Chronic Pain in Hospitalized Infants: Health Professionals' Perspectives
Received 24 September 2008; received in revised form 16 April 2009; accepted 21 April 2009. published online 22 June 2009.
Abstract
Potentially significant numbers of infants hospitalized in Neonatal Intensive Care Units (NICUs) and Pediatric Intensive Care Units (PICUs) experience chronic pain. However, the phenomenon of chronic pain in infancy has neither been defined nor described adequately by researchers. To stimulate and focus further work in the area, the purpose of this study was to explore expert opinions on definitional and assessment parameters of infant chronic pain. Forty-five health care professionals, with a median of 17 years of clinical experience, were recruited from 4 tertiary-level, university-affiliated institutions. Individual (n=24) and group (n=21) interviews were conducted by trained interviewers. Qualitative data were analyzed using a standard descriptive method. Health care professionals were able to offer preliminary definitions of chronic pain in infants. The most contentious definitional issue was whether iatrogenically prolonged pain (pain induced and maintained by medical procedures) should be considered chronic pain. Possible indicators for chronic pain included inability to settle, social withdrawal, constant grimacing, tense body, hypo- or hyper-reactions to acute pain, and dysregulated sleep or feeding patterns. These indicators differed significantly from those traditionally used to measure acute pain.
Perspective
Despite infants' established capacity to physiologically experience chronic pain, no current definitions exist that are wholly applicable to infancy. By exploring the definitional parameters and potential assessment cues of infant chronic pain, this study provides a foundation for improving pain measurement and management in infants with chronic pain.
∗Department of Psychology, York University, Toronto, Ontario, Canada
†Department of Psychiatry Research, Hospital for Sick Children, Toronto, Ontario, Canada
‡Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Ontario, Canada
§Child Health Evaluative Sciences Program, Research Institute, Hospital for Sick Children, Toronto, Ontario, Canada
‖Department of Newborn and Developmental Paediatrics, Sunnybrook and Women's, Toronto, Ontario, Canada
¶Department of Pediatrics, University of Toronto, Ontario, Canada
∗∗Toronto General Research Institute, Toronto General Hospital, Ontario, Canada
††Bloorview Research Institute, Bloorview Kids Rehab, Toronto, Ontario, Canada
Address reprint requests to Dr Rebecca Pillai Riddell, York University, The O.U.C.H. Lab, Department of Psychology, Faculty of Health, 119 Behavioural Sciences Building, Toronto, Ontario M3J 1P3.
Supported by a grant from the Canadian Institutes of Health Research, a C.I.M.R. New Investigator Award to Dr Pillai Riddell, and student awards to Ms Din and Ms Ahola (also supported over the duration of this project by the Ontario Graduate Scholarship program).
ABSTRACT