Despite the increasing acceptance of biopsychosocial models of pain and multidisciplinary treatments for pain, relatively little is known about the specific psychological variables and social processes related to postoperative pain in children, especially in an outpatient setting. The present study examined demographic, medical, and psychological predictors of children's pain and parents' administration of pain medication. Two hundred and thirty-six families with children aged 2 to 12 undergoing day surgery participated in the study. This included a subset of 100 children aged 6 to 12, who were asked to complete self-report measures of anxiety, expected pain, coping style, and pain. Parents of all children completed measures of expected pain, expected benefit from medication, perspective taking, and negative attitudes towards analgesics. Parents and school-aged children completed pain diaries on the day of surgery and two days following surgery. The prevalence of clinically significant pain was somewhat lower than in previous studies, but both pain and undertreatment (parents who gave less than the recommended amount of pain medication) remained common. Predictors of pain were examined by multiple regression, using data from the subset of 100 children aged 6 to 12. More intense pain was related to more invasive surgery, a constellation of analgesic-related variables (more doses of analgesia given, the use of a regional block, the use of local infiltration), high anxiety, high expectations of pain, and a tendency to cope with pain by acting out and catastrophizing. Predictors of dosing were examined by multiple regression, using data from the entire sample of 236 children. Parents gave more medication when their children had invasive surgery and high levels of pain, when they expected a lot of pain, and when they were relatively unconcerned about the negative effects of pain medication. In each case, the psychological variables, entered as a block, were significant predictors of pain even after controlling for demographic and medical variables. Health care providers should be aware of psychological factors predicting pain, as they may help to identify families that are at "high risk" for pain and undermedication. In addition, the variables identified in this study are appropriate targets for further research on psychological factors that cause, mediate or contribute to pain processes, and as such may contribute to the development of theoretical models of pain and pain management.

Chronic pain among children is poorly understood and few studies attempt to elicit and portray the experiences of the sufferers and their families. This qualitative case study used art inquiry and narrative methodologies as a means to understand the participants' stories of chronic pain. The participating family has a child aged 6 who has been experiencing unexplained chronic pain for over 2 years. Data were gathered through five art making sessions. The first stage of analysis occurred during the art making sessions as participants and researcher worked together to understand the messages and meanings within their creations. The researcher then compiled the debriefing transcripts into stories that capture the core of these messages and meanings. Finally, the researcher pulled together themes and points of interest in terms of satisfying the purpose of this inquiry and responding to the guiding research questions.

Tez (Tıpta Uzmanlık) - Süleyman Demirel Üniversitesi, Tıp Fakültesi, Çocuk Sağlığı ve Hastalıkları Anabilim Dalı, 2002. / Bibliyografya var.

Despite the increasing acceptance of biopsychosocial models of pain and multidisciplinary treatments for pain, relatively little is known about the specific psychological variables and social processes related to postoperative pain in children, especially in an outpatient setting. The present study examined demographic, medical, and psychological predictors of children's pain and parents' administration of pain medication. Two hundred and thirty-six families with children aged 2 to 12 undergoing day surgery participated in the study. This included a subset of 100 children aged 6 to 12, who were asked to complete self-report measures of anxiety, expected pain, coping style, and pain. Parents of all children completed measures of expected pain, expected benefit from medication, perspective taking, and negative attitudes towards analgesics. Parents and school-aged children completed pain diaries on the day of surgery and two days following surgery. The prevalence of clinically significant pain was somewhat lower than in previous studies, but both pain and undertreatment (parents who gave less than the recommended amount of pain medication) remained common. Predictors of pain were examined by multiple regression, using data from the subset of 100 children aged 6 to 12. More intense pain was related to more invasive surgery, a constellation of analgesic-related variables (more doses of analgesia given, the use of a regional block, the use of local infiltration), high anxiety, high expectations of pain, and a tendency to cope with pain by acting out and catastrophizing. Predictors of dosing were examined by multiple regression, using data from the entire sample of 236 children. Parents gave more medication when their children had invasive surgery and high levels of pain, when they expected a lot of pain, and when they were relatively unconcerned about the negative effects of pain medication. In each case, the psychological variables, entered as a block, were significant predictors of pain even after controlling for demographic and medical variables. Health care providers should be aware of psychological factors predicting pain, as they may help to identify families that are at "high risk" for pain and undermedication. In addition, the variables identified in this study are appropriate targets for further research on psychological factors that cause, mediate or contribute to pain processes, and as such may contribute to the development of theoretical models of pain and pain management. / Arts, Faculty of / Psychology, Department of / Graduate

