Children with juvenile idiopathic arthritis rate the intensity of their pain lower than their parents or their physicians do. They also rate their overall sense of well-being as being much higher, according to Dr. Pablo Garcia-Munitis, formerly of the Università di Genova (Italy) and now of the Hospital de Ninos “Superiora Sor Maria Ludovica,” La Plata, Argentina, and his associates.
The finding suggests that children may cope with their disease better than their parents realize, or that parents tend to be oversolicitous about their children's health problems, wrote Dr. Garcia-Munitis and his associates.
Observing the intensity of a child's pain plays an important role in determining therapy for children with juvenile idiopathic arthritis (JIA). Because the experience of pain is personal and subjective, children's self-reports are given preference whenever possible. Yet physicians usually rely on information obtained from the parents, most often from the mother. There is growing awareness that the sole use of parent proxy reports may fail to capture the fact that parents and children may differ in their perceptions of health, hence the need to understand the relationship between parent proxy reporting and patient self-reporting, said the researchers (Arthritis Rheum. 2006;55:177–83).
The researchers examined the level of agreement between children, parents, and physicians in rating JIA pain intensity. The study group comprised 94 children, aged 5–18 years, who attended an outpatient clinic accompanied by both parents.
The child, mother, and father independently rated the intensity of the child's present pain and of pain during the previous week according to a visual analog scale. They also completed the discomfort scale of the Childhood Health Assessment Questionnaire. Rather than being combined with the visual analog scale, the questionnaire was presented in a separate form to avoid possible confusion, the researchers said.
On average, the children rated their pain and disability as consistently lower, and their overall well-being as better, than did their mothers, fathers, and physicians. Mothers and fathers were similar in their mean ratings of their child's pain, disability, and well-being. Physicians gave the worst scores of all. With regard to the level of present pain, mothers and children had moderate agreement, whereas fathers and children and physicians and children had poor agreement. The parents and physicians had moderate agreement in rating present pain.