How often is pain present?
44%
Weekly pain (moderate–profound impairment)
41–42%
Almost-daily pain (severe–profound impairment)
Only 8% of pain episodes are due to tests or procedures.
The Hidden Pain Problem
The Challenges Pediatricians Face in Recognizing Pain in SNI
Even the most experienced clinicians can struggle to identify pain in children with severe neurological impairment. These patients often cannot communicate pain traditionally, and subtle cues may be misinterpreted or overlooked leading to unnecessary suffering and delayed care.
The Silent Expression Trap
Nonverbal children may show discomfort through subtle behaviors that mimic other conditions making pain easy to miss.
The Diagnostic Overlap
Pain symptoms often overlap with spasticity, reflux, dystonia, or irritability challenging even seasoned clinicians to distinguish causes.
Management Difficulty & Complexity
Pain control in SNI is rarely “single-issue.” Clinicians must balance multimodal therapies, drug interactions, tone/spasticity management, feeding intolerance, dysautonomia, and caregiver capacity—while avoiding over-testing and undertreatment.