Management of Post Operative Pain in Underserved Populations

描述（由申请人提供）：在美国接受手术的500多万儿童中，据估计，高达65%的儿童在医院和以后在家时会经历严重的疼痛。在过去的十年里，门诊手术变得越来越普遍，因此在家处理术后疼痛的负担主要落在了父母身上。不幸的是，我们实验室的一些研究以及其他研究表明，许多儿童手术后的疼痛在家庭环境中明显得不到充分治疗。考虑到美国近25%的5岁以下儿童是西班牙裔，了解种族和文化在家庭环境中术后疼痛体验中的作用尤为重要。在成人中，不同环境和类型的疼痛在感知、评估和治疗方面存在种族差异是公认的。事实上，医学研究所已经建议对疼痛管理和潜在干预策略中种族差异的来源进行调查，这是研究的重点。目前，在儿童这一领域的研究或干预措施明显缺乏。我们的实验室已经证明，低社会经济地位（SES）的西班牙裔儿童的父母更有可能对疼痛管理产生误解，并且在接受手术后，这些儿童更有可能在家中接受更少的止痛药。下一步，我们认为有必要了解这一独特人群的疼痛管理障碍，并制定具体的干预措施。本R21应用的目的是确定低经济社会地位的西班牙裔儿童术后疼痛管理的障碍。这项研究将采用定量和定性两种方法。在后续R01调查中，我们计划开发和测试针对这一服务不足人群的量身定制的干预措施。公共卫生相关性：在研究结束时，我们将确定在服务不足的人群中进行家庭疼痛管理的具体障碍。此外，这些信息将使我们能够开发一种数据驱动的干预措施，以改善目前西班牙裔儿童在家疼痛管理方面的差距。

DESCRIPTION (provided by applicant): Of the over five million children who undergo surgery in the United States, it is estimated that up to 65% will experience significant pain while in hospital and later at home. Over the past decade outpatient surgery has become much more prevalent and as a result the burden of managing postoperative pain at home falls mostly on the parents. Unfortunately, a number of studies by our laboratory as well as others indicate that many children's pain after surgery is significantly undertreated in home settings. Understanding the role of ethnicity and culture in the experience of postoperative pain at home settings is of particular importance when one considers that nearly 25% of children under the age of 5 in the United States are Hispanic. In adults, the existence of ethnic differences in perception, assessment, and treatment across settings and types of pain is well established. Indeed, the Institute of Medicine has recommended that the investigation of the sources of ethnic disparities in pain management and potential intervention strategies be a research priority. At the current time there is significant paucity of studies or interventions in this area in children. Our laboratry has demonstrated that parents of children of Hispanic origin with low socioeconomic status (SES) are significantly more likely to have misconceptions about pain management and after undergoing surgery these children are significantly more likely to receive less analgesics while at home. As a next step, we submit the need to understand the barriers for pain management in this unique population and next develop a specific intervention. The goal of this R21 application is to identify barriers to postoperative pain management in children of Hispanic origin of low SES. The study will employ both quantitative and qualitative approaches. In a follow up R01 investigation, we plan to develop and test a tailored intervention that will be directed at this underserved population. PUBLIC HEALTH RELEVANCE: At the conclusion of the study, we will have identified specific barriers to pain management at home in an underserved population. Additionally, this information will allow us to develop a data-driven intervention that will improv the present disparity in pain management of Hispanic children at home. PUBLIC HEALTH RELEVANCE: The present study seeks to identify the sources of ethnic disparities in pain management after surgery among children of Hispanic origin of low SES. Understanding potential barriers (i.e., misconceptions, miscommunication, cultural values) will allow us to develop in a follow up application an innovative, evidence- based, culturally-tailored intervention that will address these barriers to successful pain management.