Els van Meijel

51 Acute pain and posttraumatic stress symptoms | Chapter 3 more common in women. The specific basis for the differences between genders is still unknown, but research suggests that multiple biological and psychosocial processes are involved (Bartley & Fillingim, 2013). Furthermore, differences between genders might be related to a difference in communication and openness about the degree of pain. This is in line with the suggestion in Paller et al. (2009) that boys and girls are reinforced differently for their expression of pain-related experiences. Another possible explanation is that medical staff evaluates the degree of pain differently in boys and girls. Although girls generally have a greater risk for PTSD than boys (Alisic et al., 2014; Stallard et al., 2004; Winston et al., 2003), our results suggest that the risk for PTSD in injured children might be influenced by injury severity, pain and pain management. In the context of our findings, the subjectivity of reported pain should be addressed. Besides the injury itself, psychological mechanisms, like fear and loss of control, play a role in mediating the pain. Many people report pain for psychological reasons (International Association for the Study of Pain [IASP], 2017). There is no way to distinguish the subjective reporting of pain from pain that is due to tissue damage. According to the IASP, if people regard their experience as pain, it should be accepted as pain. This definition avoids tying pain to the stimulus. This clearly indicates the importance of pain measurement and subsequent pain medication according to the patient’s report as stated in pain protocols. In a review of the availability and content of acute pain protocols in emergency departments in the Netherlands, the authors emphasized the importance of adequate acute pain control, not only from the perspective of good patient care, but also due to adverse physical effects and the risk of developing chronic pain (Gaakeer, van Lieshout, & Bierens, 2010). The latter is strongly associated with chronic PTSD (Chossegros et al., 2011). From the responding Dutch emergency departments, 35% did not have a pain management protocol for children (Gaakeer et al., 2010), which heightens the risk of misjudgment and undertreatment. Several studies lend further support to the relationship between pain and later PTSD development by describing how aggressive pharmacological pain management at the time of initial hospitalization can reduce the likelihood of PTSD development (Gold et al., 2008). In addition to medication, the use of psychological strategies (e.g., distraction) by the medical staff can be of great help in reducing the subjective experience of pain,