PAINception: identification of contents and methods for delivering information about pain to children, adolescents, parents, and teachers

Highlights

• •Children’s pain knowledge is moderate, with room for improvement in understanding.
• •Parents have slightly better pain knowledge than teachers, but both groups show gaps.
• •Teachers show excessive concern about pain, which may affect how they manage it.
• •Interest in pain topics includes treatments, causes, and types of pain.
• •Online methods, especially videos, are the preferred way to learn about pain.

Abstract

Background

Pain in children is influenced by multiple factors, including parents and teachers, requiring better pain education programs and methods.

Objective

This study aimed to explore pain knowledge, beliefs, key educational content, and preferred methods for learning about pain among children, adolescents, parents, and teachers.

Methods

We conducted a cross-sectional survey with children aged 8–18 years, parents, and teachers. Children’s pain knowledge was measured via the Conceptualisation of Pain Questionnaire (COPAQ), whereas parents’ and teachers’ pain knowledge was measured via the Neurophysiology of Pain Questionnaire (NPQ). We also evaluated the importance of receiving pain-related information and gathered participants’ preferences regarding pain-related content and delivery methods.

Results

We recruited 189 children (mean age = 12), their parents (mean age = 43), and 63 teachers (mean age = 40). Children had a mean pain knowledge score of 8/15 (SD=2.1; 95% CI 7.6 to 8.2) on the COPAQ, whereas parents and teachers had scores of 8/12 (SD=3.6; 95% CI 7.2 to 8.2) and 7/12 (SD=1.5; 95% CI 6.3 to 7.1), respectively, as assessed by the NPQ. Nearly 90% of participants considered learning about pain “moderately” or “extremely” important, with the greatest interest in pain treatments, causes, and types. Participants preferred receiving information through online videos featuring healthcare professionals.

Conclusion

Our study shows that children and adults value learning about pain and prefer online and visual teaching methods, emphasising the need for tailored, accessible and interactive educational interventions. This presents an opportunity to design programs aligned with their learning preferences to enhance future outcomes.

Introduction

Pain is a common experience in childhood and can become persistent and affect the lives of children and adolescents. The prevalence of persistent pain in children and adolescents is 21%, which means that 1 in 5 children and adolescents experience persistent pain.¹ Pain can also be associated with disability, negative impacts on quality of life, school absenteeism, and emotional distress and is a predictor of persistent pain in adults.2, 3, 4, 5, 6

Childhood and adolescence are marked by physical, biological, psychological, and behavioural changes that may influence the way pain is experienced.⁷ Children also acquire knowledge about pain by observing and imitating others' behavior.⁸ Parents and teachers are the primary influences on children’s lives and might help children understand and manage their pain.⁹ Parental perceptions of pain and a family history of pain are directly associated with children’s experience of pain.^10,11 Parents’ behavior, including catastrophizing and overprotective reactions, is associated with negative outcomes in children, such as increased pain intensity and disability.¹² Likewise, how teachers describe pain can impact their understanding of and reactions to children’s pain at school, potentially affecting how children perceive and manage their own pain.¹³ Recognising the multifactorial nature of pain in children, which is influenced by parents and teachers, may be important for effectively supporting children’s pain management.

Pain education programs for children and adolescents are still in the early stages, and their effectiveness in both preventing and treating pain remains unknown.¹⁴ The design of pain education programs requires an initial assessment of individuals’ pain knowledge, potential knowledge gaps, and the establishment of specific learning goals.¹⁵ Despite attempts to improve the quality of evidence for this population, little is known about which pain-related content should be delivered and how it should be delivered. A recent Delphi study suggested a pain education curriculum for adolescents, but it involved a small group of researchers and clinicians, excluding the opinions of the adolescents or their parents.¹⁶ This communication gap between the target population and educators or healthcare providers could impact adherence to and understanding of the program.¹⁷ Therefore, involving families and teachers in pain education is crucial and could enhance the positive impact of such programs.

