Commentary: current status and future directions in acute pediatric pain assessment and treatment.

In the last decade, the paradigm used by researchers in the study of acute pediatric pain has broadened from simply examining the level of children’s distress behaviors or reports of distress to discerning distress in a historical, medical, and social context. That context includes children’s previous medical treatments, the different phases of the current procedure, the efficacy of particular coping behaviors used by children for reducing distress, and the influence of parents’ and medical staffs’ behaviors on children’s coping and distress. Assessment research evaluating the proximal aspects of the ProximalDistal Model of Children’s Acute Procedural Distress During Acute Painful Medical Procedures (Blount, Bunke, & Zaff, in press; Varni, Blount, Waldron, & Smith, 1995) has produced clear implications for the design of empirically derived treatment protocols. Additional lines of research have examined the influence of the more distal factors, including temperament, coping styles, and other personality variables. Although some interesting findings have resulted from these studies, these findings have not yet proven heuristic for the development of treatment interventions. Whether this is due to the nature of, and associations among, these distal variables, or simply to researchers not using those results to develop effective treatments, remains to be seen. Recommendations for the Future