Highlights
- •Families experienced major surgery as a stressful event, well beyond return home.
- •Families felt under-prepared for surgery, particularly pain and physical recovery.
- •Families and providers were interested in a perioperative psychosocial intervention.
- •Flexible delivery of an intervention teaching coping skills at home would be ideal.
Abstract
Research developing targeted treatment focused on coping with children's long-term
pain after surgery is needed because of the high prevalence of chronic pain after
surgery. This qualitative study aimed to: 1) understand the child's and family's experiences
of pain over the course of their surgical experience, and 2) gather stakeholder input
regarding potential barriers and facilitators of perioperative intervention delivery.
Fifteen children ages 10 to 18 years who underwent recent major surgery, their primary
caregivers, and 17 perioperative health care providers were interviewed. Interviews
were coded using semantic thematic analysis. The perioperative period presented emotional
challenges for families. Families felt unprepared for surgery and pain. Recovery and
regaining physical functioning at home was challenging. Families struggled to return
to valued activities. Families reported interest in a perioperative psychosocial intervention.
Providers endorsed that families would benefit from enhanced coping skills. They emphasized
that families would benefit from more detailed preparatory information. Providers
suggested that flexible intervention delivery at home would be ideal. Research developing
interventions addressing pain and anxiety in children undergoing major surgery is
critically needed. The findings of the present study can inform intervention development
with the aim of improving short- as well as long-term recovery in children undergoing
major surgery.
Perspective
This qualitative study examined children and their parents’ experience of long-term
pain and recovery after major surgery, identifying barriers and facilitators of perioperative
intervention delivery. Families experienced surgery as stressful, and felt underprepared
for pain and recovery. Families and health care providers expressed interest in a
preoperative intervention teaching coping skills.
Key words
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to The Journal of PainAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Early rehabilitation targeting cognition, behavior, and motor function after lumbar fusion: a randomized controlled trial.Spine (Phila Pa 1976). 2010; 35: 848-857
- Using thematic analysis in psychology.Qual Research Psychol. 2006; 3: 77-101
- Caregivers’ descriptions of sleep changes and depressive symptoms.Oncol Nurs Forum. 2002; 29: 1277-1283
- Guided imagery for adolescent post-spinal fusion pain management: A pilot study.Pain Manag Nurs. 2015; 16: 211-220
- Importance of the back-cafe concept to rehabilitation after lumbar spinal fusion: A randomized clinical study with a 2-year follow-up.Spine (Phila Pa 1976). 2003; 28: 2561-2569
- Predictors of postoperative pain trajectories in adolescent idiopathic scoliosis.Spine. 2014; 39: E174-E181
- Psychological interventions in managing postoperative pain in children: A systematic review.Pain. 2016; 157: 1872-1886
- 2004 National Hospital Discharge Survey.Adv Data. 2006; : 1-19
- Psychological therapies (remotely delivered) for the management of chronic and recurrent pain in children and adolescents.Cochrane Database Syst Rev. 2015; : CD011118
- Web-based tailored intervention for preparation of parents and children for outpatient surgery (WebTIPS): Formative evaluation and randomized controlled trial.Anesth Analg. 2015; 120: 915-922
- The effects of hypnosis/guided imagery on the postoperative course of children.J Dev Behav Pediatr. 1996; 17: 307-310
- Cognitive-behavioral intervention effects on adolescents’ anxiety and pain following spinal fusion surgery.Nurs Res. 2003; 52: 183-190
- Use of the PREPARE (PREhabilitation, Physical Activity and exeRcisE) program to improve outcomes after lumbar fusion surgery for severe low back pain: A study protocol of a person-centred randomised controlled trial.BMC Musculoskelet Disord. 2016; 17: 349
- Management of catastrophising and kinesiophobia improves rehabilitation after fusion for lumbar spondylolisthesis and stenosis. A randomised controlled trial.Eur Spine J. 2014; 23: 87-95
- Standards for reporting qualitative research: A synthesis of recommendations.Acad Med. 2014; 89: 1245-1251
- Hispanic parents’ experiences of the process of caring for a child undergoing routine surgery: A focus on pain and pain management.J Spec Pediatr Nurs. 2015; 20: 165-177
- Parental risk factors for the development of pediatric acute and chronic postsurgical pain: A longitudinal study.J Pain Res. 2013; 6: 727-741
- Identification of pain-related psychological risk factors for the development and maintenance of pediatric chronic postsurgical pain.J Pain Res. 2013; 6: 167-180
- Internet-delivered cognitive-behavioral treatment for adolescents with chronic pain and their parents: A randomized controlled multicenter trial.Pain. 2016; 157: 174-185
- Pain and health-related quality of life after pediatric inpatient surgery.J Pain. 2015; 16: 1334-1341
- Trajectories of postsurgical pain in children: Risk factors and impact of late pain recovery on long-term health outcomes after major surgery.Pain. 2015; 156: 2383-2389
- Interrelationships between sleep and pain in children undergoing major surgery.J Pain. 2016; 17: S37
- Does preoperative orientation and education alleviate anxiety in posterior spinal fusion patients? A prospective, randomized study.J Pediatr Orthop. 2015; 35: 276-279
- Does a preoperative cognitive-behavioral intervention affect disability, pain behavior, pain, and return to work the first year after lumbar spinal fusion surgery?.Spine (Phila Pa 1976). 2015; 40: 593-600
- Stress symptoms among adolescents before and after scoliosis surgery: Correlations with postoperative pain.J Clin Nurs. 2016; 25: 1086-1094
- Parents’ self-identified stressors and coping strategies during adolescents’ spinal surgery experiences.Clin Nurs Res. 2007; 16: 212-230
- Understanding the information and service needs of young adults with chronic pain: Perspectives of young adults and their providers.Clin J Pain. 2013; 29: 600-612
- Qualitative rigor or research validity in qualitative research.J Spec Pediatr Nurs. 2011; 16: 151-155
- Commentary: Writing and evaluating qualitative research reports.J Pediatr Psychol. 2016; 41: 493-505
Article info
Publication history
Published online: February 20, 2017
Accepted:
February 6,
2017
Received in revised form:
January 31,
2017
Received:
December 15,
2016
Footnotes
This study was funded by the American Pain Society Future Leaders in Pain Research Award (PI: Rabbitts); J.A.R. is also supported by Eunice Kennedy Shriver National Institute of Child Health & Human Development of the National Institutes of Health under Award Number K23HD078239; T.M.P. is supported by NIH K24HD060068; R.V.A. is supported by T32GM086270.
The authors have no conflicts of interest to declare.
Identification
Copyright
© 2017 by the American Pain Society