The aims of this study were to investigate pain knowledge and beliefs, identify important pain education content, and determine preferred delivery methods for pain education among children, adolescents, parents, and teachers.

Methods

Study design and settings

We conducted an online cross-sectional survey. We recruited children, parents, and teachers from public and private schools in Brazil through social media. According to the Declaration of Helsinki, the Ethical Committee of the Universidade Cidade de São Paulo (protocol # 50,441,421.2.0000.0064) approved the study. The study followed the recommendations of the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) for cross-sectional studies¹⁸ and the Checklist for Reporting Results of Internet E-Surveys (CHERRIES).¹⁹ Children, parents and teachers were recruited from February to September 2023.

Participants

We included children aged 8 to 18 years who could read and understand Brazilian Portuguese, and parents who consented to participate in the study via the online consent form. The minimum age of 8 years was chosen because children at this age can usually self-report their feelings and opinions.²⁰ We also included teachers of school-aged children (8–18 years old) who consented to participate in the study through the online consent form. Participants were included regardless of whether they reported experiencing pain.

Procedures

Before data collection, we conducted a pilot test of the survey with the study population to make necessary adjustments. Data obtained in the pilot study were not analysed as part of the study.

We contacted the principals of public and private schools in the urban area of São Paulo state, Brazil, to request their participation in the study. We asked principals to share the study link with their students and teachers via the school’s social media and informational flyers, including a QR code for access. Additionally, we shared the study link through personal social media, sports clubs, and paediatric orthopaedic outpatient clinics. Data collection was conducted via an online survey created in Typeform®. The survey was entirely self-administered online, without any researcher involvement during data collection. Two separate survey links were made available: one for parents and their children, and another for teachers. In the parent-child link, parents provided informed consent and completed their questionnaires before their child accessed their portion of the survey. Children completed the survey at home, in the presence of their parents. Teachers accessed their own link independently and could complete the survey at a time and place of their choosing.

Data security was ensured through Typeform®, hosted on Amazon Web Services (AWS), which maintains stringent privacy standards.

Measures

Sociodemographic characteristics

To characterise the sample, we collected data on age, gender, ethnicity, socioeconomic status (from parents and teachers), and educational level.

Pain characteristics

Data on idiopathic pain experience (i.e., pain without a specific cause or injury) were collected from students, parents and teachers and were based on each participant’s individual experience of pain. If any participant reported pain, we collected data on the pain location, experience of persistent pain (i.e., pain >3 months), pain frequency, and impacts caused by the pain.²¹

Parents’ and teachers’ attitudes related to children’s reports of pain

We aimed to understand parents’ and teachers’ attitudes towards children reporting pain. All variables in this section were assessed using multiple-choice questions with predefined response options. Parents were asked to select, from a list of predefined options, their typical response when their child reports pain (e.g., seek medication, talk with the child, seek professional help, or other). Teachers were asked the same question, with the additional option of contacting the child’s parents. Teachers were also asked to select, from predefined options, how seriously they take students’ reports of pain (e.g., always, depends on the student, or rarely) and how frequently students miss school due to pain (e.g., never, sometimes, or often).

Pain knowledge

For children and adolescents, we used the Conceptualisation of Pain Questionnaire (COPAQ) ,²² which was specifically developed to assess pain conceptualisation in this age group. The COPAQ was originally created and tested in the Catalan language, with an internal consistency of 0.81.²² The COPAQ contains 15 items assessing pain concepts, with responses given as “true” or “false”.²² Scores range from 0–15, with 1 point awarded for each correct answer and higher scores indicating better understanding of pain concepts.²² At the time of this study, the cross-cultural translation and the clinimetric properties of the COPAQ had not been evaluated in Brazilian Portuguese. Therefore, we conducted cross-cultural adaptation by translating and back-translating the questionnaire from Catalan into Brazilian Portuguese following the six-step guidelines suggested by Beaton et al.²³ The level of understanding of the cross-cultural translation was assessed during the pilot study, and adaptations were made, as needed. It should be noted that, while cross-cultural adaptation was performed, formal psychometric validation of the COPAQ for the Brazilian population was beyond the scope of this study, which may limit the interpretability of scores. The final version of the COPAQ for Brazilian Portuguese is available in Appendix A – Table A.1.

