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大问题。据报道，高达49%的儿童在住院期间遭受临床显著疼痛，并且这种疼痛绝大多数都没有得到治疗。阿片类药物和非甾体抗炎药等药理学方法通常被认为是术后疼痛管理的第一线。然而，有充分的证据表明，疼痛是一种复杂的、多方面的疾病，不能仅靠药物治疗。相反，有必要采取非药物方法来解决疼痛。改变医护人员和父母对儿童疼痛的反应行为是手术疼痛环境中的有效干预（例如，免疫接种），但对成人行为与儿童术后疼痛之间的关系知之甚少。手术环境和术后环境之间存在明显差异，这无疑会影响成人行为和儿童疼痛之间的关系。例如，术后疼痛的持续时间比手术疼痛长，父母和孩子在围手术期环境中的经验通常少于初级护理。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，首先经验性地确定特定的父母和医护人员的行为，增加或减少儿童的术后疼痛。这将通过获得一个术后序贯过程为导向的观点，父母-儿童-医疗保健提供者的行为相互作用，并通过使用强大的序贯分析技术来实现。这项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的行为。作为第二个目标，我们将确定儿童的特征（例如，年龄），这可能会缓和父母和医疗保健提供者的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。 公共卫生相关性：在本申请中描述的研究结束时，我们将确定与手术后即刻和家中疼痛增加或减少相关的特定父母和医疗保健提供者行为。这些信息将使我们能够开发数据驱动的行为准备计划，这些计划将教导父母，护士，麻醉师和外科医生如何减少儿童在术后过程中的疼痛。这种新开发的，低成本的，父母和医疗保健提供者的准备程序可以广泛适用于几乎任何医疗设施在美国。

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.