The multidisciplinary approach to the treatment of paediatric chronic pain: a qualitative analysis through focus groups
Barra laterale dell'articolo
Contenuto principale dell'articolo
Abstract
Background: Access to pain care is recognized as a fundamental human right, ratified by Law 38/2010 and supported by the professional codes of conduct for healthcare practitioners. Pain, defined by the International Association for the Study of Pain (IASP), as an unpleasant sensory and emotional experience associated with actual or potential tissue damage. It becomes chronic when it persists beyond three months, affecting quality of life and clinical prognosis. The World Health Organization (WHO) has recently promoted a multidisciplinary approach for pediatric chronic pain, integrating physical, psychological, and pharmacological interventions, given the high prevalence of pain in pediatric populations, affecting up to 46% of children and adolescents. However, recent studies highlight gaps in healthcare providers’ competencies in managing pediatric chronic pain, and the need to update professional training and explore further non-pharmacological approaches to improve its management.
Objectives: To explore healthcare professionals’ perceptions and expectations regarding the multidisciplinary approach to chronic pediatric pain, and identify areas for improvement to optimise rehabilitative practices.
Methods: The study adopted a qualitative design, utilizing the Focus Group technique and unstructured interviews, following Consolidated Criteria for Reporting Qualitative Research (COREQ) guidelines. Six pediatric rehabilitation professionals, each with at least 10 years of experience, were involved to investigate the multidisciplinary management of chronic pain.
Results: Family involvement (30%), the multidisciplinary approach (25%), and the biopsychosocial model (20%) were identified as key elements in the management of pediatric chronic pain. The importance of preventing physical complications and improving the child’s quality of life also emerged.
Discussion: The results confirm the importance of a holistic, multidisciplinary approach to managing pediatric chronic pain. However, some critical issues emerged, such as the limited early involvement of rehabilitation professionals and the need for better coordination between different healthcare professionals.
Conclusions: The study highlights that a multidisciplinary and personalized approach is crucial in the management of pediatric chronic pain. While confirming the efficacy of the holistic approach, the results reveal the need for more efficient coordination between professionals and early involvement of rehabilitation specialists. Future studies with larger samples could validate the findings and refine recommendations for effective chronic pain management in pediatric patients.
Downloads
Dettagli dell'articolo
Gli autori mantengono i diritti sulla loro opera e cedono alla rivista il diritto di prima pubblicazione dell'opera, contemporaneamente licenziata sotto una Licenza Creative Commons - Attribuzione che permette ad altri di condividere l'opera indicando la paternità intellettuale e la prima pubblicazione su questa rivista.
Riferimenti bibliografici
M. Allegri, C. Lucioni, S. Mazzi, and G. Serra, "Il costo sociale del dolore cronico in Italia," *Global & Regional Health Technology Assessment*, vol. 2, no. 1, pp. 33-42, 2015, doi: 10.5301/GRHTA.5000187.
"Codice deontologico del Fisioterapista," Associazione Italiana Fisioterapisti (AIFI), 2019, Capo III, art. 34.
"Costituzione etica della Federazione nazionale degli Ordini dei Tecnici sanitari di radiologia medica e delle professioni sanitarie tecniche, della riabilitazione e della prevenzione," 2019, Art. 5, “Centralità della persona,” p. 5.
Società Italiana di Cure Palliative. Core Curriculum del Fisioterapista in Cure Palliative. Settembre 2024 ed. Milano: SICP; p. 7, 38. Available from: Il Core Curriculum del Fisioterapista in Cure Palliative - SICP
A. C. de Williams and K. D. Craig, "Updating the definition of pain," PAIN”, vol. 157, pp. 2420-2423, 2016, doi: 10.1097/j.pain.0000000000000613.
T. M. Palermo, “Cognitive-behavioral therapy for chronic pain in children and adolescents”, New York, NY: Oxford University Press, 2012.
F. Benini, L. Manfredini, and P. Papacci, "I fondamentali della fisiopatologia del dolore per una terapia mirata," “Il dolore nel bambino. Strumenti pratici di valutazione e terapia”, vol. 3, pp. 9-22, 2014.