The Neurophysiology of Pain Questionnaire (NPQ) was used to assess parents’ and teachers’ knowledge of pain.²⁴ We used the revised version with 12 items, which were translated and adapted into Brazilian Portuguese.²⁵ The measurement properties of the NPQ in Brazilian Portuguese have been previously tested and presented an internal consistency of 0.63.²⁵ The NPQ ranged from 0 to 12, with 1 point awarded for each correct answer, with higher scores indicating greater levels of pain neurophysiology knowledge. During the pilot, some parents and teachers reported difficulties in understanding items 1, 3, 6, 9 and 12 of the questionnaire. These items were simplified to improve linguistic clarity without altering their conceptual content. For example, technical anatomical terms were replaced with more accessible language (details in Appendix A – Table A.2). Of note, these modifications may limit direct comparability with studies using the original version. Modifications can be found in Appendix A – Table A.2.

Teachers’ pain beliefs

We assessed teachers’ pain beliefs using an adapted short form of the Survey of Pain Attitudes (SOPA).²⁶ This version comprises 28 items covering beliefs and attitudes towards pain and related domains.²⁶ The short version of the SOPA was translated and adapted into Brazilian Portuguese, demonstrating good (between 0.74 and 0.85) and moderate (between 0.58 and 0.65) reliability for its domains.²⁶ Each item is rated on a 5-point Likert scale, with scores calculated for each domain ranging from 0 to 4.²⁶ There are no cut-off points or strictly correct answers, but there are guidelines indicating more preferable responses and scores within each domain. The recommended scores for each domain are concern/solicitude = 0, emotion = 4, medical cure = 0, control = 4, physical harm = 0, disability = 0, and medication = 0.²⁶ To increase the response rate, we adapted the short version to a new 12-item version by selecting the questions that our research team judged to be the most important. For example, redundant items within each domain were excluded, such as multiple solicitude items addressing the same concept, and individual emotion items (anxiety, stress, depression) subsumed by a single broader item. Although made to improve feasibility, this adaptation may limit direct comparability with studies using the original version. Moreover, formal psychometric validation of the SOPA for the Brazilian population has not been established, and its construct validity in this context remains unknown, potentially affecting the interpretability of scores. The modifications can be found in Appendix A – Table A.3.

Importance and relevance of content related to pain

We assessed the importance of receiving pain-related information via a scale ranging from “not important” to “extremely important”. We also explored participants’ preferences for important pain-related content, using predefined content from an educational book for children and adolescents.²⁷ Additionally, the participants were encouraged to suggest additional content of interest.

Methods for delivering information about pain

We assessed the best method for delivering information about pain in a logical sequence aligned with participants’ preferences.

Teachers’ pain teaching curricula

We investigated whether teachers received training to address children’s pain complaints in their background. Moreover, we collected data on current school curricula, challenges in teaching pain to their students, and pain content that teachers want to learn about to enhance their students’ knowledge.

Data analysis

Our study was developed with an exploratory aim, focusing on pain education data rather than hypothesis testing. Therefore, we did not calculate a sample size. Our recruitment strategy employed consecutive sampling,²⁸ facilitating the inclusion of any eligible participant during a specific period.²⁸ This approach reduces the risk of study selection bias and enhances representativeness.²⁸ Data analysis was performed via descriptive statistics. Continuous variables were analysed through means and standard deviations, and dichotomous variables were analysed through frequencies and percentages. Means are presented with their standard deviations and 95% confidence intervals, calculated using the t-distribution. The open-ended questions were analysed via qualitative methods, which involved summarising the data and identifying themes.

