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Henkel ED, Haller CN, Diaz LZ, Ricles V, Wong Grossman AV, Nemergut ME, Krakowski AC. Optimizing pediatric periprocedural pain management part I-Evolving ethics and topical anesthetics. Pediatr Dermatol 2024; 41:577-587. [PMID: 38743586 DOI: 10.1111/pde.15635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 04/13/2024] [Indexed: 05/16/2024]
Abstract
Pediatric procedure-related pain management is often incompletely understood, inadequately addressed, and critical in influencing a child's lifelong relationship with the larger health care community. We highlight the evolution of ethics and expectations around optimizing periprocedural pain management as a fundamental human right. We investigate the state-of-the-art of topical anesthetics, reviewing their mechanisms of action and providing comparisons of their relative safety and efficacy data to help guide clinical selection. In total, this two-part review offers a combination of conventional approaches and innovative techniques that should be used multimodally-in series and in parallel-to help optimize pain management and provide alternatives to sedation medication and general anesthesia.
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Affiliation(s)
- Emily D Henkel
- Division of Dermatology, Dell Medical School, University of Texas at Austin, Austin, Texas, USA
| | - Courtney N Haller
- Division of Dermatology, Dell Medical School, University of Texas at Austin, Austin, Texas, USA
| | - Lucia Z Diaz
- Division of Dermatology, Dell Medical School, University of Texas at Austin, Austin, Texas, USA
- Dell Children's Medical Center, Austin, Texas, USA
- Department of Pediatrics, Dell Medical School, University of Texas at Austin, Austin, Texas, USA
| | - Victoria Ricles
- Drexel School of Medicine, Philadelphia, Pennsylvania, USA
- Department of Dermatology, St. Luke's University Health Network, Easton, Pennsylvania, USA
| | | | | | - Andrew C Krakowski
- Department of Dermatology, St. Luke's University Health Network, Easton, Pennsylvania, USA
- St. Luke's Children's Hospital, St. Luke's University Health Network, Bethlehem, Pennsylvania, USA
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2
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Eccleston C, Fisher E, Howard RF, Slater R, Forgeron P, Palermo TM, Birnie KA, Anderson BJ, Chambers CT, Crombez G, Ljungman G, Jordan I, Jordan Z, Roberts C, Schechter N, Sieberg CB, Tibboel D, Walker SM, Wilkinson D, Wood C. Delivering transformative action in paediatric pain: a Lancet Child & Adolescent Health Commission. THE LANCET. CHILD & ADOLESCENT HEALTH 2021; 5:47-87. [PMID: 33064998 DOI: 10.1016/s2352-4642(20)30277-7] [Citation(s) in RCA: 111] [Impact Index Per Article: 37.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 07/30/2020] [Accepted: 08/06/2020] [Indexed: 02/07/2023]
Affiliation(s)
- Christopher Eccleston
- Centre for Pain Research, University of Bath, Bath, UK; Cochrane Pain, Palliative, and Supportive Care Review Groups, Churchill Hospital, Oxford, UK; Department of Clinical-Experimental and Health Psychology, Ghent University, Ghent, Belgium.
| | - Emma Fisher
- Centre for Pain Research, University of Bath, Bath, UK; Cochrane Pain, Palliative, and Supportive Care Review Groups, Churchill Hospital, Oxford, UK
| | - Richard F Howard
- Department of Anaesthesia and Pain Medicine, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK; Clinical Neurosciences, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Rebeccah Slater
- Department of Paediatrics, University of Oxford, Oxford, UK; Wellcome Centre for Integrative Neuroimaging, Oxford Centre for Functional MRI of the Brain, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Paula Forgeron
- School of Nursing, Faculty of Health Sciences, University of Ottawa, ON, Canada
| | - Tonya M Palermo
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA, USA; Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, WA, USA
| | - Kathryn A Birnie
- Department of Anesthesiology, Perioperative and Pain Medicine, University of Calgary, AB, Canada
| | - Brian J Anderson
- Department of Anaesthesiology, University of Auckland, Auckland, New Zealand
| | - Christine T Chambers
- Department of Psychology and Neuroscience, and Department of Pediatrics, Dalhousie University, Halifax, NS, Canada; Centre for Pediatric Pain Research, IWK Health Centre, Halifax, NS, Canada
| | - Geert Crombez
- Department of Clinical-Experimental and Health Psychology, Ghent University, Ghent, Belgium
| | - Gustaf Ljungman
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | | | | | | | - Neil Schechter
- Division of Pain Medicine, Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital, Boston, MA, USA; Department of Anesthesiology, Harvard Medical School, Boston, MA, USA
| | - Christine B Sieberg
- Division of Pain Medicine, Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital, Boston, MA, USA; Department of Psychiatry, Boston Children's Hospital, Boston, MA, USA; Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Dick Tibboel
- Intensive Care and Department of Pediatric Surgery, Erasmus MC-Sophia Children's Hospital, Rotterdam, Netherlands
| | - Suellen M Walker
- Department of Anaesthesia and Pain Medicine, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK; Clinical Neurosciences, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Dominic Wilkinson
- Oxford Uehiro Centre for Practical Ethics, Faculty of Philosophy, University of Oxford, Oxford, UK; John Radcliffe Hospital, Oxford, UK; Murdoch Children's Research Institute, Melbourne, VIC, Australia
| | - Chantal Wood
- Department of Spine Surgery and Neuromodulation, Poitiers University Hospital, Poitiers, France
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Tam MT, Wu JM, Page PM, Lamb EA, Jordan I, Chambers CT, Robillard JM. Barriers and Facilitators to Effective Pain Management by Parents After Pediatric Outpatient Surgery. J Pediatr Health Care 2020; 34:560-567. [PMID: 32868162 DOI: 10.1016/j.pedhc.2020.06.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 06/16/2020] [Accepted: 06/21/2020] [Indexed: 11/30/2022]
Abstract
INTRODUCTION The purpose of this study was to describe the experience of postoperative pain management from the perspectives of parents and identify areas for improvement. METHOD Forty parents or legal guardians of children aged 5-18 years who underwent outpatient surgery at BC Children's Hospital were recruited. Qualitative semistructured interviews were conducted to explore participants' experiences with the discharge instructions and at-home pain management. RESULTS Overall, participants reported positive experiences with pain management. Facilitators in pain management communication included the combination of verbal and written instructions. Barriers to effective pain management included discrepancies in the information provided by different health care professionals and the experience of stress at the time of pain management communication. DISCUSSION The exploration of parent narratives highlighted the need for detailed information resources and patient-centered care surrounding pain management. The practical recommendations identified will inform future research and improve the quality of care for pediatric pain.
