Background & Aims

Children with chronic pain suffer adverse outcomes, including psychological, physical, daily functioning difficulties, isolation, insomnia, and school challenges.

The World Health Organization’s latest guidelines for the management of chronic pain in children emphasized the importance of prioritizing children’s needs (1). What the needs of children with chronic pain in Spain are remains unknown. A first step to develop a tailored and culturally relevant treatment for this population is to learn about their needs. For this purpose, in addition to the children’s views, clinicians and caregivers can be an important source of information about children`s needs.

The aim of this study is to learn about the clinician´s perspective on unmet healthcare needs in children with chronic pain and their caregivers.

Methods

This work is part of Phase 1 of the Digital SPA project (2). We present the results of the first focus group conducted with healthcare professionals. The inclusion criterion was to work with children with chronic pain in their usual practice. All health-related specialties were accepted. There were no exclusion criteria.

An online questionnaire was administered to collect sociodemographic information from the participants.

In an online focus group, healthcare professionals were asked about barriers and facilitators in their daily practice with pediatric patients with chronic pain, as well as their perspectives on children´s needs. Answers were audio recorded and transcribed verbatim. For the analysis, the Consolidated Framework of Implementation Research (CFIR) model (3) is being used to conduct a qualitative framework analysis currently in progress. Finally, the Public and Patient Engagement Evaluation Tool (PPEET) (4) was administered to assess satisfaction with the focus group

Results

Five healthcare professionals from 3 hospitals in Spain participated (2 men, 3 women, ages 37 to 51), 4 pediatricians (Palliative, Intensive Care Unit, and Emergency) and 1 clinical psychologist.

In the CFIR Outer Setting Domain, clinicians reported a lack of knowledge about which service refer children to when they transition to adults.

In the Inner Setting Domain, there was a long waitlist in pediatric and psychological care for children, lack of follow-up visits, and a need for Interdisciplinary Pediatric Pain Units.

At the Individuals Domain, families needed realistic expectations about treatment, psychoeducation about the neurophysiology of pain, normalize the life of children despite pain, and get involved in pain treatment. Family conciliation determined the children’s visits to the hospital. Clinicians reported a lack of training in pain management and that parents were the greatest challenge to work with.

All participants expressed satisfaction in the PPEET.

Conclusions

Preliminary results appear to support current literature. Pain Units in Spain with an interdisciplinary approach to pain management is a current shortcoming. Additionally, clinicians expressed their need for training in pain management.

The transition from pediatric to adult healthcare services is a milestone for the children’s future well-being and attitude toward medical care. Clinician´s lack of knowledge about which service refer children should be addressed.

Clinicians’ attitudes about children´s pain is close to the Acceptance and Commitment Therapy model, which can be seen in themes like “normalize the life of children despite pain” and “set realistic expectations about treatment”. Clinicians’ biopsychosocial approach and family´s involvement in pain treatment supports the WHO´s recommendations (1).

References

1. W.H.O. Guidelines on the management of chronic pain in children ISBN 978-92-4-001787-0 (electronic version. 2020 [cited 2023 May 8]; Available from: https://www.ncbi.nlm.nih.gov/books/NBK566553/

2.de la Vega R, Serrano-Ibáñez ER, Ruiz-Párraga GT, Palermo TM, Wicksell R, Fernández-Jiménez E, et al. Protocol for a multi-phase, multi-center, real-world, hybrid effectiveness–implementation study of a digital intervention for pediatric chronic pain co-designed with patients (Digital SPA). Digit Health. 2023 Jan 1;9.

3.Damschroder LJ, Reardon CM, Widerquist MAO, Lowery J. The updated Consolidated Framework for Implementation Research based on user feedback. Implementation Science. 2022 Dec 1;17(1).

4.Public and Patient Engagement Evaluation Tool (PPEET). McMáster University [Internet]. 2018 Aug [cited 2023 May 15]; Available from: https://healthsci.mcmaster.ca/docs/librariesprovider61/default-document-library/ppeet-complete-set-final.pdf?sfvrsn=d1617fe6_2

Presenting Author

Adrián Fernández-González

Poster Authors

Adrián Fernández González

PhD

Universidad de Málaga

Lead Author

E-mail

Elena R. Serrano-Ibáñez

Universidad de Málaga

Lead Author

E-mail

Ana C. Robles-Rosa. MsC.

University of Málaga

Lead Author

E-mail

Sergio Márquez-Fernández. BsC

University of Málaga

Lead Author

E-mail

Rosa Esteve. PhD

University of Málaga

Lead Author

E-mail

Gema Ruiz-Párraga

University of Málaga

Lead Author

E-mail

María José Peláez. MD

Maternal and Child Hospital of the Regional University Hospital, Málaga, Spain

Lead Author

E-mail

Silvia Oliva. PhD and MD

Maternal and Child Hospital of the Regional University Hospital, Málaga, Spain

Lead Author

E-mail

Eduardo Fernández-Jiménez. PhD

Department of Psychiatry, Clinical Psychology and Mental Health, La Paz University Hospital, Madrid,

Lead Author

E-mail

Moisés Leyva Carmona. MD

Torrecárdenas Maternal and Child University Hospital, Almería, Spain

Lead Author

E-mail

Susana Roldán. MD

Virgen de las Nieves Maternal and Child Hospital, Granada, Spain

Lead Author

E-mail

Laura Monfort. MD

Hospital Sant Joan de Déu, Barcelona, Spain

Lead Author

E-mail

Rocío De la Vega

Ph.D.

University of Málaga

Lead Author

E-mail

Topics

  • Pain in Special Populations: Adolescents