Results

Sample characteristics

We recruited 189 children and their parents and 63 teachers. The children had a mean age of 12 years and were evenly distributed by gender. The parents, with a mean age of 43 years (SD=8.0; 95% CI 42.0 to 44.2), were predominantly female (77%). The mean age of the teachers was 40 (SD=10.8; 95% CI 37.2 to 42.6) years; most were female (79%), primarily teaching primary school (73%) and in public schools/institutions (53%) (Table 1).

Table 1.

Sample characteristics.

Variables	Children (n = 189)	Parents (n = 189)	Teachers (n = 63)
Family relationship of parents
Mother	-	142 (75.1)
Father	-	42 (22.2)
Other		5 (2.7)
Age, mean (SD) [95% CI]a	12.3 (4.0) [11.7 to 12.9]	43.1 (8.0) [42.0 to 44.2]	39.9 (10.8) [37.2 to 42.6]
Sex, n (%)
Female	95 (50.3)	147 (77.8)	50 (79.4)
Male	93 (49.2)	41 (21.7)	12 (19.0)
Prefer not to answer	1 (0.5)	1 (0.5)	1 (1.6)
Race, n (%)
White	118 (62.5)	123 (65.1)	46 (73.0)
Brown	43 (22.8)	42 (22.2)	13 (20.6)
Asian	5 (2.6)	12 (6.3)	0 (0.0)
Black	17 (9.0)	9 (4.8)	3 (4.8)
Indigenous	1 (0.5)	1 (0.5)	0 (0.0)
Prefer not to answer	5 (2.6)	2 (1.1)	1 (1.6)
Educational level, n (%)
Postgraduate degree	-	55 (29.1)	-
Higher education	-	59 (31.2)	-
High school	-	53 (28.1)	-
Primary school	-	11 (5.8)	-
Incomplete primary school	-	10 (5.3)	-
Never attended school	-	1 (0.5)	-
Grade levels taught by teachers
Primary school	-	-	46 (73.0)
High school	-	-	17 (27.0)
Type of school, n (%)
Private school	97 (51.3)	-	20 (25.0)
Public school	92 (48.7)	-	60 (75.0)
Socioeconomic level; n (%)
Class 1b	-	78 (41.3)	28 (44.4)
Class 2c	-	63 (33.3)	29 (46.0)
Class 3d	-	17 (9.0)	3 (4.8)
Class 4e	-	5 (2.6)	1 (1.6)
Prefer not to answer	-	26 (13.8)	2 (3.2)

^aSD:standard deviation.

^bClass 1: (US$ 1804.34 - 5686.96 monthly).

^cClass 2: (US$ 550.64 - 1804.34 monthly).

^dClass 3: (US$ 244.64 - 550.64 monthly).

^eClass 4: (US$ 159.53–244.64 monthly).

Pain characteristics

All data on pain characteristics are presented in Table 2.

Table 2.

Pain characteristics.