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Kaur H, Negi V, Sharma M, Mahajan G. Study of pain response in neonates during venipuncture with a view to analyse utility of topical anaesthetic agent for alleviating pain. Med J Armed Forces India 2018; 75:140-145. [PMID: 31065181 DOI: 10.1016/j.mjafi.2017.12.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Accepted: 12/22/2017] [Indexed: 11/19/2022] Open
Abstract
Background Neonates being nonverbal are unable to express their pain leading to underestimation of their pain and hence insufficient pain relief. Neonatal pain is assessed by pain scales based on the behavioural and physiological changes that occur in response to painful stimuli. This cross sectional study was conducted at a tertiary care centre using Premature Infant Pain Profile (PIPP) score with 4% lidocaine as local anaesthetic agent to produce surface anaesthesia of skin prior to intravenous cannulation. Methods Sample size was collected by simple randomisation method. Our study groups included 50 term and 50 preterm neonates with POG of 28-40 weeks requiring IV cannulation. Heart rate (HR), SpO2, facial expressions and behavioural state were noted before venipuncture and after venipuncture using PIPP scale. Same cohort of patients was assessed for pain response after applying 4% lidocaine cream during future venipuncture with help of PIPP score. Results The PIPP score in preterm group before and after anesthesia was 11.28 ± 3.72 and 9.58 ± 3.39. PIPP score in term group before and after anesthesia was 11.54 ± 2.84 and 9.04 ± 2.97. There was reduction in mean PIPP score after using topical anesthetic agent in both study groups and the results were statistically significant. Conclusion This study found that topical anesthetic agents were effective in reducing pain during venipuncture. Based on the facts of the study, it is recommended that pain scoring should be a part of routine monitoring in neonatal intensive care units and appropriate measures should be used to reduce pain.
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Affiliation(s)
- Hardeep Kaur
- Graded Specialist (Paediatrics), Military Hospital Nasirabad, Rajasthan, India
| | - Vandana Negi
- Head of Department (Paediatrics & Neonatology), Base Hospital Delhi Cantt 10, India
| | - Mukti Sharma
- House no. 73, Sector 5, Chandigarh 160009, India
| | - Gaurav Mahajan
- Graded Specialist (Medicine), Military Hospital Nasirabad, Rajasthan, India
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Curran-Smith J, Abidi SSR, Forgeron P. Towards a collaborative learning environment for children’s pain management: leveraging an online discussion forum. Health Informatics J 2016. [DOI: 10.1177/1460458205050682] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Effective management of pediatric pain requires proactive and effective collaboration between health practitioners from a variety of health disciplines. This article investigates the merits of a collaborative learning environment to address the knowledge gaps experienced by a community of pediatric pain practitioners. We present a knowledge management solution that leverages an online discussion forum as a collaborative learning environment rooted in team members sharing experiences, offering support to solve problems, guiding members to information/knowledge resources, informing peers about clinical practice guidelines, and simply seeking advice on matters pertaining to pediatric pain management. Team interactions, via the discussion forum, will be captured and represented as a social network to provide useful insights into the dynamics of team collaboration and to identify the patterns of knowledge flow amongst the team members.
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Affiliation(s)
- Janet Curran-Smith
- Health Informatics Lab, Faculty of Computer Science, Dalhousie University, Halifax, Canada
| | - Syed Sibte Raza Abidi
- Health Informatics Lab, Faculty of Computer Science, Dalhousie University, Halifax, Canada
| | - Paula Forgeron
- Children’s Health Program, IWK Health Centre, Halifax, Canada
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Houlahan KE, Branowicki PA, Mack JW, Dinning C, McCabe M. Can End of Life Care for the Pediatric Patient Suffering With Escalating and Intractable Symptoms Be Improved? J Pediatr Oncol Nurs 2016; 23:45-51. [PMID: 16689405 DOI: 10.1177/1043454205283588] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Over twelve thousand children are diagnosed each year with cancer, and approximately 2200 children die each year from the disease. A percentage of these patients experiences escalating and intractable distress with symptoms that include pain, dyspnea, and agitation. These symptoms may continue for hours to days. Intractable symptoms of pain, agitation, and dyspnea can be very distressing to the patient, family, and staff and often a challenge for the physicians and nursing staff to treat. To meet this challenge, The Dana-Farber Cancer Institute/Children's Hospital Cancer Care Program has made it a priority to create a process of care that includes identifying barriers to care and the development of an end-of-life (EOL) rapid response model that includes guidelines and physiciantemplated orders for rapid escalation of opioids. The goal of this quality-improvement initiative was to develop a model of care that would enable the caregivers to provide effective comfort care to any patient experiencing symptoms of rapid escalation of pain, dyspnea, and agitation. A model of care was created to overcome barriers to care. The model includes role clarification, “Guidelines for the Management of Escalating Pain/Dyspnea/Agitation at the End of Life,” and “Rapid Titration-Templated Physician Orders.” Staff feedback was solicited relative to the content, format, and usability of the guidelines and templated orders. The physician and nursing staff reported that they found the templated orders and guidelines very helpful and effective and suggested only a few edits. A retrospective chart review is currently under way. The purpose of this chart review is to systematically document and compare the record of management of rapidly escalating symptoms of pain and/or dyspnea and/or agitation prior to and after instituting the EOL Rapid Response Model of Care. Care of the EOL patient experiencing symptoms of pain, dyspnea, and agitation is challenging. The EOL Rapid Response Model of Care outlines a process of care and provides recommendations and templated physician orders for rapid titration of opioids.
