Every child is different in terms of their risks for experiencing post-surgical pain. Researchers at BC Children’s Hospital are developing a tool to help accurately predict and communicate an individual child’s risk of experiencing a higher level of post-surgical pain. This tool will help make healing after surgery more comfortable for kids.

One in five children who have surgery experience persistent pain up to 12 months after their procedure. This long-term pain can significantly impact their quality of life and lead to increased use of pain medication, reduced trust in the health-care system, and more frequent hospital visits.

Each patient has a different set of risks for experiencing long-term post-surgical pain. Some characteristics that might increase the chance of post-surgical pain complications include anxiety, past pain, and pain catastrophizing. Research has shown that individual pain risk is not adequately communicated to families of pediatric patients.

A post-surgical pain risk communication tool for this population would help ensure that both clinicians and family members have the information they need to best support children in hospital and once recovering at home. Knowing the pain risks and how to mitigate them through patient-specific interventions can improve children’s post-surgical comfort.

young girl listens to doctor
Some children are more at risk for postoperative pain, but care plans outlining various interventions specific to the patient (e.g., diet and nutrition, physical function, and exercise capacity) can result in improved pain management and post-surgical outcomes.

Dr. Matthias Görges, Dr. Michael Wood, Kim Correa, Peijia Ding, Dr. Rama Sreepada, Kent Loftsgard, Isabel Jordan, Nicholas West, Dr. Simon Whyte, and Dr. Elodie Portales-Casamar recently defined the requirements and features needed for the development of a pediatric pain risk communication tool prototype. To do this, they conducted a qualitative study of 10 clinicians (four nurse practitioners and six physicians) and nine family members of pediatric patients who’d had surgery at BC Children’s Hospital.

“This study is part of a larger project to develop pain risk prediction tools,” says Dr. Görges. “Here, we aimed to design an easy-to-use pain risk communication tool to communicate children’s risk of post-surgical pain to both clinicians and family members. This tool would help improve or replace current processes used to communicate pain risk and suggest intervention strategies to reduce that risk.”

The researchers found that while physicians often discuss post-surgical pain with family members, the information shared is sometimes not specific enough to each child. Additionally, the information may not be retained, especially when conveyed verbally in one sitting, and/or when shared during a potentially stressful time while preparing for surgery.

Some study participants indicated that the option of an app-based pain risk communication tool would allow them to more easily refer to the information anytime they’d like or share it with other family members. An app-based option would be an improvement over other more traditional methods. Verbal communication of pain risk can be forgotten and a paper-based pain risk communication tool may be lost or damaged.

child sits between her mom and dad and they are talking and laughing
Use of a post-surgical pediatric pain risk communication tool could help kids return to their normal activities more quickly and comfortably after surgery.

“Family members would like pain risk information delivered before surgery as opposed to the day of their child’s surgery,” says Dr. Görges.

“This would replace the use of potentially unreliable or incomplete online resources, which caregivers often consult during the days and weeks leading up to their child’s surgery.”

The themes that emerged from the research have informed the design requirements for a pediatric post-surgical pain risk communication tool prototype.

“We want to make a pain risk communication tool that is accessible, accurately indicates the individual child’s pain risk, includes discussion prompts for clinicians and families, and highlights personalized risk reduction strategies,” says Dr. Görges. “For example, we could say, ‘there is a 38 per cent chance your child will experience moderate-to-severe post-surgical pain, and here are some actions you can take to increase their comfort’.”

The researchers’ next step is to recruit a large number of health-care workers and families to assist in the co-design and testing of the pediatric pain risk communication tool prototype.

Read more in “Identification of Requirements for a Postoperative Pediatric Pain Risk Communication Tool: Focus Group Study With Clinicians and Family Members,” JMIR Pediatrics and Parenting.