Context

Reporting current pain or pain memories are both crucial for accurate pain diagnosis. Recalling past pain experiences in children is influenced by age, with memory accuracy generally improving with cognitive development.1 Other factors such as recall delay, pain context and type of pain might affect recollection.2 Trait anxiety and fear can also impact memory distortion, but findings are inconsistent.3 Although understanding the influences on pain memory can aid in better pain treatments and clinical prediction in children, a systematic summary of these factors is lacking.

Findings

A total of 12 observational studies and three RCTs with 942 participants were ultimately included in the review.4 The meta-analysis revealed a small effect size, indicating an overestimation in recalled pain intensity compared with experienced pain (Standardized Mean Difference, SMD=0.28), especially in the clinical context (SMD=0.33). Only the average age of participants (β=0.08, R²=28.28%) and the proportion of female participants (β=0.03, R²=32.62%) were significantly associated with the accuracy of pain memory. To be noted, R² indicates the percentage of variance in the data that is explained by the factor.

Commentary

Pain memory is an essential basis of pain diagnoses and treatments and will influence children’s experiences and decisions regarding future medical care. This paper highlights that children’s recollections of pain can significantly differ from the pain experienced, with overestimation being common. This distortion in pain memory is influenced by factors like age, gender, cognitive development and the context in which the pain occurred. However, the studies included in the analysis varied in the designs, sample sizes and pain contexts, leading to inconsistencies in the findings. For example, some studies did not assess baseline pain intensity immediately after the painful event until 2–6 weeks post-surgery, which could lead to inaccurate baseline measures and affect the comparison with recalled pain intensity. In addition, the quality of studies included in the analysis is not high, with only three relevant RCT studies and 12 observational studies.

Despite the clinical heterogeneity across the studies in the meta-analyses, the findings align with existing literature that children’s pain memories are often biased.5 The study supports the notion that pain memory in children is influenced by cognitive development and emotional factors such as anxiety and fear. When assessing pain memory, practitioners should consider the potential for children particularly in the ages of 5–7 years old to overestimate pain memory in clinical settings. In addition, pain memory can be exacerbated if it is perceived as less controllable and more threatening in comparison to more controlled settings. Future research is needed to develop age-appropriate pain assessment tools and memory-reframing techniques to reduce biased pain memories in the paediatric population.6