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Affiliation(s)
- Kathleen E Houlahan
- Hematology/Oncology/Stem Cell Transplant Program, Children's Hospital Boston, 300 Longwood Avenue, Boston, MA 02115, USA.
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Ameringer S, Serlin RC, Hughes SH, Frierdich SA, Ward S. Concerns About Pain Management Among Adolescents With Cancer: Developing the Adolescent Barriers Questionnaire. J Pediatr Oncol Nurs 2016; 23:220-32. [PMID: 16766687 DOI: 10.1177/1043454206289736] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Investigators have examined barriers to pain management in adults with cancer, but these patient-related barriers have rarely been studied in adolescents. This article summarizes 2 studies used in the development and initial psychometric testing of the Adolescent Barriers Questionnaire (ABQ). Building on the Barriers Questionnaire-II, the ABQ is designed to measure the extent to which adolescents with cancer have concerns about reporting pain and using analgesics. Study 1 was a qualitative study investigating pain management concerns of 5 adolescents with cancer. Concerns emerged that could potentially impede pain management such as fear of addiction and worry about communicating pain to parents and providers. Each of the adolescents revealed at least 1 concern about pain management or held fatalistic beliefs that cancer pain cannot be relieved. In study 2, content validity of the preliminary ABQ (52 items assessing 13 barrier sub-scales) was assessed by 2 panels, adolescents with cancer and clinicians. Based on results, the ABQ was modified to contain 45 items that assess 11 barriers. Further examination of barriers in adolescents with cancer is warranted.
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Affiliation(s)
- Suzanne Ameringer
- School of Nursing, University of Wisconsin-Madison, Madison, WI 53792, USA.
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Anghelescu DL, Snaman JM, Trujillo L, Sykes AD, Yuan Y, Baker JN. Patient-controlled analgesia at the end of life at a pediatric oncology institution. Pediatr Blood Cancer 2015; 62:1237-44. [PMID: 25820345 PMCID: PMC4433603 DOI: 10.1002/pbc.25493] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2015] [Accepted: 02/03/2015] [Indexed: 11/06/2022]
Abstract
BACKGROUND Patient controlled anesthesia (PCA) is increasingly used to manage pain in pediatric cancer patients and is important in the treatment of escalating pain at the end of life. The description of the use of opioid PCA in this population has been limited. PROCEDURE This retrospective chart review of the last 2 weeks of life addressed the following objectives: (1) to describe the patient population treated with opioid PCA; (2) to describe the morphine-equivalent doses (MED) (mg/kg/day); and (3) to describe the pain scores (PS). RESULTS Twenty-eight percent of inpatients used opioid PCA for pain control during the last 2 weeks of life. The mean MED (mg/kg/day) (SD) at 2 weeks prior and the day of death were 10.7 (17.9) and 19 (25.8). The mean MED increased over the last 2 weeks of life for all patients and across age groups and cancer diagnoses (all P < 0.05). The mean MED was significantly higher in the younger age group (age <13 vs. age ≥ 13) on the day of death (P < 0.04). There was a significant change in mean PS over the last 2 weeks of life (P < 0.001), with the highest PS on the day before death. The most frequently used concurrent medications were benzodiazepines (91%). CONCLUSIONS Children and young adults with cancer experience high opioid requirements and significant dose increases during the last 2 weeks of life. Additionally, PS increase toward the end of life. Opioid rotation and addition of adjuvant medications merit consideration in the context of escalating opioid requirements.
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Affiliation(s)
- Doralina L. Anghelescu
- Pediatric Medicine, Division of Anesthesiology; Director, Pain Management Service, St. Jude Children's Research Hospital
| | | | - Luis Trujillo
- Pediatric Medicine, Division of Anesthesiology, St. Jude Children's Research Hospital
| | - April D. Sykes
- Department of Biostatistics, St. Jude Children's Research Hospital
| | - Y Yuan
- Department of Biostatistics, St. Jude Children's Research Hospital
| | - Justin N. Baker
- Department of Oncology, St. Jude Children's Research Hospital
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Ameringer S, Fisher D, Sreedhar S, Ketchum JM, Yanni L. Pediatric pain management education in medical students: impact of a web-based module. J Palliat Med 2012; 15:978-83. [PMID: 22747064 DOI: 10.1089/jpm.2011.0536] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Reports from the Institute of Medicine and American Medical Association's Pain and Palliative Medicine Specialty Section Council emphasize the need for pain management education in medical schools, yet training in pediatric pain management (PPM) is limited. In this pilot program, we evaluated the effectiveness of a web-based PPM module on knowledge, confidence, attitudes, and self-reported skills in medical students. METHODS Third- and fourth-year medical students (n = 291) completed the module and a knowledge test. Of these students, 53 completed a pre- and postsurvey of confidence, attitudes, and self-reported skills and module evaluation. RESULTS For the 291 students, knowledge scores increased significantly by 21.8 points (95% confidence interval [CI] = 19.7-23.8; p<0.001). The majority of scores on the survey items significantly increased postmodule, including: increase in confidence in assessing pain in pediatric patients (6% to 25%; p = 0.004), increase in responses of "strongly disagree" or "disagree" to the belief that opioids will delay diagnosis (62% to 85%; p = 0.005), and increase in responses of "frequently" or "very frequently" to "how often do you use behavioral instruments to assess pain severity?" (35% to 57%; p = 0.008). The majority reported they intend to make changes in behavior or practice (71%), and would recommend the module to fellow students (88%). CONCLUSION This pilot program supports the effectiveness of a web-based module in improving knowledge, confidence, attitudes, and self-reported skills in PPM. Evaluation responses indicate high-quality content. Further evaluation for sustained impact is warranted.
