(108) The pain experience of hospitalized youth: assessment and management preferences

Abstract

Accurate pediatric pain assessment is necessary to ensure quality pain management. Patient self-report of pain intensity is the most common assessment of pain in clinical practice. Assessing pain is complicated by the child's age and developmental level. A number of reliable, valid tools exist to measure pediatric pain. However, evidence continues to be published indicating inadequacies in pediatric pain management. Therefore, it is useful to consider how the process of pain assessment might be implicated in this problem. We conducted a qualitative, descriptive study using semi-structured interviews to explore patient pain experience and discuss select validated pain scales to illicit pain reports and preferences. Interviews were 20-40 minutes in length with questions focused on current pain experience, pain related symptoms, evaluation of pain treatment and preferences for select pain assessment scales: a 0-10 point numeric rating scale, The Oucher, Faces Pain Scale - Revised and the Adolescent Pediatric Pain Tool (APPT). Subjects were 40 youth hospitalized on a medical inpatient unit; ages 10-17 yrs. (mean 13 yr., S. D. 2.4); subjects were mainly White (47.5%) or Black (45%); female (52.5%); and had diagnoses inclusive of the following: SCD pain/fever (28%), asthma (12,5%), Rheumatology (12.5%), Inflammatory Bowel Disease (10%), Aplastic anemia (7.5%), General Surgery (7.5%), Migraine (5%) & other (17,5%). Each patient had previous experience with pain and the majority (62.5%) had either chronic or episodic pain. Analysis of transcribed interviews yielded three themes: My Pain Now, including detailed descriptors of pain; Patient Treatment Expectations, such as goals for improvement and methods to alleviate pain; & Telling Healthcare Providers About My Pain, preferences for pain scales, desired frequency of assessment and discussion of how behavior, activity and pain expression is different for each person. Multidimensional individualized assessment was deemed superior. Interviewed youth indicated personal preferences for pain management and their expected outcomes.