title: Biobehavioral responses to acute pain in adolescents with a significant neurologic impairment.
abstract: OBJECTIVE
  To further understand acute pain response in children with a significant neurologic impairment (SNI), we undertook a descriptive hypothesis-generating study of the response to a routine vaccine among adolescents with SNI.
  
  
  METHODS
  Within-subject crossover design.
  
  
  METHODS
  Tertiary care facility for children and adolescents with SNI.
  
  
  METHODS
  Eight adolescents (mean age = 15 years).
  
  
  METHODS
  Mock and real vaccine injections.
  
  
  METHODS
  Quantitative measures of heart rate, videotaped facial action, Child Facial Coding System (CFCS), and Facial Action Coding System (FACS); observer ratings visual analog scale (VAS) were obtained before, during, and after a mock injection and routine annual influenza vaccine injection presented in a counterbalanced order.
  
  
  RESULTS
  VAS scores were significantly higher during the injection phase than during the other time periods; however, there were no significant differences across study time periods when using the other outcome measures.
  
  
  CONCLUSIONS
  Although the dampened behavioral and physiologic reactions to an acute noxious stimulus were similar to those of previous work with developmentally delayed children and frail elderly, it remains unclear what underlies the apparent reduced pain response in this setting. These findings have potentially important implications for the daily care of individuals with significant neurologic impairment and illustrate the compelling need tor further study of the unique character of the pain experience in this setting.
authors.affiliation: Sunny Hill Heath Centre for Children, Department of Pediatrics, University of British Columbia, Vancouver, Canada. timothyo@interchange.ubc.ca
authors.forename: T F
authors.initials: TF
authors.lastname: Oberlander
authors.forename: C A
authors.initials: CA
authors.lastname: Gilbert
authors.forename: C T
authors.initials: CT
authors.lastname: Chambers
authors.forename: M E
authors.initials: ME
authors.lastname: O'Donnell
authors.forename: K D
authors.initials: KD
authors.lastname: Craig
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000294:Adolescent Behavior; D018592:Cross-Over Studies; D005149:Facial Expression; D005260:Female; D006339:Heart Rate; D006801:Humans; D008297:Male; D010146:Pain / Q000209:etiology / Q000523:psychology*; D010147:Pain Measurement / Q000379:methods; D011782:Quadriplegia / Q000503:physiopathology* / Q000523:psychology*; D014611:Vaccination