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Affiliation(s)
- Suzanne Ameringer
- School of Nursing, Virginia Commonwealth University, Richmond, Virginia 23298, USA.
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Vern-Gross T. Establishing communication within the field of pediatric oncology: a palliative care approach. Curr Probl Cancer 2012; 35:337-50. [PMID: 22136707 DOI: 10.1016/j.currproblcancer.2011.10.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Ayling Campos A, Amaria K, Campbell F, McGrath PA. Clinical impact and evidence base for physiotherapy in treating childhood chronic pain. Physiother Can 2011; 63:21-33. [PMID: 22210976 DOI: 10.3138/ptc.2009-59p] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE As part of the special series on pain, our objectives are to describe the key features of chronic pain in children, present the rationale for interdisciplinary treatment, report a case study based on our biopsychosocial approach, and highlight the integral role of physiotherapy in reducing children's pain and improving function. We also evaluate the evidence base supporting physiotherapy for treating chronic neuropathic pain in children. SUMMARY OF KEY POINTS Chronic pain affects many children and adolescents. Certain challenging pain conditions begin primarily during adolescence and disproportionately affect girls and women. Children with these conditions require an interdisciplinary treatment programme that includes physiotherapy as well as medication and/or psychological intervention. Converging lines of evidence from cohort follow-up studies, retrospective chart reviews, and one randomized controlled trial support the effectiveness of physiotherapy within an interdisciplinary programme for treating children with chronic pain. CONCLUSIONS Evidence-based practice dictates that health care providers adopt clear guidelines for determining when treatments are effective and for identifying children for whom such treatments are most effective. Thus, additional well-designed trials are required to better identify the specific physiotherapy modalities that are most important in improving children's pain and function.
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Affiliation(s)
- Anne Ayling Campos
- Anne Ayling Campos, PT: Physiotherapist, Departments of Anesthesia and Pain Medicine and Rehabilitation Services, The Hospital for Sick Children, Toronto, Ontario
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Hoon LS, Hong-Gu H, Mackey S. Parental involvement in their school-aged children's post-operative pain management in the hospital setting: a comprehensive systematic review. ACTA ACUST UNITED AC 2011; 9:1193-1225. [PMID: 27820216 DOI: 10.11124/01938924-201109280-00001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
BACKGROUND Paediatric pain management remains a challenge in clinical settings. Parents can contribute to the effective and accurate pain assessment and management of their child. No systematic reviews regarding the parental involvement in their child's post-operative pain management have been published. OBJECTIVE To determine the best available evidence regarding parental involvement in managing their children's post-operative pain in the hospital setting. INCLUSION CRITERIA The review considered studies that included parents of all ethnic groups with children aged between 6 to 12 years old who were hospitalised and undergone surgery of any kind with post-operative surgical or incision site pain where care was provided in acute hospital settings. The phenomena of interest were the experiences of parents in managing their children's post-operative pain. SEARCH STRATEGY A three-step search strategy was utilised in each component of this review. Major databases searched included: MEDLINE, CINAHL, Scopus, ScienceDirect, the Cochrane library, PubMed as well as Google Scholar. The search included published studies and papers in English from 1990 to 2009. METHODOLOGICAL QUALITY Each included study was assessed by two independent reviewers using the appropriate appraisal checklists developed by the Joanna Briggs Institute (JBI). DATA COLLECTION Quantitative and qualitative data were extracted from the included papers using standardised data extraction tools from the JBI, Meta-analysis Statistics Assessment and Review Instrument data extraction tool for descriptive/case series and the JBI-Qualitative Assessment and Review Instrument data extraction tool for interpretive and critical research. DATA SYNTHESIS The five quantitative studies included in this review were not suitable for meta-analysis due to clinical and methodological heterogeneity and therefore the findings are presented in a narrative form. The two qualitative studies were from the same study, therefore meta-synthesis was not possible. Hence the results of the studies were presented in a narrative format. RESULTS Seven papers were included in this review. The evidence identified topics including: pharmacological and non-pharmacological interventions carried out by parents; the experience of concern, fear, helplessness, anxiety, depression, frustration and lack of support felt by parents during their child's hospitalisation; communication issues and knowledge deficits; need for information by parents to promote effective participation in managing their child's post-operative pain. CONCLUSION This review revealed pharmacological and non-pharmacological interventions carried out by parents to alleviate their children's post-operative pain. Obstacles and promoting factors influencing parents' experiences as well as their needs in the process of caring were identified. IMPLICATIONS FOR PRACTICE Parents' roles in their child's surgical pain management should be clarified and their efforts acknowledged, which will encourage parents' active participation in their child's caring process. Nurses should provide guidance, education and support to parents. IMPLICATIONS FOR RESEARCH More studies are needed to examine parents' experiences in caring for their child, investigate the effectiveness of education and guidance provided to parents by the nurses and explore the influence of parents' cultural values and nurses' perceptions of parental participation in their child's care.
