Vol. 3 No. 4 (2024): caring for nurses
Articles

Use of Non Pharmacological Therapies for Pain Management in Children: A Survey of Pediatric Healthcare Provides

Marina Maffeo
Pediatric Intensive Care Unit, Meyer Children’s Hospital IRCCS, Florence, Italy
Asia Bianchi
Department of Health Sciences, University of Florence, Florence, Italy
Beatrice Fogli
Department of Health Sciences, University of Florence, Florence, Italy
Veronica Meucci
Department of Health Sciences, University of Florence, Florence, Italy
Biagio Nicolosi
Department of Health Professions. Meyer Children’s Hospital IRCCS, Florence, Italy
Daniele Ciofi
Department of Health Professions. Meyer Children’s Hospital IRCCS, Florence, Italy

Published 2024-12-31

Keywords

  • Pain,
  • Cognitive Behavioral Therapy,
  • Nursing,
  • Pain Management

Abstract

Introduction. Pediatric pain management is a complex challenge, particularly in settings such as intensive care units and in postoperative care, where the use of analgesic drugs can result in significant side effects. The use of non-pharmacological therapies (NPTs) has been shown to be effective in reducing both pain and anxiety. Since they are safe and free of side effects, they are therefore suitable for reducing the adverse effects of pharmacotherapy and improving the compliance of pediatric patients.

Methods. A descriptive survey was carried out by means of an ad hoc questionnaire with multiple-choice questions and was open to 202 voluntary healthcare personnel of pediatric departments of a Tuscany pediatric health agency with non-probability convenience sampling. The questionnaire assessed knowledge, skills and attitudes toward NPTs, with a statistical analysis of qualitative and quantitative variables.

Results. Forty-six percent of participants considered NPTs effective for pain control, but a significant proportion (54%) remained skeptical. Pediatric nurses demonstrated greater expertise in the use of NPTs, with 91% showing sufficient knowledge compared to 63% in other professions (Odds Ratio = 6.1; CI: 2.8–13; p < 0.0001).

Conclusions. The study highlights the need for specific and ongoing educational programs on provision NPTs for healthcare personnel. Integration of NPTs into care plans could reduce dependence on analgesics, helping both to significantly reduce pain and to ensure a more holistic approach.

