Parent Misconceptions May Contribute to Pediatric Pain Under Management

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Racial, ethnic, and socioeconomic differences influenced parent beliefs about appropriate analgesic use in children.

Healthcare providers should be aware of the potential for parent misconceptions about pediatric pain medications.
Healthcare providers should be aware of the potential for parent misconceptions about pediatric pain medications.

PALM SPRINGS, Calif. — Greater prevalence of misconceptions about pediatric analgesic use among a sample of Latino parents was associated with fewer doses administered to children for post-surgical pain management, study findings indicate.

“Parents and families may have these misconceptions whether or not they're communicating them. If we're not addressing it as researchers and clinicians, it can potentially contribute to the problem of pain under management in children,” Alvina Rosales, PhD, a postdoctoral fellow at the University of California Irvine Center on Stress and Health at the UC Irvine School of Medicine, said during a poster session at the 2015 American Pain Society Annual Meeting

To examine whether racial/ethnic differences exist in parent beliefs about analgesic use for children's pain, Rosales and colleagues assessed attitudes toward medication before surgery  among 293 children aged 2 to 15 years (Latino, N=161; non-Latino white, N=115), who underwent outpatient surgery at the Children's Hospital of Orange County and Yale University.

Prior to surgery, parents were administered a 16-item Medication Attitudes Questionnaire (MAO) that measured three subclass on a seven-point Likert-type scale: avoidance, fear of side effects, and appropriate use. 

After surgery, nurses provided pain management instructions based on directions from the surgeon, including standard recommendations for over-the-counter analgesic use. Parents were asked to record analgesic doses for seven days and to complete the Parents Posteooperative Pain Measure (PPPM), a 15-item checklist of behavioral changes associated with pain severity, on the first postoperative day.

Latino parents endorsed higher levels of misconceptions compared with non-Latino White parents after the researchers controlled for pain severity and income (P=0.018), and endorsed lower levels of appropriate analgesic use (P<0.001), the researchers found. For example:

  • 44.7% of Latino parents agreed with the statement that pain medication works best when given as little as possible compared with with 23.5% of non-Latino white parents (P<0.001)
  • 63.5% of Latino parents agreed that pain medication works best if saved for when the pain is quite bad compared with 29% of non-Latino white parents (P<0.001)
  • 22% of Latino parents felt that using pain medication for children's pain would lead to later drug abuse compared with 4% of non-Latino white parents (P<0.001)

Higher levels of misconceptions predicted fewer number of analgesic doses provided to children among Latino parents (B=-0.030; P=0.028). However, this finding that was only true among non-Latino white parents when examining the upper and lower quartiles of misconception scores. 

There were no differences between groups in the number of analgesic doses provided on the first postoperative day after controlling for pain intensity and income, the researchers found. 

“Healthcare providers should be attuned to the possibility of misconceptions regarding analgesic use among families from diverse ethnic, acculturative and socioeconomic backgrounds,” Rosales said. “It is possible that higher levels of misconceptions among Latino parents can be explained by cultural beliefs, negative experiences, limited access to health care, and use and value of traditional or alternative medicines.”

Reference

  1. Rosales A. Poster #102. “What you don't know can hurt you: Misconceptions of analgesic use for children's postoperative pain.” Presented at: APS 2015. May 13-16, 2015. Palm Springs, California. 
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