question: Do adults feel less pain then children or are they just more used to it?
comment: The most significant difference between a child and an adult experiencing physical pain is the emotional reaction. Pain can cause fear, which in turn may increase the sensation of pain. Tl;dr: We were wimps when we were wee.
passages: The nerves of young babies respond more readily to noxious stimuli, with a lower threshold to stimulation, than those of adults. A baby's threshold for sensitization is also substantially decreased, whilst the process involves a much larger area of sensitization with each trauma. The neural pathways that descend from the brain to the spinal cord are not well developed in the newborn, resulting in the ability of the central nervous system to inhibit nociception being more limited than in the adult.
   Nociceptive pathways are pathways in the brain that send and receive pain signals and are responsible for how we perceive pain. They develop before a baby is born and continue to develop during the critical period of development. It was once thought that because infants’ nociceptive pathways in the brain were still developing, they could not feel pain. However, infants "can" feel pain and infant surgeries providing early pain experiences can alter the brain’s tolerance for pain later so by increasing number of A fibers and C fibers—two types of pain receptors—located in the area where injury occurred and by reducing pain tolerance in the areas where incision has occurred. This reduction in pain tolerance is seen in male rats even when they are adolescents. In those rats, the area of their brain where an incision was made as an infant remains hypersensitive to pain thereafter. This effect was not seen as prominently in female rats.
   The causes of pain in children are similar to the causes in adults.
  
  Pain can be experienced in many ways and depends on the following factors in each child:
  
  BULLET::::- Prior painful episodes or treatments
  
  BULLET::::- Age and developmental stage
  
  BULLET::::- Disease or type of trauma
  
  BULLET::::- Personality
  
  BULLET::::- Culture
  
  BULLET::::- Socioeconomic status
  
  BULLET::::- Presence of family members and family dynamics.
  
  Section::::Causes.:During treatment.
   Section::::Diagnosis.
  
  Assessment of pain in children depends on the cooperation and developmental stage of the child. Some children cannot assist in their assessment because they have not matured enough cognitively, emotionally, or physically. The following sections list signs of distress and possible pain in children by age group:
  
  Section::::Diagnosis.:Younger infants.
  
  BULLET::::- Inability to distinguish the stimulus from the pain
  
  BULLET::::- Ability to exhibit a reflexive response to pain
  
  BULLET::::- Expressions of pain
  
  BULLET::::- Tightly closed eyes
  
  BULLET::::- Open mouth resembling a square rather than an oval or circle
  
  BULLET::::- Eyebrows lowered and tightly drawn together
  
  BULLET::::- Rigid body
  
  BULLET::::- Thrashing
   Although pain is subjective and can occur in a continuous spectrum of intensities, there are assessment tools that compare pain levels over time. This kind of assessment incorporates pain scales and requires a high enough developmental level for the child to respond to questions. A verbal response is not always necessary to quantify pain.
  
  Section::::Diagnosis.:Pain scales.
   A survey of 6,636 children (0–18 years of age) found that, of the 5,424 respondents, 54% had experienced pain in the preceding three months. A quarter reported having experienced recurrent or continuous pain for three months or more, and a third of these reported frequent and intense pain. The intensity of chronic pain was higher for girls, and girls' reports of chronic pain increased markedly between ages 12 and 14.
  
  Section::::History.
   BULLET::::- Boys circumcised without anesthesia were found to have greater distress than uncircumcised boys;
  
  BULLET::::- Severe pain as a child is associated with higher reports of pain in adults.
  
  Section::::Types.:Neuropathic.
  
  Neuropathic pain is associated with nerve injuries or abnormal sensitivities to touch or contact. Though neuropathic pain is relatively uncommon in children compared to adults, greater awareness of these conditions is on the rise. Some causes may include past surgeries and amputations, "autoimmune and degenerative neuropathies", and injury to the spinal cord.
   Section::::Factors affecting outcomes.:Demographic factors.
   Section::::Factors affecting outcomes.:School support.:Peer education.
   Childhood chronic pain
  
  Childhood chronic pain affects at least 5% of the population under the age of 18, according to conservative epidemiological studies. Rates of paediatric chronic pain have also increased in the past 20 years. While chronic pain conditions vary significantly in severity, they often affect children's mental health, academic performance, and general quality of life. The outcomes of childhood chronic pain are affected by a number of factors, including demographic factors, genetics, and school and family support.
  