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Affiliation(s)
- Lim Siew Hoon
- 1. National University of Singapore & Centre for Evidence-based Nursing, National University Hospital, Singapore: A Collaborating Centre of the Joanna Briggs Institute
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13
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Jünger S, Vedder AE, Milde S, Fischbach T, Zernikow B, Radbruch L. Paediatric palliative home care by general paediatricians: a multimethod study on perceived barriers and incentives. BMC Palliat Care 2010; 9:11. [PMID: 20525318 PMCID: PMC2902453 DOI: 10.1186/1472-684x-9-11] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2010] [Accepted: 06/04/2010] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Non-specialist palliative care, as it is delivered by general practitioners, is a basic component of a comprehensive palliative care infrastructure for adult patients with progressive and far advanced disease. Currently palliative care for children and adolescents is recognized as a distinct entity of care, requiring networks of service providers across different settings, including paediatricians working in general practice. In Germany, the medical home care for children and adolescents is to a large extent delivered by general paediatricians working in their own practice. However, these are rarely confronted with children suffering from life-limiting diseases. The aim of this study was therefore to examine potential barriers, incentives, and the professional self-image of general paediatricians with regard to paediatric palliative care. METHODS Based on qualitative expert interviews, a questionnaire was designed and a survey among general paediatricians in their own practice (n = 293) was undertaken. The survey has been developed and performed in close cooperation with the regional professional association of paediatricians. RESULTS The results showed a high disposition on part of the paediatricians to engage in palliative care, and the majority of respondents regarded palliative care as part of their profile. Main barriers for the implementation were time restrictions (40.7%) and financial burden (31.6%), sole responsibility without team support (31.1%), as well as formal requirements such as forms and prescriptions (26.6%). Major facilitations were support by local specialist services such as home care nursing service (83.0%), access to a specialist paediatric palliative care consultation team (82.4%), as well as an option of exchange with colleagues (60.1%). CONCLUSIONS Altogether, the high commitment to this survey reflects the relevance of the issue for paediatricians working in general practice. Education in basic palliative care competence and communication skills was seen as an important prerequisite for the engagement in paediatric palliative home care. A local network of specialist support on site and a 24/7 on-call service are necessary in order to facilitate the implementation of basic palliative care by paediatricians in their own practice.
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Affiliation(s)
- Saskia Jünger
- Department of Palliative Medicine, RWTH Aachen University Hospital, Pauwelsstrasse 30, 52057 Aachen, Germany.
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14
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Correlates of Pain-rating Concordance for Adolescents With Sickle Cell Disease and Their Caregivers. Clin J Pain 2008; 24:438-46. [DOI: 10.1097/ajp.0b013e3181646038] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Schiffman JD, Chamberlain LJ, Palmer L, Contro N, Sourkes B, Sectish TC. Introduction of a Pediatric Palliative Care Curriculum for Pediatric Residents. J Palliat Med 2008; 11:164-70. [PMID: 18333729 DOI: 10.1089/jpm.2007.0194] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Joshua D. Schiffman
- Division of Pediatric Hematology-Oncology, Stanford University School of Medicine, Palo Alto, California
| | - Lisa J. Chamberlain
- Division of General Pediatrics, Stanford University School of Medicine, Palo Alto, California
| | - Laura Palmer
- Division of Child Psychiatry, Stanford University School of Medicine, Palo Alto, California
| | - Nancy Contro
- Division of Pediatric Palliative Care, Stanford University School of Medicine, Palo Alto, California
| | - Barbara Sourkes
- Division of Pediatric Palliative Care, Stanford University School of Medicine, Palo Alto, California
| | - Theodore C. Sectish
- Division of General Pediatrics, Harvard Medical School, Boston, Massachusetts
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Hatchette JE, McGrath PJ, Murray M, Finley GA. The role of peer communication in the socialization of adolescents' pain experiences: a qualitative investigation. BMC Pediatr 2008; 8:2. [PMID: 18190716 PMCID: PMC2254410 DOI: 10.1186/1471-2431-8-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2007] [Accepted: 01/11/2008] [Indexed: 11/15/2022] Open
Abstract
Background Recurrent pain is a common complaint among adolescents. Children learn to resolve or cope with pain largely through family dynamics, particularly maternal influences. By adolescence, young people possess an array of pain behaviors, the culmination of multiple opportunities for modeling and reinforcement of attitudes and beliefs about pain. Adolescence is a time of increased autonomy characterized by, among other complex factors, significant increases in peer influence. Although peers are influential in health-risk behavior, little is known how peers impact adolescents' pain experience. The present study explored the role of peers in adolescents' attitudes toward pain, pain behaviors and over-the-counter analgesics. Methods Sixty-minute focus groups were conducted with a sample 24 junior high school students from Halifax, Nova Scotia, Canada (11 male: mean age = 13.45 years, range = 12–15 years; 13 female: mean age = 13.31 years, range = 12–15 years). Participants were randomly assigned to one of five same-gender focus groups designed to explore a wide breadth and depth of information. Sessions were run until theoretical data saturation. Textual data, from transcribed audiotapes, were analyzed with the constant comparative method. Results Peer influences were apparent in how adolescents communicate about pain and how those communications effect pain expression. Overt pain responses to injury were primarily contextual and depended on perceived threats to peer-time and pain severity. Adolescents were intolerant of peers' pain behaviors when the cause was perceived as not severe. These attitudes impacted how adolescents responded to their own pain; males were careful not to express embarrassing pain in front of peers, females felt no restrictions on pain talk or pain expression. Evidence for peer influence on attitudes toward OTC analgesics was apparent in perceptions of over-use and ease of access. Findings are discussed within the context of social information-processing and gender role expectations. Conclusion Little research has addressed how young people experience pain within the context of the psychosocial influences that dominate during adolescence. The findings provide some insight into the role of peer influences via verbal and non-verbal communication, in adolescents' pain experience. This exploratory study is a necessary first step in understanding the socialization of adolescents' pain experiences.