World Health Organization. New guidelines on the management of chronic pain in children. Geneva: World Health Organization; 2021.
B. W. Landry, P. R. Fischer, S. W. Driscoll, et al., "Managing chronic pain in children and adolescents: a clinical review," PM R, pp. 295-315, 2015,
doi: 10.1016/j.pmrj.2015.09.006.
K. L. Meert, J. Clark, and S. Eggly, "Family-centered care in the pediatric intensive care unit," Pediatr Clin North Am., vol. 60, no. 3, pp. 761-772, 2013,
doi: 10.1016/j.pcl.2013.02.011.
Gatchel, R. J., Peng, Y. B., Peters, M. L., Fuchs, P. N., & Turk, D. C. (2007). The biopsychosocial approach to chronic pain: Scientific advances and future directions. Psychological Bulletin, 133(4), 581–624.
https://doi.org/10.1037/0033-2909.133.4.581)
Kovačević I, Pavić J, Filipović B, Ozimec Vulinec Š, Ilić B, Petek D. Integrated approach to chronic pain—the role of psychosocial factors and multidisciplinary treatment: a narrative review. Int J Environ Res Public Health. 2024;21(9):1135. doi: 10.3390/ijerph21091135.
L. E. Simons, C. B. Sieberg, C. Conroy, et al., "Children with chronic pain: response trajectories after intensive pain rehabilitation treatment," The Journal of Pain, vol. 19, pp. 207-218, 2017, doi: https://doi.org/10.1016/j.jpain.2017.10.005.
M. Laekeman, A. Schäfer, M. Egan Moog, and K. Kuss, "Recommendations for a pediatric pain education curriculum for physical and occupational therapists: scoping review and survey," Children-Basel, vol. 8, no. 5, pp. 390-413, 2021, doi: 10.3390/children8050390.
Pico, M., Matey-Rodríguez, C., Domínguez-García, A., Menéndez, H., Lista, S., & Santos-Lozano, A. (2023). Healthcare Professionals’ Knowledge about Pediatric Chronic Pain: A Systematic Review. Children, 10(4), 665. https://doi.org/10.3390/children10040665
Chambers CT, Dol J, Tutelman PR, Langley CL, Parker JA, Cormier BT, et al. The prevalence of chronic pain in children and adolescents: a systematic review update and meta-analysis. Pain. 2024;165(10):2215-2234.
doi:10.1097/j.pain.0000000000003267.
Nyumba, T. O., Wilson, K., Derrick, C. J., & Mukherjee, N. (2018). The use of focus group discussion methodology: Insights from two decades of application in conservation. Methods in Ecology and Evolution, 9(1), 20-32.
George, T. (2023, June 22). Unstructured Interview | Definition, Guide & Examples. Scribbr. Retrieved October 15, 2024,
from https://www.scribbr.com/methodology/unstructured-interview/
Tong, A., Sainsbury, P., & Craig, J. (2007). Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups. International Journal for Quality in Health Care, 19(6), 349–357.
https://doi.org/10.1093/intqhc/mzm042.
O'Brien, B. C., Harris, I. B., Beckman, T. J., Reed, D. A., & Cook, D. A. (2014). Standards for reporting qualitative research: a synthesis of recommendations. Academic Medicine: Journal of the Association of American Medical Colleges, 89(9), 1245–1251. https://doi.org/10.1097/ACM.0000000000000388.
Fisher E, Legge E, Dudeney J, Palermo TM, Stewart G, Eccleston C. Psychological therapies for the management of chronic and recurrent pain in children and adolescents. Cochrane Database of Systematic Reviews. 2018;9(9)
doi: 10.1002/14651858.CD003968.pub5.
Collins AB. Chronic pain in children: Interdisciplinary management. Pediatric Clinics of North America. 2023;70(3):575-88. doi: 10.1016/j.pcl.2023.01.010.
