Momentary associations of parent psychological factors, perceived child pain, and home opioid administration for postoperative pain management.

Abstract

Characterizing the affective processes parents experience following a child's surgery and how these processes might predict their perceptions of children's pain and postoperative medication administration is critical for refining interventions to improve children's pain management. This study evaluated concurrent and lagged associations among parent affect (pain catastrophizing, negative affect, and positive affect), perceived child pain intensity, and opioid administration in the 7 days after tonsillectomy in a sample of youth ages 7 to 12 years (n = 138). Parents of potentially eligible patients were recruited before surgery and completed electronic diaries through a smartphone application 3 times daily for 7 days after surgery. Opioid administration was evaluated in the context of routine clinical care. Patients were generally prescribed a 3-day supply of liquid oxycodone for parents to administer if pain was uncontrolled by acetaminophen and ibuprofen. Of the 138 parents who completed ≥1 diary, 90 parents reported administering an opioid during the diary period (65.2%) and were included in opioid analyses. In multilevel models, both average and momentary levels of parent affect predicted parents' perceptions of their child's pain intensity, whereas only average negative affect and momentary levels of parent affect predicted odds of opioid administration. Parent pain catastrophizing had a bidirectional relation with perceived child pain in lagged analyses, with higher parent pain catastrophizing predicting higher perceived pain intensity at subsequent timepoints and vice versa. Assessing momentary levels of parent affect may be particularly important for capturing dynamic shifts that predict escalations in children's pain and opioid administration.