;25:355–383.CrossRefGoogle Scholar
  4. Branson SM, Craig KD. Children’s spontaneous strategies for coping with pain: A review of the literature. Can J Behav Sci 1988;20:402–412.CrossRefGoogle Scholar
  5. Cohen LL. Behavioral approaches to anxiety and pain management for pediatric venous access. Pediatrics 2008;122(Suppl):S134–139.PubMedCrossRefGoogle Scholar
  6. Craig KD. The social communication model of pain. Can Psychologist 2009; 20:22–32.CrossRefGoogle Scholar
  7. Craig KD. Emotions and psychobiology. In: McMahon S. and Koltzenburg M. (eds). Melzack and Wall’s Textbook of Pain. 5th ed. Elsevier/ Churchill-Livingstone, 2005, pp231–239.Google Scholar
  8. Craig KD, Grunau RVE. Developmental Issues: Infants and Toddlers. In: Bush JP, Harkins SW. (eds.). Children in pain clinical and research issues from a developmental perspective. New York: Springer-Verlag, 1991.Google Scholar
  9. Craig KD, Korol CT. Developmental issues in understanding, assessing, and managing pediatric pain. In: Walco G, Goldschnieder K. (eds.). Pediatric Pain Management in Primary Care: A Practical Guide. Totowa, New Jersy (USA): The Humana Press Inc, 2008.Google Scholar
  10. Craig KD, Lilley CM, Gilbert CA. Barriers to optimal Pain management in infants, Children, and adolescents social barriers to optimal pain management in infants and children. Clin J Pain 1996;12(3):232–242.PubMedCrossRefGoogle Scholar
  11. Craig KD, Stanford EA, Fairbairn NS, Chambers CT. Emergent pain language communication competence in infants and children. Enfance 2006;1:52–71.CrossRefGoogle Scholar
  12. Crombez G, Bijttebier P, Eccleston C, et al. The Child version of the Pain Catastrophizing Scale (PCS-C): A preliminary validation. Pain 2003:104;639–646.PubMedCrossRefGoogle Scholar
  13. Davey GCL. Dental phobias and anxieties: evidence for conditioning processes and modulation of a learned fear. Behav Res Ther 1989;27:51–58.PubMedCrossRefGoogle Scholar
  14. Gaffney A, McGrath PJ, Dick B. Measuring pain in children: developmental and instrument issues. In: Schechter NL, Berde CB, Yaster M. (eds.). Pain in infants, children, and adolescents. Philadelphia (USA): Lippincott Williams and Wilkins, 2003.Google Scholar
  15. Gedaly-Duff V. Developmental issues: preschool and school-age children. In: Bush JP, Harkins SW. (eds.). Children in pain clinical and research issues from a developmental perspective. New York: Springer-Verlag, 1991.Google Scholar
  16. Harbeck C, Peterson L. Elephants dancing in my head: a developmental approach to children’s concepts of specific pains. Child Dev 1992;63:138–149.PubMedCrossRefGoogle Scholar
  17. Hester NO, Foster RL, Jordan-Marsh M, Vojir CP, Miller KL. Putting pain measurement into clinical practice. Prog Pain Res Manag 1998;10:179–198.Google Scholar
  18. Hodgins MJ, Lander J. Children’s coping with venepuncture. J Pain Symptom Manage 1997;13:274–283.PubMedCrossRefGoogle Scholar
  19. IASP. Pain terms: a list with definitions and notes on usage. Pain 1979;6:249–252.Google Scholar
  20. Johnston CC, Stevens B, Pinelli J, et al. Kangaroo care is effective in diminishing pain response in preterm neonates. Arch Pediatr Adolesc Med. 2003;157(11):1084–1088.PubMedCrossRefGoogle Scholar
  21. Kleinknecht RA, Klepac RK, Alexander LD. Origins and characteristics of fear of dentistry. J Am Dent Assoc 1973;86(4):842–848.PubMedGoogle Scholar
  22. Klingberg G. Dental fear and behaviour management problems in children. A study of measurement, prevalence, concomitant factors, and clinical effects. Swed Dent J Suppl 1995;103:1–78.Google Scholar
  23. Klingberg G, Berggren U, Carlsson SG, Noren JG. Child dental fear: causerelated factors and clinical effects. Eur J Oral Sci 1995;103(6):405–412.PubMedCrossRefGoogle Scholar
  24. Klingberg G, Broberg AG. Dental fear/anxiety and dental behaviour management problems in children and adolescents: a review of prevalence and concomitant psychological factors. Int J Paediatr Dent. 2007;17(6):391–406.PubMedCrossRefGoogle Scholar
  25. Locker D, Liddell A, Dempster L, Shapiro D. Age of onset of dental anxiety. J Dent Res 1999;78:790–796.PubMedCrossRefGoogle Scholar
  26. Lubow RE. Latent inhibition. Psychol Bull 1973;79:398–407.PubMedCrossRefGoogle Scholar
  27. Murtomaa H, Milgrom P, Weinstein P, Vuopio T. Dentists’ perceptions and management of pain experienced by children during treatment: a survey of groups of dentists in the USA and Finland. Int J Paediatr Dent 1996;6:25–30.PubMedCrossRefGoogle Scholar
  28. Rachman S. The conditioning theory of fear acquisition: a critical examination. Behav Res Ther 1977;15:375–387.PubMedCrossRefGoogle Scholar
  29. Stanford EA, Chambers CT, Craig KD. A normative analysis of the development of pain-related vocabulary in children. Pain 2005;114:278–284.PubMedCrossRefGoogle Scholar
  30. Stinson JN, Kavanagh T, Yamada J, Gill N, Stevens B. Systematic review of the psychometric properties, interpretability and feasibility of self-report pain intensity measures for use in clinical trials in children and adolescents. Pain 2006;125:143–157.PubMedCrossRefGoogle Scholar
  31. Versloot J, Veerkamp JSJ, Hoogstraten J, Martens LC. Children’s coping with pain during dental care. Community Dent Oral Epidemiol 2004a;32:456–61.PubMedCrossRefGoogle Scholar
  32. Versloot J, Veerkamp JSJ, Hoogstraten J. Assessment of pain by the Child, Dentist, and Independent Observers. Pediatr Dent 2004b;26(5):445–449.PubMedGoogle Scholar
  33. Versloot J, Veerkamp JSJ, Hoogstraten J. Children’s self-reported pain at the dentist. Pain 2008;137(2):389–394.PubMedCrossRefGoogle Scholar
  34. von Baeyer CL, Spagrud LJ. Systematic review of observational (behavioural) measures of pain for children and adolescents aged 3 to 18 years. Pain 2007;127:140–150.CrossRefGoogle Scholar
  35. Wright KD, Stewart SH, Finley GA, Buffett-Jerrott SE. Prevention and intervention strategies to alleviate preoperative anxiety in children: a critical review. Behav Modif 2007;31:2–79.CrossRefGoogle Scholar

Copyright information

© European Academy of Paediatric Dentistry 2009

Authors and Affiliations

  1. 1.Department of PsychologyUniversity of British ColumbiaVancouverCanada
  2. 2.Dept. Paediatric dentistry, Academic Centre for Dentistry (ACTA)University of Amsterdam/Vrije UniversityAmsterdamThe Netherlands

Personalised recommendations