Procedural and postoperative pain management in children : experiences, assessments and possibilities to reduce pain, distress and anxiety

Abstract: Introduction Children’s visits to hospital are often connected with painfulexaminations and treatments. If these situations are associated withunsuccessful alleviation of pain, the children may develop distress, anxiety and even pain sensitization. Effective pain management including pharmacological treatment and coping methods that support the children when undergoing examinations or treatments could reduce these harmful effects. Distraction methods such as serious games and music medicine are techniques to deviate attention away from procedural or postoperative pain, and these may help children create positive experiences. There is a need to examine these interventions among children in hospital. Aim The overall purpose of this thesis was to investigate procedural and postoperative pain management among children in hospital. The specific aims were to describe a group of children’s experiences of pain in conjunction with procedural pain to validate an observational behavioural scale for procedural pain assessment in children aged 5-16 years to study pain intensity and distress among children using serious games and music medicine to describe children’s experiences of the use of serious games and music medicine. Methods Two hundred and twelve children who underwent a medical or surgical procedure at the Queen Silvia Children’s hospital in Gothenburg participated in one or two studies, and data were collected with assessment scales, vital signs and interviews. All the data were analyzed using approved methods of analysis. Results The results showed that the children emphasized nurses who were clinically competent and that they wanted to participate in decision making concerning distraction techniques as a complement to pharmacological treatment. An observational assessment scale, the Face, Legs, Activity, Cry and Consolability (FLACC) scale, was avaluable tool for assessing procedural pain and complementing retrospective self-reported pain and distress. Distraction techniques were helpful coping strategies for the children, who also needed to feel secure in the pain management. In children undergoing needle related procedures, serious games reduced pain intensity, but only for those who liked the game, and the interviews showed increased wellbeing. Music medicine reduced morphine consumption and decreased the children’s distress when they underwent day surgery. Conclusions The conclusions of this thesis are that procedural pain can be evaluated using the FLACC scale, the children want to participate in decision-making on distraction techniques such as serious games or music medicine and these self-selected distraction techniques are also helpful coping strategies for the children.