Commentary on Twycross A, Finley GA (2013) Children's and parents' perceptions of postoperative pain management: a mixed methods study. Journal of Clinical Nursing 22, 3095–3108

Authors

  • Eileen Wake MSc, RNMH, RSCN

    Paediatric Nurse Lecturer, Corresponding author
    1. University of Hull, Hull, UK
    • Correspondence: Eileen Wake, Paediatric Nurse Lecturer, University of Hull, Cottingham Road, Hull HU6 7RX, UK. Telephone: +1482 463342.

      E-mail: e.v.wake@hull.ac.uk

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The study by Twycross and Finley (2013) illustrates that paediatric pain management following elective surgery remains problematic. It demonstrates that despite the wide ranging pharmacological and nonpharmacological resources available, children continue to experience unjustifiable pain. The study questions whether some practitioners, despite evidence-based guidance, (Association of Paediatric Anaesthetists 2012) manage children's pain suboptimally. The rationale for the study was, despite a wealth of literature on paediatric pain, much is over a decade old and few studies use data from parents and children. This study confirms this and stresses advocacy for sick children, especially given the long-term health outcomes when acute pain is poorly managed. Although a small study (10 children and 10 parents), the study would be transferable to other settings due to a strong design. The methodology used with the children was that of draw and tell/write Horstman et al. (2008), an effective tool to listen to children's feelings and wishes, for example used by Gibson et al. (2005). Parents were interviewed using the Foster and Varni (2002) Information about Pain Questionnaire. Interviews occurred in the hospital; however, postdischarge replication would have enabled participants to speak more freely, an acknowledged study limitation. The study is invaluable as it raises concerns about practitioners' responses to children's pain. Despite the child and family focus of paediatric nursing, children's expressions of distress and pain are not always used as part of pain management decision-making. It also shows the longstanding myth that children overestimate their pain remains. The authors recommend the use of mutual pain goals to be used with the children and parents. This is an effective way forward, particularly given that parents in the study appeared to express commonly held beliefs regarding over medication, which could be explored pre-operatively to reassure them. Indeed, two parents commented positively on the use of morphine, thus it would been useful to have interviewed parents pre-operatively to illicit whether they had concerns that were alleviated by the pain strategies used. One theme consistently highlighted was an expectation that children will experience significant pain and that nurses did everything they could to ameliorate the pain. However, given that elective postoperative pain can be anticipated, it raises questions for further study; why the pain was not anticipated by staff and prophylactic pain relief provided – perhaps the myths about children's pain management still prevail? It is also of note that whilst pain relief was administered, it appears that children were offered pharmacological or nonpharmacological approaches rather than a more effective combination. An additional concern was the lack of pre-operative preparation for some children which is known to exacerbate children's distress. In conclusion, this study reinforces the need for practitioners to revisit their attitudes, beliefs and behaviours in relation to paediatric pain management. Further study is needed to explore why some practitioners appear unable to effectively respond to children's needs despite the guidance and education for practitioners in place.

Disclosure

The authors have confirmed that all authors meet the ICMJE criteria for authorship credit (www.icmje.org/ethical_1author.html), as follows: (1) substantial contributions to conception and design of, or acquisition of data or analysis and interpretation of data, (2) drafting the article or revising it critically for important intellectual content, and (3) final approval of the version to be published.

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