title: Relation between pain and self-injurious behavior in nonverbal children with severe cognitive impairments.
abstract: OBJECTIVE
  To explore whether self-injurious behavior (SIB) alters pain expression in children with severe cognitive impairments and the relation between SIB and chronic pain.
  
  
  METHODS
  Caregivers of 101 nonverbal children 3 to 18 years of age (55% boys) completed the Non-Communicating Children's Pain Checklist-Revised (NCCPC-R) retrospectively and for an observed pain episode. Caregivers of children with SIB (n = 44) completed the Behavior Problems Inventory, the Self-Injury Grid, and the Self-Injury and Self-Restraint Checklist.
  
  
  RESULTS
  Multivariate analysis of variance indicated that NCCPC-R scores did not differ between children with and those without SIB. However, t tests indicated that children with chronic pain (n = 13) self-injured less body surface (P =.01) and fewer body sites (P =.04) than did children without (n = 31). Multiple Correspondence Analysis generated 2 dimensions (49% variance), suggesting a distinction between two SIB forms: (1) high frequency of SIB to the head/hand and absence of chronic pain and (2) less frequent SIB near the site of pain.
  
  
  CONCLUSIONS
  Children with severe cognitive impairments who display SIB do not have reduced pain expression, and chronic pain may influence the frequency and location of SIB. Further research should examine the usefulness of these findings for management of SIB and pain.
authors.affiliation: Pediatric Pain Research Laboratory, Division of Child Neurology, Pediatric Pain Management Service, Halifax, Nova Scotia, Canada. lbreau@ns.sympatico.ca
authors.forename: Lynn M
authors.initials: LM
authors.lastname: Breau
authors.forename: Carol S
authors.initials: CS
authors.lastname: Camfield
authors.forename: Frank J
authors.initials: FJ
authors.lastname: Symons
authors.forename: James W
authors.initials: JW
authors.lastname: Bodfish
authors.forename: Alison
authors.initials: A
authors.lastname: Mackay
authors.forename: G Allen
authors.initials: GA
authors.lastname: Finley
authors.forename: Patrick J
authors.initials: PJ
authors.lastname: McGrath
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006304:Health Status; D006801:Humans; D008607:Intellectual Disability / Q000150:complications*; D008297:Male; D015999:Multivariate Analysis; D009633:Nonverbal Communication; D010146:Pain / Q000175:diagnosis / Q000523:psychology*; D010147:Pain Measurement; D012189:Retrospective Studies; D016728:Self-Injurious Behavior / Q000209:etiology* / Q000517:prevention & control; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires