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Long-Term Pain and Recovery After Major Pediatric Surgery: A Qualitative Study With Teens, Parents, and Perioperative Care Providers

  • Jennifer A. Rabbitts
    Correspondence
    Address reprint requests to Jennifer A. Rabbitts, MB, ChB, Seattle Children's Hospital, 4800 Sand Point Way NE, MB.11.500.3, Seattle, WA 98105.
    Affiliations
    Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, Washington

    Center for Clinical and Translational Research, Seattle Children's Hospital, Seattle, Washington
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  • Rachel V. Aaron
    Affiliations
    Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, Washington

    Center for Child Health, Behavior and Development, Seattle Children's Hospital, Seattle, Washington
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  • Emma Fisher
    Affiliations
    Center for Child Health, Behavior and Development, Seattle Children's Hospital, Seattle, Washington
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  • Emily A. Lang
    Affiliations
    Center for Child Health, Behavior and Development, Seattle Children's Hospital, Seattle, Washington

    Department of Biological Sciences, Columbia University, New York, New York
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  • Caroline Bridgwater
    Affiliations
    Department of Microbiology, University of Washington, Seattle, Washington

    Center for Child Health, Behavior and Development, Seattle Children's Hospital, Seattle, Washington
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  • Gabrielle Ghafari Tai
    Affiliations
    Center for Child Health, Behavior and Development, Seattle Children's Hospital, Seattle, Washington
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  • Tonya M. Palermo
    Affiliations
    Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, Washington

    Center for Child Health, Behavior and Development, Seattle Children's Hospital, Seattle, Washington
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Published:February 20, 2017DOI:https://doi.org/10.1016/j.jpain.2017.02.423

      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

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