References

  1. Raja SN, Carr DB, Cohen M, et al. The revised International Association for the Study of Pain definition of pain: concepts, challenges, and compromises. Pain. 2020;161(9):1976–1982.
  2. Pain terms: a list with definitions and notes on usage. (1979). Recommended by the IASP Subcommittee on Taxonomy. Pain. 6(3):249.
  3. Simons LE, Sieberg CB, Claar RL. Anxiety and impairment in a large sample of children and adolescents with chronic pain. Pain Res Manag. 2012;17(2):93–7.
  4. Fortier MA, Kain ZN. Treating perioperative anxiety and pain in children: a tailored and innovative approach. Paediatr Anaesth. 2015;25(1):27–35.
  5. Moll-Bertó A, López-Rodrigo N, Montoro-Pérez N, et al. A Systematic Review of the Effectiveness of Non-Pharmacological Therapies Used by Nurses in Children Undergoing Surgery. Pain Manag Nurs. 2024;25(2):195–203.
  6. Friedrichsdorf SJ, Goubert L. Pediatric pain treatment and prevention for hospitalized children. Pain Rep. 2019;5(1): e804.
  7. Alencar IGM, Dantas JKDS, Matias de Araújo SC, et al. Non-pharmacological therapies for pain management in paediatric intensive care units: a protocol for a scoping review. BMJ Open. 2024;14(2): e074952.
  8. LaFond CM, Hanrahan KS, Pierce NL, et al. Pain in the Pediatric Intensive Care Unit: How and What Are We Doing? Am J Crit Care. 2019;28(4):265–273.
  9. Kopf, A., Patel, N.B. Guide to pain management in low-resource settings. Seattle: ©IASP. 2010. Available: https://www.iasp-pain.org/publications/free-ebooks/guide-to-pain-management-in-low-resource-settings.
  10. Grunauer M, Mikesell C, Bustamante G, et al. Pain Assessment and Management in Pediatric Intensive Care Units Around the World, an International, Multicenter Study. Front Pediatr. 2021;9:746489.
  11. Carter, B., & Simons, J. Stories of children’s pain. SAGE Publications Ltd. 2014.
  12. Monitto CL, Hsu A, Gao S, et al. Opioid Prescribing for the Treatment of Acute Pain in Children on Hospital Discharge. Anesth Analg. 2017;125(6):2113–2122.
  13. Zhang Y, Yang Y, Barnard M, et al. Opioid Use for Treatment of Acute Pain Among Children and Adolescents Enrolled in the Mississippi Medicaid Program. J Pharm Pract. 2021;34(4):558–566.
  14. Brummel NE, Girard TD. Preventing delirium in the intensive care unit. Crit Care Clin. 2013;29(1):51–65.
  15. Baldo BA. Toxicities of opioid analgesics: respiratory depression, histamine release, hemodynamic changes, hypersensitivity, serotonin toxicity. Arch Toxicol. 2021;95(8):2627–2642.
  16. Lewis MJM, Kohtz C, Emmerling S, et al. Pain control and nonpharmacologic interventions. Nursing. 2018;48(9):65–68.
  17. Chang KL, Fillingim R, Hurley RW, et al. Chronic pain management: legal and licensure issues. FP Essent. 2015;432:39–42.
  18. Uman LS, Birnie KA, Noel M, et al. Psychological interventions for needle-related procedural pain and distress in children and adolescents. Cochrane Database Syst Rev. 2013;(10):CD005179.
  19. Zeleke S, Kassaw A, Eshetie Y. Non-pharmacological pain management practice and barriers among nurses working in Debre Tabor Comprehensive Specialized Hospital, Ethiopia. PLoS One. 2021;16(6):e0253086.
  20. Tohol WJ, Abuejheisheh AJ, Fashafsheh I, et al. Using of non-pharmacological pain methods, and the perceived barriers, among nurses in critical care unit in Palestine. BMC Nurs. 2023;22(1):467.
  21. Coyne I, Scott P. Alternatives to restraining children for clinical procedures. Nurs Child Young People. 2014;26(2):22–7.
  22. Vagnoli L, Mammucari M, Graziani D, et al. Doctors and Nurses' Knowledge and Attitudes Towards Pediatric Pain Management: An Exploratory Survey in a Children's Hospital. J Pain Palliat Care Pharmacother. 2019;33(3–4):107–119.
  23. von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP; STROBE Initiative. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement: guidelines for reporting observational studies. Int J Surg. 2014;12(12):1495–9.
  24. Aydin D, Sahiner NC. Effects of music therapy and distraction cards on pain relief during phlebotomy in children. Appl Nurs Res. 2017;33:164–168.
  25. Goktas N, Avci D. The effect of visual and/or auditory distraction techniques on children's pain, anxiety and medical fear in invasive procedures: A randomized controlled trial. J Pediatr Nurs. 2023;73:e27–e35.
  26. Johnston C, Campbell-Yeo M, Disher T, Benoit B, Fernandes A, Streiner D, et al. Skin-to-skin care for procedural pain in neonates. Cochrane Database Syst Rev. 2017;2(2):CD008435.
  27. Stevens B, Yamada J, Ohlsson A, Haliburton S, Shorkey A. Sucrose for analgesia in newborn infants undergoing painful procedures. Cochrane Database Syst Rev. 2016;7(7):CD001069.
  28. Svendsen EJ, Bjørk IT. Experienced nurses' use of non-pharmacological approaches comprise more than relief from pain. J Pediatr Nurs. 2014;29(4):e19–28.
  29. Jira L, Weyessa N, Mulatu S, Alemayehu A. Knowledge and Attitude Towards Non-Pharmacological Pain Management and Associated Factors Among Nurses Working in Benishangul Gumuz Regional State Hospitals in Western Ethiopia, 2018. J Pain Res. 2020;13:2917–2927.
  30. Soltani S, Noel M, Bernier E, et al. Pain and insomnia as risk factors for first lifetime onsets of anxiety, depression, and suicidality in adolescence. Pain. 2023;164(8):1810–1819.
  31. Tran ST, Jastrowski Mano KE, Anderson Khan K, Davies WH, Hainsworth KR. Patterns of anxiety symptoms in pediatric chronic pain as reported by youth, mothers, and fathers. Clin Pract Pediatr Psychol. 2016;4(1):51–62.
  32. Kusi Amponsah A, Kyei EF, Agyemang JB, Boakye H, Kyei-Dompim J, Ahoto CK, Oduro E. Nursing-Related Barriers to Children's Pain Management at Selected Hospitals in Ghana: A Descriptive Qualitative Study. Pain Res Manag. 2020;2020:7125060.
  33. Hu J, Ruan H, Li Q, Gifford W, Zhou Y, Yu L, et al. Barriers and Facilitators to Effective Procedural Pain Treatments for Pediatric Patients in the Chinese Context: A Qualitative Descriptive Study. J Pediatr Nurs. 2020;54:78–85.
  34. Radi M, Pittino S, Lanna A, Dalla Gasperina S, Cerri L, Milan I, et al. Complementary care: results of a national survey. L’Infermiere. 2021;58(4):e58–e67.