Comparison of behavioural, physiological, and self-reported pain responses in Pakistani children with dental pain: a descriptive cross-sectional study.

Purpose: This study aimed to evaluate behavioral, physiological, and self-reported responses to pain-inducing stimuli in children to comprehensively understand their pain experiences.

Methods: This descriptive cross-sectional study involved 100 children aged 5-15 years with moderate-to-severe dental pain. Behavioral, physiological, and self-reported pain responses were assessed using the FLACC (Face, Legs, Activity, Cry, Consolability) Behavior Pain Assessment Tool, physiological parameter pain assessment, and 10-point Visual Analog Scale (VAS). The statistical tests utilized were multivariate logistic regression analysis, Cohen's kappa for inter-observer reliability, and chi-square tests to examine relationships between pain responses and various demographic, behavioral, and physiological variables.

Results: The study results showed that the participant group was gender-balanced, with most aged 5-8 years, and approximately 68% had dental caries. Pain stimuli included cold (61%), heat (26%), and pressure (13%). Behavioral responses showed no significant sex differences (P = 0.480). Still, they were influenced by age (P = 0.022), type of pain stimulus (P = 0.019), caries experience (P = 0.022), caries severity (P = 0.020), and type of dental procedure (P = 0.014). Physiological measures correlated with pain severity, including heart rate (P = 0.002), blood pressure (P = 0.025), respiration rate, and skin conductance (both P = 0.000). Self-reported pain varied significantly with age (P = 0.001) and type of pain stimulus (P = 0.040) but not with sex (P = 0.386), caries experience (P = 0.641), severity (P = 0.201), or procedure type (P = 0.330). Inter-rater reliability indicated substantial agreement between observers (0.734, 0.659, 0.681) but only moderate agreement between observers and patients (0.209, 0.308; 0.282, 0.312; 0.447, 0.451), suggesting discrepancies between perceived and observed pain.

Conclusions: This study revealed the influence of age and type of pain stimulus on children's pain perception, underscoring the need for tailored pain management and the integration of multiple assessment methods. This highlights the importance of enhanced pain communication, preventive care, and ongoing research in pediatric dentistry.

Trial registration: Registered at ClinicalTrials.gov (NCT05883566), dated 01/06/2023.