  Section::::Classification and epidemiology.
   Chronic pain in children is unresolved pain that affects activities of daily living and may result in a significant amount of missed school days. Chronic pain is present for long periods of time and is characterized as mild to severe. Chronic pain has also been described as the pain experienced when the child reports a headache, abdominal pain, back pain, generalized pain or combination of these. Chronic pain can develop from disease or injury and can occur simultaneously with acute pain. Children who experience chronic pain can have psychological effects. Caring for a child in pain may cause distress to the caregiver, may cause costs due to healthcare or lost wages from time off work, and may stop caregivers from leaving the house.
   Pain is a concept that develops and grows more sophisticated over our lifespan. Not being able to understand or make sense of pain can also be detrimental to a child’s mental state. During infancy and toddlerhood, pain is external and not localized. This means that an infant cannot determine the location of pain and pain does not seem to be an internal force. During middle childhood an individual can determine the qualities of pain and have a more abstract way of thinking about pain. During adolescence an individual can describe pain, understand physiological and psychological factors/causes.
  
  Section::::Interventions.
   Non-pharmacological treatment for pain associated with venipuncture in children includes hypnosis and distraction. These treatments reduced self-reported pain and when combined with cognitive-behavioural therapy (CBT) the reduction of pain was even greater. Other interventions have not been found to be effective and these are suggestion, blowing out air, and distraction with parent coaching did not differ from control for pain and distress.
   All observations, both movement and physiological, tend to decrease when pain is persistent, thus rendering the scale unreliable in acute or prolonged cases. In addition, hyperalgesia and allodynia, occur more quickly and more extensively in babies than in adults. Day to day changes in the response to a specific injury may therefore become unpredictable and variable.
  
  Section::::Treatment.
  
  Where the baby is to undergo some form of planned procedure, health professionals will take steps to reduce pain to a minimum, though in some circumstances it may be not be possible to remove all pain.
   The present understanding of pain in babies is largely due to the recognition that the fetal and newborn unmyelinated nerve fibres are capable of relaying information, albeit slower than would be the case with myelinated fibres. At birth a baby has developed the neural pathways for nociception and for experiencing pain, but the pain responses are an immature version of that of an adult. There are a number of differences in both nerve structure and in the quality and extent of nerve response which are considered to be pertinent to understanding neonatal pain.
   In a study of patients at a paediatric pain clinic, researchers found that chronic pain had a significant negative impact on quality of life. Depression was also prevalent, and was correlated with functional disability. Additionally, psychosocial adjustment is a better predictor of school attendance than pain severity, which suggests that it is an important variable in examining outcomes of children with chronic pain. The psychological consequences of chronic pain may be exacerbated with the stigma associated with it. Many people do not typically associate chronic pain with children, and so may minimize or dismiss its impact.
  
  Section::::Factors affecting outcomes.
   Age also has a significant impact on children's experiences with chronic pain. Young children often cannot describe their pain in ways that adults understand, and even older children may lack the vocabulary to clearly communicate with medical professionals. Doctors, especially general practitioners, may also lack experience diagnosing or treating paediatric chronic pain disorders, and so make patients and their families feel "judged, disbelieved, and labeled as difficult or dysfunctional".
  
  Section::::Factors affecting outcomes.:Genetics and family factors.
   Inadequate pain management in children can lead to psycho-social consequences, including lack of interest in food, apathy, sleep problems, anxiety, avoidance of discussions about health, fear, hopelessness and powerlessness. Other consequences include extended hospital stays, high re-admission rates and longer recovery.
  