Variables	Children (n = 189)	Parents (n = 189)	Teachers (n = 63)
Experience of idiopathic pain, n (%)
Yes	160 (84.7)	168 (88.9)	60 (95.2)
No	29 (15.3)	21 (11.1)	3 (4.8)
Pain location, n (%)
Head	64 (40.8)	79 (47.0)	27 (45.0)
Neck	46 (29.3)	64 (38.1)	26 (43.3)
Upper limb	38 (24.2)	54 (32.1)	21 (35)
Back	78 (49.7)	119 (70.8)	44 (73.3)
Lower limb	97 (61.8%)	100 (59.6%)	45 (75%)
Experience of persistent pain, n (%)
Yes	34 (21.2)	87 (51.8)	25 (41.7)
No	126 (78.8)	81 (48.2)	35 (58.3)
Weekly pain frequency, n (%)
Never	46 (28.7)	40 (23.8)	11 (18.3)
1 to 3 days	78 (48.7)	68 (40.5)	30 (50.1)
4 to 6 days	22 (13.8)	28 (16.7)	11 (18.3)
Every day	14 (8.8)	32 (19.0)	8 (13.3)
Experience with impact of pain, n (%)
Yes	79 (49.4)	80 (47.6)	41 (68.3)
No	81 (50.6)	88 (52.4)	19 (31.7)
Attitudes towards children’s report of pain, n (%)
Medication	-	31 (30.1)	2 (2.1)
Talk	-	38 (36.9)	28 (30.1)
Take the focus off the pain	-	3 (2.9)	4 (4.3)
Seek professional help	-	17 (16.5)	9 (9.7)
Call to parents		-	47 (50.5)
Other	-	14 (13.6)	3 (3.2)
How seriously do teachers take children’s reports of pain?, n (%)
I always take it seriously	-	-	29 (46.7)
Depends on the student	-	-	34 (53.3)
I rarely take it seriously	-	-	0 (0.0)
I never take it seriously	-	-	0 (0.0)
How often do students tend to miss school due to pain?, n (%)
Never	-	-	0 (0.0)
Rarely	-	-	14 (22.2)
Sometimes	-	-	39 (62.0)
Often	-	-	5 (7.9)
Everyday	-	-	0 (0.0)
I do not know	-	-	5 (7.9)
Pain knowledge, mean (SD) [95% CI]
NPQa score (score ranging from 0 to 12)	-	7.7 (3.6) [7.2 to 8.2]	6.7 (1.5) [6.3 to 7.1]
COPAQb score (score ranging from 0 to 15)	7.9 (2.1) [7.6 to 8.2]	-
Beliefs about pain (SOPAc - score ranging from 0 to 4), mean (SD) [95% CI]
Concern/Solicitude	-	-	2.2 (1.0) [1.9 to 2.5]
Emotion	-	-	3.4 (0.8) [3.2 to 3.6]
Medical cure	-	-	2.0 (0.9) [1.8 to 2.2]
Pain control	-	-	2.2 (1.2) [1.9 to 2.5]
Physical harm	-	-	1.8 (1.3) [1.5 to 2.1]
Disability	-	-	1.5 (1.2) [1.2 to 1.8]
Medication	-	-	2.2 (1.0) [1.9 to 2.5]
Importance of learning about pain, n (%)
Not important	9 (4.8)	2 (1.0)	0 (0.0)
Somewhat important	22 (11.6)	17 (9.0)	1 (1.6)
Moderately important	107 (56.6)	103 (54.5)	35 (55.5)
Extremely important	51 (27.0)	67 (35.5)	27 (42.9)
Contents – Most like to know about pain, n (%)
What is pain?	75 (19.5)	48 (12.0)	21 (14.2)
Are there different types of pain?	77 (20.1)	87 (21.8)	36 (24.3)
What causes pain?	107 (27.8)	125 (31.3)	43 (29.1)
What is the treatment for pain?	114 (29.6)	133 (33.3)	47 (31.8)
Other	12 (3.1)	6 (1.5)	1 (0.6)
Teachers – received training on addressing pain complaints in children, n (%)
None at all	-	-	37 (58.7)
A little bit	-	-	19 (30.2)
Moderate	-	-	6 (9.5)
A lot of	-	-	1 (1.6)
Teachers – currently teach children about pain, n (%)
Yes	-	-	14 (22.2)
No	-	-	49 (77.8)
Teachers – feel confident to teach children about pain, n (%)
Yes	-	-	10 (15.9)
No	-	-	53 (84.1)

^aNPQ: Neurophysiology Pain Questionnaire.

^bCOPAQ: Conceptualisation of Pain Questionnaire.

^cSOPA: Survey of Pain Attitudes.

Attitudes related to children’s reports of pain

Parents generally prefer to talk with their children to comprehend the source of their pain (37%), followed by considering medication (30%). Some parents reported other strategies when their children reported pain, such as using hot packs, massage, exercising with their children, and giving advice.

Approximately 50% of teachers prefer to contact students’ parents when students report feeling pain during class, whereas 30% prefer to talk directly with their students. Over half of the teachers (53%) indicated that whether they took pain reports seriously depended on the student.