Several etiological models of recurrent abdominal pain (RAP) in children have been proposed but no one model has been able to adequately account for the symptoms of all children with RAP. The present study proposed that symptom presentation may provide a basis for treatment selection. Two etiological models were tested in the present study: the constipation model and the operant learning model. Subjects were assigned to either model based upon whether or not they presented with symptoms of constipation. The treatments derived from these two models were: daily dietary fiber supplements, and teaching children relaxation skills and teaching parents to respond to their child’s pain complaints by encouraging their child to cope with pain through relaxation. Thirteen subjects between the ages of six and 12 years of age were treated in a nonconcurrent multiple baseline A-B or A-B-C design. To control for nonspecific effects, some subjects in each model received the treatment suggested by the alternative model first. All four subjects in the constipation model showed substantial reductions in stomachache activity following the introduction of the dietary fiber treatment. Of the nine subjects in the operant learning model, one showed substantial reductions in stomachache activity following the introduction of the relaxation and parent instruction treatment, two showed reductions during both treatments, four responded to the dietary fiber treatment, and two showed no response to treatment. Results support the effectiveness of a dietary fiber treatment for children with RAP with symptoms of constipation. Minimal support was obtained for the effectiveness of a relaxation and parent instruction treatment for children with RAP without symptoms of constipation. Limitations, implications and directions for future research are discussed. / Ph. D.

Indiana University-Purdue University Indianapolis (IUPUI) / Chronic pain, defined as pain lasting more than 3 months, is a common and costly health condition. Thirty-three percent of adults and upwards of 35% of children report experiencing pain due to various diseases, disorders, or accidents. Recent research has identified perceived injustice and anger as important constructs in an adult’s pain experience and a possible focus for intervention efforts. The present study explored the extent to which perceived injustice and anger expression operate similarly in children with chronic pain as in adults. This was a retrospective analysis of data from 122 patients seeking treatment at a pediatric pain clinic. Results supported anger expression as a mediator in the relationship between perceived injustice and pain intensity but not psychological distress, suggesting that anger expression operates similarly in children as in adults with chronic pain. Unlike previous findings in adults with chronic pain, injustice did not moderate the relationship between pain intensity and psychological distress, suggesting that injustice operates differently in children with chronic pain compared to adults. The strong association between injustice and pain outcomes (i.e. pain intensity, quality of life, functional disability) suggests that injustice is an important construct to explore in the chronic pain experience of children.

This study was designed to investigate the experience of having arthritic pain from the children's perspective. Previous research on how Canadian children perceive and manage arthritic pain and how it affects their daily lives is nonexistent. Therefore the purpose of this qualitative descriptive study was to explore and describe the arthritic pain experience of school age children with juvenile rheumatoid arthritis (JRA) and to understand the impact/influence of various factors on the construction of that experience. Ten children, aged 10 to 13 years, with either early (at 2 to 4 years) or late (at 7 to 11 years) onset arthritis participated in this study. Descriptive data were obtained during two open-ended in depth interviews with the children in their homes. Using content analysis, data were analyzed for themes and their elements. An analytical framework of themes and their elements was developed that reflected the children's descriptions of and explanations for arthritic pain in the context of their day to day in the context of their day to day living with arthritis, both in the past and currently. The children perceived pain to be synonymous with arthritis and the mediating factor in how they functioned. They described arthritic pain in relation to distinguishing factors: intensity, duration, and frequency. Intermittent arthritic pain was attributed to cessation of medications, arthritis "flare-ups," inactivity, and activity. A current concern for most children was pain attributed to activity because it meant limitations in activities with peers. The children identified strategies they used to manage pain and cope with pain's unpredictability. The findings of this study were discussed in relation to selected research studies that either supported or refuted the findings of this study. Implications for nursing practice and research were addressed. / Applied Science, Faculty of / Nursing, School of / Graduate

A review of the literature identified that few research studies have been published which examined the post-operative pain of children, particularly those between the ages of 4 and 7 years. As a result, theoretical literature has been the major contributor to the understanding of the concept of children's post-operative pain. Therefore, the purpose of this study was to describe the post-operative pain of hospitalized children aged 4 to 7 years on the first postoperative day, through a self-reported measure of pain intensity levels as well as descriptions of the children's overt behaviours used to express pain. Data were gathered on the pain intensity levels (using the PCT) and overt behaviours of 11 children between the ages of 4 and 8 years on the first post-operative day between the hours of 0800 and 2000. In addition, data regarding parental presence and the administration of analgesics were also collected for these children. Findings related to pain intensity scores provided the basis for three important conclusions. First, all of the children were able to place a value on their pain using the PCT. Second, all of the children were experiencing some degree of post-operative pain possibly related to the lack of consistent administration of analgesia. Third, parental presence did not influence the pain intensity scores reported by the children. Findings related to the overt behaviours exhibited by children also provided the basis for three important conclusions. First, the most frequent behaviours identified were not those normally associated with feelings of pain. The researcher believed that this lack of expected response was as a result of the children's ability to adapt and cope with the pain. Second, behavioural measurement of pain may not be a reliable and valid measure of post-operative pain. Third, parental presence or absence did not influence the overt behaviours exhibited. / Applied Science, Faculty of / Nursing, School of / Graduate

The purpose of this current study is to examine the impact of non-pharmacologic pain interventions administered by trained Child Life professionals in an emergency department on pain perception in children. Results showed no significant decrease in children's pain report during the medical procedure compared to before the medical procedure. However, pain after the medical procedure is significantly less than pain during the medical procedure.