POS1490-HPR “WHERE DOES IT HURT?”: IDENTIFYING PAIN CONTENT AND ITS CONTEXT WITHIN PAEDIATRIC AND ADOLESCENT RHEUMATOLOGY TRAINING
Authors: R. Lee, J. Mcdonagh, M. Connelly, S. Peters, L. Cordingley
Journal: Annals of the Rheumatic Diseases (2021)

Background: Complex pain symptoms present across a wide spectrum of long-term musculoskeletal conditions in paediatric rheumatology. Pain training should therefore be part of a core curriculum for the professionals working in this speciality, but it is unclear to what extent this is the case currently. Objectives: To identify the extent of pain-specific content included in the training of healthcare professionals in paediatric and adolescent rheumatology in the UK. Methods: A systematic search of documental data using key internet search engines was conducted using combinations of the following terms: ‘training’, ‘curriculum’, ‘competency’, ‘paediatric’, ‘adolescent’ and ‘rheumatology’. A targeted search of online content from the main professional organisations followed; doctors (Royal College of Paediatric and Child Health [RCPCH]), nurses (Royal College of Nursing [RCN]), physiotherapists (Chartered Society of Physiotherapy), occupational therapists (Royal College of Occupational Therapists) and psychologists (British Psychological Society). Documents from professional learned societies such as The British Society of Paediatric and Adolescent Rheumatology (BSPAR) and The Scottish Paediatric and Adolescent Rheumatology Network (SPARN) were also included. Document search strategies were designed by the authors in partnership with healthcare professionals. Data were extracted and analysed following a summative content analysis. Pain-related terms were quantified. Latent content was interpreted qualitatively to explore the context in which pain-related phrases were presented. Results: Nine documents were identified. Pain-related terms represented 0.17% of all words across texts (used 55 times in total). Most pain terms were found in documents aimed at doctors (n=40, 72.7%). Of the pain terms used, most were used in the context of referring to specific pain syndromes such as chronic regional pain, generalized idiopathic pain and pain amplification. Content around the assessment and management of pain was vague and no detail was given as to how health professionals should perform these tasks. There was no reference to pain intensity, location or emotion. There were several problematic conceptual issues in the way pain was presented, with pain mostly portrayed either in the context of inflammatory or non-inflammatory pain and rarely in the context of both. Musculoskeletal pain was also positioned as a ‘somatic’ symptom, potentially conveying an interpretation of pain as being psychologically mediated. Conclusion: Training for healthcare professionals in paediatric rheumatology would benefit from updates informed by contemporary pain theories and evidence-based practices. This is key to ensuring that children and young people with chronic pain receive effective pain care from tertiary care services focused on treating musculoskeletal disease. Table 1. Documents and pain terms identified Profession Title Organisations, year. % of document covered by pain terms Doctors Generic syllabus level 1. RCPCH, 2018. 0.14% Doctors Generic syllabus level 2. RCPCH, 2018. 0.14% Doctors Generic syllabus level 3. RCPCH, 2018. 0.06% Doctors Paediatric rheumatology level 3. RCPCH, 2018. 0.48% Doctors Competencies for the special interest module in paediatric rheumatology RCPCH, 2014. 0.43% Nurses Competencies for rheumatology nurses. RCN, 2020. 0.05% Nurses Competencies for clinical nurse specialists/advanced nurse practitioners. BSPAR, 2014. 0.29% Nurses Role of the paediatric rheumatology nurse. SPARN, 2016. 0% Allied Health Professionals (AHPs) Competencies for AHPs BSPAR, 2019. 0.73% Disclosure of Interests: None declared