Pain knowledge and beliefs about pain

The mean pain knowledge of the children assessed using the COPAQ was 7.9 (SD=2.1; 95% CI 7.6 to 8.2) on a scale ranging from 0 to 15 points. The pain knowledge of parents and teachers assessed by the NPQ was 7.7 (SD=3.6; 95% CI 7.2 to 8.2) and 6.7 (6.7 (SD=1.5; 95% CI 6.3 to 7.1), respectively, on a scale ranging from 0 to 12 points.

With respect to teachers’ pain beliefs, they appear to have excessive concern/solicitude regarding pain (total = 2.2, expected = 0) and confidence, greater than recommended, in the use of medication for pain treatment (total = 2.2, expected = 0). These attitudes may negatively influence how they understand and manage pain. Teachers have a good understanding of the role of emotions associated with pain (total = 3.4, expected = 4) and recognise the importance of emotional aspects in pain management.

Relevant contents and methods for delivering pain information

Approximately 90% of all the participants rated learning about pain as “moderately” or “extremely” important. Among the pain-related content, participants were most interested in learning about pain treatments, causes, and types. Some children also provided free-text responses with questions such as “Why do we have to feel pain?”, “How can we not feel pain?”, “What is the difference between physical pain and emotional pain?”, “How does the body signal pain?”, and “How do I know if I am sick because of pain?”. Some parents also mentioned other relevant content, such as “pain prevention” and “pain as a protective factor”. One teacher expressed interest in learning more about “physical pain arising from emotional pain”.

According to the children’s preferences, the best method for delivering information about pain would be online (59%), through videos (45%), through some type of animation (31%), with instructions from a healthcare professional (39%), and for 5–10 min (31%). Similarly, parents preferred an online method (78%), videos (66%) with recorded classes (41%), healthcare professional guidance (52%), and videos lasting 5–10 min (36%). Teachers also prefer an online (82%) method, primarily through videos (58%) featuring recorded classes (33%), with the involvement of a health professional (43%) and a duration of 5–10 min (43%). The participants’ preferences regarding the content and methods used to deliver pain information are summarised in Fig. 1. All preferences categorised according to children, parents, and teachers can be found in Appendix B – Figure B.1.

Fig. 1.

Participants’ preferences regarding the content and methods used to deliver pain information.

Teachers’ pain teaching curricula

Approximately 59% of teachers had no prior training on pain in children. Most of them (78%) currently do not teach their students about pain, and 84% do not feel confident in teaching their students about pain.

Discussion

Main findings

Our study included 189 children and their parents, as well as 63 teachers from public and private schools in Brazil. Children scored 8 out of 15 on pain knowledge assessed by the COPAQ questionnaire, whereas parents scored 8/12 and teachers scored 7/12 on the NPQ questionnaire. Nearly all participants rated learning about pain as moderately to extremely important and were particularly interested in learning about pain treatment. The participants preferred methods for delivering information about pain through online videos featuring healthcare professionals.

A key strength of our study was establishing a baseline of pain knowledge across our target population, which is essential for identifying gaps and informing tailored pain education programmes. Another strength of our study was our focus on exploring educational content and methods that could engage our population more effectively. Our findings indicate that education on pain treatment and the causes and types of pain delivered online was preferred by all age groups. We also considered the preferences of families and teachers, as their involvement has been underscored as a key element in successful educational interventions.²⁹

