An Innovative Assessment of Adult Influences on Children's Postoperative Pain

描述（由申请人提供）：在美国，每年有超过500万儿童接受手术，尽管最近取得了进展，但手术后儿童的疼痛仍然是一个重要问题。据报道，高达49%的儿童在住院期间患有临床上明显的疼痛，而且这种疼痛绝大多数得不到治疗。阿片类药物和非甾体类抗炎药等药物方法通常被认为是术后疼痛管理的第一线。然而，有充分证据表明，疼痛是一种复杂的、多方面的疾病，单靠药物治疗是无法达到最佳治疗效果的。相反，有必要注意解决疼痛的非药物方法。改变医护人员和家长的行为，以应对儿童的疼痛，是一种有效的干预手术疼痛设置（例如，免疫接种），但很少知道成人的行为和儿童的疼痛之间的关系，在术后设置。手术过程和术后环境之间存在明显差异，这无疑会影响成人行为与儿童疼痛之间的关系。例如，术后疼痛比手术疼痛持续时间更长，父母和儿童在围手术期环境中的经验通常少于初级保健。为了制定有效的干预措施，解决成人的行为，这是至关重要的，首先经验确定具体的父母和卫生保健人员的行为，增加或减少儿童术后疼痛。这将通过获得父母-儿童保健提供者行为相互作用的术后顺序过程导向视图，并通过使用稳健的顺序分析技术来实现。该研究的主要目的是确定影响儿童术后疼痛的特定父母和医疗保健提供者行为。作为次要目的，我们将确定儿童特征（例如，年龄），可能会缓和父母和医疗保健提供者行为对儿童术后疼痛的影响。识别影响儿童术后疼痛的行为互动模式将有助于为父母和医疗保健提供者制定和评估术后疼痛管理的循证培训计划。

DESCRIPTION (provided by applicant): Over five million children undergo surgery in the United States each year and, despite recent advances, pain in children following surgery continues to be a significant problem. It is reported that up to 49% of children suffer clinically significant pain while in hospital and this pain is overwhelmingly under treated. Pharmacological methods such as opioids and non-steroidal anti-inflammatory agents are generally considered the first line of postoperative pain management. It is well documented, however, that pain is a complex, multidimensional condition that can not be optimally treated by medication alone. Instead, it is necessary to attend to nonpharmacological methods of addressing pain. Changing behaviors of healthcare personnel and parents in response to children's pain has been an effective intervention in procedural pain settings (e.g., immunizations), but little is known about the relations between adult behavior and children's pain in postoperative settings. There are distinct differences between the procedural and postoperative environments that undoubtedly influence the relations between adult behaviors and children's pain. For example, postoperative pain is of a longer duration than procedural pain and parents and children generally have less experience in perioperative environments than in primary care. To develop effective interventions that address adult behavior, it is of utmost importance to first empirically identify the specific parent and health-care personnel behaviors that increase or decrease children's postoperative pain. This will be achieved by obtaining a postoperative sequential process-oriented view of parent-child-health care provider behavioral interactions and by using robust sequential analysis techniques. Primary aims of the study are to identify specific parent and healthcare provider behaviors that influence children's postoperative pain. As a secondary aim, we will identify child characteristics (e.g., age) that may moderate the influence of parent and healthcare provider behaviors on children's postoperative pain. Identification of behavioral interaction patterns that influence children's postoperative pain will facilitate the development and evaluation of evidence-based training programs for parents and healthcare providers' in postoperative pain management. PUBLIC HEALTH RELEVANCE: At the conclusion of the study described in this application, we will have identified specific parental and healthcare provider behaviors that are associated with increased or decreased pain immediately following surgery and at home. This information will allow us to develop data-driven behavioral preparation programs that will teach parents, nurses, anesthesiologists and surgeons in how to reduce children's pain in the postoperative process. This newly developed, low-cost, parental and healthcare provider preparation program can be widely adaptable to nearly any medical facility in the United States.