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Affiliation(s)
- Jill E Hatchette
- Interdisciplinary Research, IWK Health Centre, Halifax, Nova Scotia, B3K 6R8, Canada.
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Kavanagh T, Watt-Watson J, Stevens B. An Examination of the Factors Enabling the Successful Implementation of Evidence-Based Acute Pain Practices into Pediatric Nursing. CHILDRENS HEALTH CARE 2007. [DOI: 10.1080/02739610701377970] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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18
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Kortesluoma RL, Nikkonen M. 'The most disgusting ever': children's pain descriptions and views of the purpose of pain. J Child Health Care 2006; 10:213-27. [PMID: 16940344 DOI: 10.1177/1367493506066482] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This article examines an area of a larger research project, aimed at investigating hospitalized children's experiences of pain. Descriptions of pain and views regarding the purpose of four to 11-year-old children's pain were investigated. A total of 44 hospitalized children participated in the study. The data were collected by means of a qualitative interview with the children. Using qualitative content analysis, interviews were coded and categories identified. Participant descriptions aimed at generalizing the pain. The children specified the nature of the pain and used paraphrases and metaphors. The study demonstrated that most of the children were able to articulate the purpose that they ascribe to their pain. The findings challenge nursing staff to regard the suffering child as an active partner in assessing their pain. An enhanced understanding can better prepare nurses for participating in the management of hospitalized children's pain.
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Peden V, Choonara I, Vater M. Validating the Derbyshire Children's Hospital Pain Tool in children aged 6-12 years. J Child Health Care 2005; 9:59-71. [PMID: 15684440 DOI: 10.1177/1367493505049647] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The Derbyshire Children's Hospital Paediatric Pain Chart (DPC) is the current pain assessment tool used at the Derbyshire Children's Hospital. It was originally devised as a simple pain tool for use in the post-operative clinical area. It is applicable across the spectrum of age groups that present for paediatric surgery. The DPC assesses pain by utilizing three parameters: facial expression, verbal (i.e. self-report) and body movement. This exploratory study was undertaken to determine its reliability and validity in children aged 6-12 years. The research nurse assessed 60 children aged 6-12 years undergoing minor and intermediate surgery and compared the DPC against the validated Oucher Scale. Assessments were performed preoperatively and for four hours post-operatively. Any analgesia administered post-operatively was recorded, and its effects noted. This study supports construct validity and inter-rater reliability of the DPC pain assessment tool for children aged 6-12 undergoing minor and intermediate surgery.
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Affiliation(s)
- Vanessa Peden
- Academic Division of Child Health, University of Nottingham, Derbyshire Children's Hospital, Derby DE22 3NE, UK.
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20
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Siden HB, Collin K. Three patients and their drugs: A parallel case paper on paediatric opiate use and withdrawal. Paediatr Child Health 2005; 10:163-8. [DOI: 10.1093/pch/10.3.163] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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22
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Zawistowski CA, DeVita MA. A descriptive study of children dying in the pediatric intensive care unit after withdrawal of life-sustaining treatment. Pediatr Crit Care Med 2004; 5:216-23. [PMID: 15115557 DOI: 10.1097/01.pcc.0000123547.28099.44] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To examine physiologic and therapeutic changes following withdrawal of life-sustaining treatment in children. DESIGN Retrospective chart review. SETTING University-affiliated tertiary care pediatric hospital. PATIENTS All patients who had life-sustaining treatment withdrawn over a 5-yr period. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS A total of 125 charts were examined to obtain 50 in which the terminal event preceding death was withdrawal of life-sustaining treatment. Data are expressed as median (1st, 3rd quartiles). Median hospital stay before death was 20 days (1st and 3rd quartiles, 8 and 30). Median time from decision to withdraw life-sustaining treatment to actual withdrawal was 30 mins (1st and 3rd quartiles, 10 and 180). All interventions were simultaneously discontinued in 80% of patients with mechanical ventilation followed by vasopressors being most common. No patients had stepwise reduction in ventilator rate before discontinuing the mechanical ventilation. Devices were rarely removed from patients including endotracheal tubes. Time from withdrawal of life-sustaining treatment to death was 15 mins (5, 30); only seven patients took >60 mins to die. Multivariable analysis (Kruskal-Wallis test) of various factors revealed simultaneous withdrawal of life-sustaining treatment, female gender, and not having received renal therapy as hastening death. CONCLUSIONS Forgoing life-sustaining treatment in a small cohort of children at a single institution follows a pattern: Most cases occur after prolonged intensive care unit stays, withdrawal of treatment occurs almost immediately after the decision to withdraw, most treatments are withdrawn simultaneously rather than sequentially, and most patients die within minutes of life-sustaining treatment cessation. This is the first pediatric study to report the time to death after withdrawal of life-sustaining treatment and factors associated with shorter time to death in children.