G. Revivo, D. K. Amstutz, C. M. Gagnon, and Z. L. McCormick, "Interdisciplinary pain management improves pain and function in paediatric patients with chronic pain associated with joint hypermobility syndrome," PMRJ, vol. 3, pp. 1-9, 2018, doi: https://doi.org/10.1016/j.pmrj.2018.06.018.
Italia. Legge 22 dicembre 2017, n. 219. Norme in materia di consenso informato e di disposizioni anticipate di trattamento. Gazzetta Ufficiale n. 12 del 16 gennaio 2018.
Istituto Superiore di Sanità. Linee di indirizzo per l’utilizzo della Medicina Narrativa in ambito clinico-assistenziale, per le malattie rare e cronico-degenerative. Quaderno n. 7. Roma: ISS; 2015. p. 14-20.
S. Persson, A. Warghoff, E. L. Einberg, and P. Garmy, "Schoolchildren’s experience of pain. A focus group interview study," Acta Paediatrica, vol. 110, pp. 909-913, 2021, doi: 10.1111/apa.15493.
L. E. Harrison, J. W. Pate, P. A. Richardson, K. Ickmans, R. K. Wicksell, and L. E. Simons, "Best-evidence for the rehabilitation of chronic pain part 1: paediatric pain," J Clin Med., vol. 8, no. 9, pp. 1267-1285, 2019, doi: 10.3390/jcm8091267.
Fricchione G. Mind body medicine: a modern bio-psycho-social model forty-five years after Engel. BioPsychoSocial Medicine. 2023;17(1):12. doi:10.1186/s13030-023-00268-3
H. N. McKillop and G. A. Banez, "A broad consideration of risk factors in pediatric chronic pain: where to go from here?" Children, vol. 3, no. 4, pp. 38-55, 2016, doi: 10.3390/children3040038.
A. Messeri, F. Benini, P. Papacci, and M. Gangemi, "Il trattamento non farmacologico del dolore," “Il dolore nel bambino. Strumenti pratici di valutazione e terapia”, vol. 3, pp. 39-47, 2014.
F. Benedetti, “Il Caso di G.I. La medicina narrativa e le dinamiche nascoste della mente”, Carrocci Editore, 2013, pp. 13-15.
S. J. Friedrichsdorf, J. Giordano, K. Desai Dakoji, A. Warmuth, C. Daughtry, and C. A. Schulz, "Chronic pain in children and adolescents: diagnosis and treatment of primary pain disorders in head, abdomen, muscles and joints," Children, vol. 3, no. 4, pp. 42-67, 2016, doi: 10.3390/children3040042.
A. A. Wren, A. C. Ross, G. D'Souza, et al., "Multidisciplinary pain management for pediatric patients with acute and chronic pain: a foundational treatment approach when prescribing opioids," Children, vol. 6, no. 2, pp. 33-54, 2019, doi: 10.3390/children6020033.
Associazione Italiana Fisioterapisti (AIFI). Codice deontologico del fisioterapista 2020 . Available from: https://www.aifi.net/codice-deontologico/
Associazione Nazionale Educatori Professionali (ANEP). Codice deontologico dell'educatore professionale 2009. Available from: https://www.anep.it/codice-deontologico
Associazione Italiana Terapisti Occupazionali (AITO). Codice deontologico del terapista occupazionale 2016. Available from: https://www.aito.it/codice-deontologico
Suder, R., DeBoth, K. K., Carrick, A., Davis, J., Farrar, B. (2023). A Systematic Review of Occupational Therapy-Related Interventions for Pediatric Chronic Pain. OTJR: Occupational Therapy Journal of Research, 43(1), 61-73.
https://doi.org/10.1177/15394492221110544
Associazione Nazionale Unitaria Terapisti della Neuro e Psicomotricità dell'Età Evolutiva (ANUPI TNPEE). Codice deontologico del TNPEE. 2018. Available from: https://www.anupitnpee.it/codice-deontologico
Federazione Nazionale Ordini TSRM-PSTRP. Codice deontologico dell'ortottista 2015. Available from: https://www.tsrm.org/codice-deontologico