We faced some difficulties in reaching our target population. Dissemination through social media was very limited, reaching only a small network of closely connected groups and hindering broader engagement. We tried to overcome this barrier by disseminating the study in public and private schools. We also aimed to include a large number of teachers, but the response rate was low. Several unexplored factors, such as time constraints, lack of motivation, the post-pandemic period and high work demands, may be related. Owing to the online nature of the study, our data may not fully reflect the broader reality of Brazil, as approximately 28 million Brazilians remained offline in 2025.³⁰ Additionally, over 30% of parents in our sample had completed higher education and 29% postgraduate, compared to only 20.5% of the general Brazilian population.³¹ This overrepresentation of more educated and financially privileged groups warrants considerable caution when generalising these findings. We also face challenges in finding appropriate tools for assessing children's knowledge of pain. While the COPAQ has been useful for children,²² its reliability and validity in Brazilian children are unknown. Even for adults, finding the best tool was difficult. We used two translated and adapted questionnaires to assess knowledge and beliefs about pain, both of which require modifications to enhance interpretability. However, we are uncertain about the extent to which these modifications affected our results. More broadly, none of the three instruments used in this study — COPAQ, NPQ, and SOPA — has been formally validated for the Brazilian population. This represents an important limitation that may affect the reliability of the findings and should be considered when interpreting the results. Future studies should prioritise the formal validation of these instruments for the Brazilian population.

Comparison with other studies

Pain education programmes have been shown to improve knowledge and beliefs about pain in children, parents, and teachers, providing both preventive and treatment effects, despite the low certainty of evidence in the results.¹⁴ A recent systematic review reported that pain education programmes use metaphors, games, videos, and lectures to teach pain content to children.¹⁴ Our findings can assist in deciding the best way to deliver pain information and to keep the population engaged and optimise learning outcomes. This systematic review also revealed that, for children, these programs can be delivered either as single videos of up to 10 min or as multiple individual educational sessions.¹⁴ Our results support these findings, as children reported preferring short videos of up to 10 min. In contrast, the systematic review reported that pain education programmes for parents and teachers often involve lectures lasting more than three hours,¹⁴ which is inconsistent with the preference of parents and teachers in our study, who preferred short videos of up to 10 min. This discrepancy may reflect broader shifts in digital consumption behaviour, in which Brazil ranks fifth globally in total number of internet users, with 185 million people online in 2025 — behind only China, India, the United States, and Indonesia.³² In this context, the strong preference for short online videos is consistent with wider trends in how digitally connected populations consume information. The results of our study can also complement and inform the way pain education content is proposed. For example, a Delphi study revealed that the three main objectives of a pain education curriculum for adolescents are to address that pain is protective, that the pain system can become overprotective, and that pain is generated by the brain.¹⁶ However, children, parents, and teachers showed greater interest in learning about treatments, causes, and types of pain. Our findings reinforce the importance of modifying communication models to fit the population.

Clinical application and future research

Our study took a first step towards educating children, parents, and teachers in ways that better reflect their realities. These findings suggest that online video-based education may be a suitable delivery method for populations with digital access, such as those represented in our sample. However, given the significant socioeconomic and educational inequalities in Brazil, these preferences cannot be directly extrapolated to the broader population or used to inform universal public health policies. For populations and regions where online delivery is not feasible, alternative strategies should be considered. In-person sessions with healthcare professionals were also among the preferred delivery methods reported by participants (Appendix B – Figure B.1), suggesting that hybrid or diversified approaches may be needed to ensure equitable access to pain education across different socioeconomic contexts. Future research should examine whether online interventions yield pain knowledge outcomes similar to those of in-person interventions. We do not know the extent to which teachers’ pain knowledge is linked to their students’ pain knowledge and the degree to which teachers’ negative pain beliefs may influence their students and affect their pain outcomes. It is necessary to identify potential barriers to and facilitators of teachers’ participation in future pain education programs. Future research should also address strategies to engage policymakers and stakeholders in implementing pain education programs in schools, given the low response rate among teachers.

Conclusion

Our study highlights that both children and adults recognise the importance of learning about pain and prefer online and visual teaching methods, emphasising the need for accessible and interactive educational interventions. These findings highlight the importance of tailoring educational content to the preferences of different audiences to enhance the effectiveness of pain education programmes.

Funding

This work was supported by the São Paulo Research Foundation (grant number: 2020/03629-0; 2017/17484–1). TY receives a research grant from São Paulo Research Foundation (FAPESP-Brazil).

Declaration of competing interest

The author(s) declared no potential conflicts of interest.