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Affiliation(s)
- Christine A Zawistowski
- University of Pittsburgh Department of Critical Care Medicine, Critical Care Medicine, Pittsburgh, PA, USA
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23
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Breau LM, MacLaren J, McGrath PJ, Camfield CS, Finley GA. Caregivers' Beliefs Regarding Pain in Children With Cognitive Impairment: Relation Between Pain Sensation and Reaction Increases With Severity of Impairment. Clin J Pain 2003; 19:335-44. [PMID: 14600533 DOI: 10.1097/00002508-200311000-00001] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To determine whether caregivers of children with cognitive impairment (CI) have systematic beliefs regarding the pain of this special group of children and whether these beliefs are related to their general attitudes towards people with mental challenges, or their experience with, or knowledge about, children with CI . PARTICIPANTS Sixty-five caregivers (52 parents and 13 health care providers) of children with significant CI. MEASURES Caregivers completed the Mental Retardation Attitude Inventory-Revised and provided information regarding their previous experience and learning about children with CI. They also completed the Pain Opinion Questionnaire, indicating the percentage of children with mild, moderate, or severe/profound CI that they believe experience 5 facets of pain "less than", "the same as", or "more than" children without CI: sensation, emotional reaction, behavioral reaction, communication, and frequency. RESULTS Caregivers believed children's pain Sensation becomes greater, relative to children without CI, as severity of CI increases and that pain reaction is most consistent with pain sensation for children with severe CI. They also believed children with mild CI may over-react to pain. Caregivers' beliefs regarding pain were not influenced by their general attitudes about people with mental challenges or by their experience with children with CI, but those with more learning regarding children with CI believed that they experience pain less than children without CI. CONCLUSIONS Caregivers have a priori beliefs regarding pain in children with CI that vary with level of cognitive impairment and pain facet. These beliefs could impact children's care.
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Affiliation(s)
- Lynn M Breau
- Department of Psychology, Dalhousie University, Nova Scotia, Canada.
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25
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Abstract
Nurse education does not appear to be preparing nurses to manage pain in the clinical area. A number of studies have demonstrated that nurses continue to have educational deficits in this context. Several studies have found no change in knowledge or behaviours following education about pain management. Others have found that changes in behaviour do occur. It is possible that innovative teaching strategies need to be used. The literature in this area is reviewed and recommendations made.
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Affiliation(s)
- Alison Twycross
- Department of Nursing and Community Care, Glasgow Caledonian University, Glasgow, UK.
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Simons J, Roberson E. Poor communication and knowledge deficits: obstacles to effective management of children's postoperative pain. J Adv Nurs 2002; 40:78-86. [PMID: 12230532 DOI: 10.1046/j.1365-2648.2002.02342.x] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
AIM OF THE STUDY To explore the perceptions of nurses and parents of the management of postoperative pain in children. This paper focuses on issues of knowledge and communication. BACKGROUND Nurses are the key health care professionals with responsibility for managing children's pain, however, nurses are not well supported educationally to manage the level of responsibility. RESULTS Using matched interviews between 20 parents and 20 nurses many issues arose relating to the nurse/parent communication process. It was also clear that despite nurses' knowledge of pain management being deficient, they had expectations that required parents to have a level of knowledge they did not possess. CONCLUSIONS The findings suggest that nurses' poor communication with parents and nurses' knowledge deficits in relation to children's pain management create obstacles to effective pain management. These obstacles need to be addressed in order to improve the management of children's pain through better education of nurses and two way communication with parents.
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Affiliation(s)
- Joan Simons
- Children's Pain Research Centre, Institute of Child Health, London [corrected].
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27
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Simons JM. An action research study exploring how education may enhance pain management in children. NURSE EDUCATION TODAY 2002; 22:108-117. [PMID: 11884191 DOI: 10.1054/nedt.2001.0655] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
The aim of this study was to explore and address the views of children's nurses in relation to their educational needs on pain management. Action research was the methodology used: focus groups were run to identify the problem of nurses' educational needs; action planning was used to develop a short programme of study for nurses to address identified needs. Evaluation was by questionnaire and semi-structured interviews. Ten children's nurses attended the study day. All the nurses said they gained knowledge on the day--in particular assessment of pain and the individuality of the pain experience. The nurses felt that their new knowledge increased their confidence and contributed to them feeling assertive when managing children's pain. The study findings suggest that the current provision in relation to education programmes for children's nurses needs to be improved, in order to provide them with the knowledge and confidence to manage children's pain more effectively.
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Affiliation(s)
- Joan M Simons
- Children Nationwide, Children's Pain Research Centre, Room 139, Province of Natal, Institute of Child Health, 30 Guildford Street, London, WC 1N IEH, UK
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Abstract
AIM OF THE STUDY This study investigated the views of parents and nurses about the involvement of parents in the management of their child's pain during the first 48 hours after surgery. BACKGROUND Children's pain management has been found to be problematic and in need of improvement. Nurses are the key health care professionals with responsibility for managing children's pain. Parents can make important contributions to assessment and management of their child's pain. METHODS Using a phenomenological approach, nurses and parents were interviewed about their perceptions of parent involvement in pain management. FINDINGS The findings indicated that parental involvement in their child's pain management is superficial and limited in nature. Parents described a passive role in relation to their child's pain care and conveyed feelings of frustration. Only a minority of parents expressed satisfaction with their child's pain care. Nurses perceived that there was adequate involvement of parents and adequate pain management for children. CONCLUSIONS These findings may be somewhat explained by differing views and a lack of effective communication between parents and nurses. There is a clear need for nurses to discuss parent involvement with parents and negotiate roles in relation to pain management.
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Affiliation(s)
- J Simons
- Institute of Child Health, London, UK.
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Abstract
Children frequently received no treatment, or inadequate treatment, for pain and for painful procedures. The newborn and critically ill children are especially vulnerable to no treatment or under-treatment. Nerve pathways essential for the transmission and perception of pain are present and functioning by 24 weeks of gestation. The failure to provide analgesia for pain results in rewiring the nerve pathways responsible for pain transmission in the dorsal horn of the spinal cord and results in increased pain perception for future painful results. Many children would withdraw or deny their pain in an attempt to avoid yet another terrifying and painful experiences, such as the intramuscular injections. Societal fears of opioid addiction and lack of advocacy are also causal factors in the under-treatment of pediatric pain. False beliefs about addictions and proper use of acetaminophen and other analgesics resulted in the failure to provide analgesia to children. All children even the newborn and critically ill require analgesia for pain and painful procedures. Unbelieved pain interferes with sleep, leads to fatigue and a sense of helplessness, and may result in increased morbidity or mortality.
