Table 3.

Quotations to illustrate the subthemes of the four main themes

Themes and subthemes	Quotations
1. My pain-related knowledge: - Varied knowledge of pain’s purpose, pain-related anatomy and pain mechanisms.	“…To alert your body that there is a virus and you are sick or something.” (Boy, 9, persistent pain) “…It’s to know you’ve hurt your knee and you need to stop playing.” (Boy, 8, persistent pain) “The nerves feel it, then they tell the brain, [ draws line up to brain outside body ] and then the brain tells the nerve maybe.” (Boy, 9, persistent pain) “Umm because like your nerves send like… It’s like a phone call to your brain saying “I just hurt myself” and then your brain will say, “oh like that’s going to hurt” and you go aww!” (Girl, 10, pain-free) “Maybe [ people with higher sensitivity ] have more nerves? And some people might have a little less.” (Boy, 11, pain-free)
- Influences of age	[ When asked how a vignette character could make his persistent abdominal pain feel different ] “…Umm well not eat as much food if he is eating a lot. Basically, go on a diet, and depending on if he is fit or not, get fit.” (Boy, 10, persistent pain)
2. Pain in the world around me :- Contextual influences on a child’s concept of pain	“My mum… she has… and my teacher… they might have to get knee replacements. My teacher had one. And my mum has to get one. And my neighbour got one.” (Girl, 9, persistent pain) [ When asked where he learnt about the role of the brain ] “Well I learnt most of it off TV, and a little bit from school.” (Boy, 12, persistent pain)
- Perceptions of how other people respond to pain	“… Some people might be more sensitive than others. Like, I guess some people who play like full contact sports they would be more tough because they are used to the punching and everything. And people who don’t do any sports or who are really sensitive naturally—you just go like “that!” (touches hand to desk lightly) it really, really hurts.” (Girl, 10, pain-free) “I guess it’s just how you’re born. And how your nerves work.” (Girl, 10, pain-free) “Some people have stronger muscles… It’s a matter between weakness and strength.” (Boy, 11, persistent pain) [ When asked about sensitivity ] “It means umm… more vulnerable”. “…Umm well not really, because some people have a high pain tolerance. Because if Sarah, Mary and I did that, Mary and Sarah would be crying because they have low pain tolerances. Because I’m kind of tougher than them, I’m the oldest.” (Girl, 11, pain-free) [When asked if different people feel the same amount of pain with the same hammer-hitting-thumb-injury] “We wouldn’t feel the same amount of pain. Because you’re older and I’m younger. I can’t hold in the pain as much as you. So I’d feel more than you.” (Boy, 8, pain-free) “Well, if you’re like 96 or something you’d feel pain like kids… Because you’re getting old.” (Boy, 8, pain-free) “[ Adults ] may be more used to it, because they may have hit it before—depending how often! Because they may have had longer time to experience pain on their thumbs.” (Boy, 10, persistent pain)
3. Pain in me: - Experiences of any pain/injury	“Well pain is like if you’ve hurt yourself, it’s the physical contact and it hurts. Or like after surgeries you’d have like pain and it hurts to move.” (Girl, 12, persistent pain) “It helps us not get into any more trouble… it’ll help us to not do [ an injury ] again. We’ll remember last time and [ do the task ] differently.” (Boy, 8, pain-free) “Well if you really didn’t like something, like a sport, then you don’t have to play it. It’d be helpful maybe.” (Girl, 10, pain-free) “If you had, like we have a presentation day that goes for 2 hours at school. If you didn’t want to go, if you have pain you can stay home.” (Girl, 9, persistent pain)
- The impact of having persistent pain	“You could go see a doctor” (Boy, 8, pain-free) “If they have pain then they can go to a physio…” (Boy, 8, pain-free) “If you maybe have a sore tummy, and you’re like “oh no I might have appendicitis!” or something like that. And then you go to the doctors and then they’re like “oh no you’re just sick” or something like that. You’re like “Oh thank goodness, I’ve only got a fever!”” (Girl, 11, pain-free) “Umm… I reckon no… I always know about it [ pain ].” (Boy, 10, persistent pain) “If you defined pain in the dictionary… it would be something that physically hurts you. So it’s a fake thing. Just a warning… It depends what you mean by real?” (Boy, 12, persistent pain) [When asked if pain was always ‘real’] “I think it’s always real. Because sometimes in your body, like right now when I’m talking, pain can still be in your body even if it doesn’t hurt.” (Boy, 8, pain-free)
- The physical is obvious, but the emotional is hidden	“I reckon if he [ the vignette character ] looked at like his favourite thing in the world, and got to play with it or just looked at it at least and just went like “I need it”—it would distract him from his pain because he is focussed on his favourite toy or something, in the world.” (Boy, 10, persistent pain)
4. Communicating my concept of pain:	[ Pain is ] “…when something hurts in your body” (Girl, 10, pain-free)
- Verbal communication	“The body is fighting the virus or something.” (Boy, 9, persistent pain)
- Individual engagement	[ Pointing to parts of the diagram whilst talking ] “[ Nerves ] release chemicals that flow up to your brain. And then your brain sends down another chemical I think, that gives it pain.” (Boy, 12, persistent pain)