  Examples of harmful consequences of unrelieved pain include:
  
  BULLET::::- Infants who have had more than average heel pricks can have poor cognitive and motor function;
  
  BULLET::::- Associations of needles with distress may make later medical treatments more difficult;
  
  BULLET::::- Children who have experienced invasive procedures often develop post-traumatic stress;
   Pain is common and may result from the inherent deficits associated with the condition, along with the numerous procedures children typically face. When children with cerebral palsy are in pain, they experience worse muscle spasms. Pain is associated with tight or shortened muscles, abnormal posture, stiff joints, unsuitable orthosis, etc. Hip migration or dislocation is a recognizable source of pain in CP children and especially in the adolescent population. Nevertheless, the adequate scoring and scaling of pain in CP children remains challenging. Pain in CP has a number of different causes, and different pains respond to different treatments.
   Chronic pain can be treated in a number of ways, and varies depending on the type and severity of the condition. Common pain medications prescribed to children include paracetamol, ibuprofen, and acetylsalicylic acid. Researchers have also found that psychotherapies are often helpful in reducing functional disability in children with chronic pain. A meta-analysis by Christopher Eccleston and colleagues found that cognitive behavioural therapy (CBT) significantly reduced pain severity for children with chronic headaches. Additionally, biofeedback and relaxation therapy can be used in conjunction with CBT to treat chronic pain. Research thus far has typically found small effects for improving psychological wellbeing, but more robust outcomes for pain relief.
   Section::::Management.:Chronic pain treatment.
  
  Chronic pain is treated with a variety of medications and non-pharmacological interventions. The World Health Organization recommends using a two step treatment approach based on the level of pain in children. The first step explains mild pain treatment, while the second step considers moderate to severe pain. Opioids, such as morphine, is an example of a drug of choice for moderate-severe pain in children with medical illnesses. Some side effects of opioid use can include cognition deficits, dependence, altered mood, and disturbances of endocrine development.
   An important component of school support for many children with chronic pain is peer education. These children often face bullying and exclusion from peers, especially when they have visible markers of disability (i.e. a wheelchair) or are unable to participate in school activities (i.e. physical education classes or recess games). Peer education programs vary based on the child's age and medical condition, but often include informative presentations, role playing, and question and answer sessions. Evaluations of the efficacy of these programs have generally shown positive effects for increasing peers' disease-related knowledge, but uncertainty remains about whether they can produce changes in attitudes and behaviours.
   Pain management in children
  
  Pain management in children is the assessment and treatment of pain in infants and children.
  
  Section::::Types.
  
  Section::::Types.:Acute.
   Pain assessment in children is often challenging due to limitations in developmental level, cognitive ability, or their previous pain experiences. Clinicians must observe physiological and behavioral cues exhibited by the child to make an assessment. Self-report, if possible, is the most accurate measure of pain; self-report pain scales developed for young children involve matching their pain intensity to photographs of other children's faces, such as the Oucher Scale, pointing to schematics of faces showing different pain levels, or pointing out the location of pain on a body outline. Questionnaires for older children and adolescents include the Varni-Thompson Pediatric Pain Questionnaire (PPQ) and the Children’s Comprehensive Pain Questionnaire, which are often utilized for individuals with chronic or persistent pain.
   Acute pain, chronic pain, neuropathic pain and recurrent pain in children is most often managed with medication. Most of these medications are analgesics. These include acetaminophen, NSAIDs, local anesthetics, opioids, and medications for neuropathic pain. The most effective approach to pain management in children is to provide pain control around the clock instead of providing pain relief as needed. Regional anesthesia is also effective and recommended whenever possible. It is important to use caution when administering opioids to neonates and young infants. There is a higher risk for apnea and hypoventilation in this population, due to their decreased breathing response.
  
presuppositions: Adults feel less pain than children.  Adults feel less pain than children because they are used to it.
corrections: Children experience more fear than adults which may increase the sensation of pain.  Adults are less emotional than children so they express pain less.
raw_presuppositions: Adults feel less pain than children.  Adults feel less pain than children because they are used to it. Adults feel less pain than children because they are used to it.
raw_corrections: Children experience more fear than adults which may increase the sensation of pain.  Adults are less emotional than children so they express pain less. Adults are less emotional than children so they express pain less.