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Affiliation(s)
- M Yaster
- Departments of Anesthesiology/Critical Care Medicine and Pediatrics, Johns Hopkins Hospital, Baltimore, MD 21287, USA
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Abstract
This article presents a model of integrated palliative care for children with life-limiting illnesses, with emphasis on collaboration of care over time among family, primary care providers, and several other groups of providers. Some of the unique aspects of caring for children related to normal developmental changes and the family unit are considered. Issues related to pain and to specific diseases are also reviewed.
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Affiliation(s)
- S Chaffee
- Department of Pediatrics, Section of Hematology/Oncology, Dartmouth Medical School, Hanover, New Hampshire, USA.
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31
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Abstract
The management of pain in terminally ill pediatric patients has incalculable benefits to patients, their families, and physicians and nurses. A therapeutic management plan is dependent on a thorough understanding of the causes of pain in these patients, on pain assessment, and on the myriad drugs and drug strategies that are essential in pain treatment. Aggressive symptom control of treatment-related side effects can ensure successful implementation of such a plan.
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Affiliation(s)
- K S Galloway
- Department of Anesthesiology, Johns Hopkins Hospital, Baltimore, Maryland, USA
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Abstract
The past decade has brought about an explosion of knowledge about the physiology of nociception and many new techniques for pain relief, new analgesic drugs, and new applications of old analgesic drugs. These techniques include methods of opioid administration by transdermal and transmucosal absorption and the use of neuraxial analgesia for the management of pain in children. Interest in the use of regional anesthesia in children has been rekindled, and analgesic properties and pre-emptive analgesic properties of many agents not typically considered analgesics, such as clonidine and ketamine, have been recognized. Perhaps the greatest advance has been the paradigm shift in the recognition that pain not only exists in infants and children but also is a significant cause of morbidity and even mortality. Given the unprecedented interest in pain management in adults and children, physicians can now look forward to the development of new methods of drug delivery and of receptor-specific drugs that divorce analgesia from the untoward side effects of existing analgesics. Improvement in the quality of life of hospitalized children also will occur.
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Affiliation(s)
- B Golianu
- Department of Anesthesia, Stanford University Medical Center, California, USA
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Greenberg RS, Billett C, Zahurak M, Yaster M. Videotape increases parental knowledge about pediatric pain management. Anesth Analg 1999; 89:899-903. [PMID: 10512262 DOI: 10.1097/00000539-199910000-00015] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
UNLABELLED Pediatric pain management often depends on parents recognition and assessment of their child's pain and their beliefs as to whether the pain should be treated. Parental misconceptions concerning pain assessment and pain management may therefore result in inadequate pain treatment, particularly in patients who are too young or too developmentally handicapped to self-report their pain. We hypothesized that viewing a concise, educational videotape would provide parents with instructive information that could correct misconceptions concerning pain and pain management in children. To do this, we evaluated the impact of an educational videotape on parental responses to a questionnaire about pediatric pain management. Parents of children scheduled for inpatient, postoperative hospital care were studied. After answering 30 questions, parents were randomly assigned to either view (Group 1) or not view (Group 2) a 19-min educational videotape. Immediately after viewing the videotape (Group 1), or 30 min after taking the first test (Group 2), parents were asked to answer the same questionnaire a second time. The effect of seeing the videotape was assessed by comparing post-pre test score differences using paired t-test. One-hundred parents were studied. Randomization was effective in assigning equitable groups. Initial scores of percent answers correct in each group were not different ([mean +/- SD] Group 1 [n = 50]: 68.7% +/- 18.8% vs Group 2 [n = 50]: 61.5% +/- 22.7%; P = 0.09). Viewing the videotape effectively increased test scores: paired t-test within groups demonstrated a significant difference in Group 1 (22.4% +/- 16.5%, P < 0.0001), whereas Group 2 scores changed to a much lesser degree (2.7% +/- 8.3%, P = 0.0271). All parents who viewed the videotape stated that it was informative regarding their understanding of their child's pain management. This study demonstrates the effectiveness of an educational videotape in changing parental knowledge concerning postoperative pediatric pain. This effective and efficient teaching medium may be useful in improving pain management in postoperative pediatric surgical patients. IMPLICATIONS Pediatric pain management often depends on parents recognition and assessment of their child's pain and their beliefs as to whether the pain should be treated. This prospective, randomized, controlled study demonstrated the effectiveness of an educational videotape in changing parental knowledge concerning postoperative pediatric pain. This effective and efficient teaching medium may be useful in preventing inadequate pain management in postoperative pediatric surgical patients.
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Affiliation(s)
- R S Greenberg
- Department of Anesthesiology/Critical Care Medicine, The Johns Hopkins Hospital, Baltimore, Maryland 21287, USA.
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Greenberg RS, Billett C, Zahurak M, Yaster M. Videotape Increases Parental Knowledge About Pediatric Pain Management. Anesth Analg 1999. [DOI: 10.1213/00000539-199910000-00015] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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35
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Abstract
Children are still enduring unnecessary pain. Nurses and other health care professionals continue to believe the misconceptions about paediatric pain which contribute to this. These misconceptions have all been shown to have no scientific basis.
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Affiliation(s)
- A Twycross
- University of Central England, Edgbaston, Birmingham
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