Postoperative pain and coping in children and adolescents

The present study examined psychological factors associated with individual variation in children's adjustment following minor surgery, and focused specifically on the process of coping with postoperative pain. Sixty children and adolescents (7 to 16 yrs) were interviewed on the day following surgery. They provided ratings and descriptions of their postoperative pain experience, perceived capacity for pain control, spontaneous coping strategies, and emotional distress. Parents also provided information about their efforts (both historical and present) to facilitate their child's coping, their own emotional distress, and perceptions of their child's distress following surgery. Thirdly, nurses rated children's pain behaviours displayed on the ward. Finally, information about analgesic medications and physical complications following surgery was recorded from children's medical charts. Qualitative data concerning the process of coping with postoperative pain and specific parental influences on children's coping were presented within a conceptual model adapted from the adult stress and coping literature. The data were also analyzed for age/developmental differences between older children (10 to 16 yrs) and younger children (7 to 9 yrs). Finally the predictive role of demographic, child coping process, and parental influence variables, in accounting for variations in child coping outcome, was analyzed. Results indicated that children and adolescents experienced moderate to severe pain following minor surgery. They reportedly tried a number of different cognitive and behavioural methods to deal with postoperative pain. Also, parents took an active role in facilitating children's coping. Age group differences were revealed in children's descriptions of postoperative pain, their reported ways of coping with pain, and their perceptions of control over pain and recovery. Age effects were interpreted with caution, however, since age and sex were confounded in this sample. Children who reported the most pain and emotional distress following surgery also reported more catastrophizing cognitions, felt less in control of their recovery, and reported having tried a greater number of behavioral coping strategies to manage pain. These results emphasize the role of children's appraisal processes in predicting coping effectiveness, and demonstrate that more coping does not imply better outcome. Future research directions and potential clinical appplications that follow from these findings were discussed.Arts, Faculty ofPsychology, Department ofGraduat