Adolescent-Centered Pain Management in School When Adolescents Have Chronic Pain-A Qualitative Study

Abstract

Chronic pain is common among Swedish adolescents, and stress is an independent factor in the onset and persistence of chronic pain. When Swedish school nurses conduct their health dialogs they have a unique opportunity to find adolescents with chronic pain. The aim of this study was to explore school nurses' and adolescents' experiences of factors that influence adolescent-centered pain management in school health care, when adolescents have chronic pain. The study context is schools in Sweden where primary health care is available through school nurses. A total of 15 school nurses and 15 adolescents participated in individual interviews, which were transcribed and analyzed by qualitative conventional content analysis. Bronfenbrenner's bioecological model was used to explain how these factors are directed at the individual or society. The results demonstrated eight different categories of factors that influenced the pain management. The categories focused mainly on the adolescents' micro-and mesosystems; few strategies were conducted on an exo-and macrosystem level. On the micro-and mesosystem levels, it was necessary to build trust to be able to influence the adolescents' behavior in the pain management. Pharmacological strategies were paracetamol and non-steroidal anti-inflammatory drugs; non-pharmacological strategies were physical activities and stress-reducing activities. Research and practice involving a more holistic perspective, studying the possibilities of both change at the organizational level and individual support for adolescents, are essential.

Medication Use among Pediatric Patients with Chronic Musculoskeletal Pain Syndromes at Initial Pain Clinic Evaluation

“…Access to medication may be more commonplace in part due to medications frequently being the most readily available and heavily marketed treatment options for both primary care and the majority of medical specialists not connected with academic teaching hospitals. Medications are considered among the less invasive treatments for conditions such as CRPS in a recent review by Katholi et al; nevertheless, this review and promising intervention research findings emphasize an increased need for behavioral approaches to optimally manage this painful condition [31,58,59].…”

Dealing with adolescents' recurrent pain problems in school health care—Swedish school nurses' view

“…The challenges in creating such relationships are discussed by adolescents and school nurses in Rosvall and Nilsson (), whereby the lack of opportunities to come into contact with each other without having prearranged these encounters was stressed. Further, this lack of opportunities to come into contact with and build a trustful relationship was described as an obstacle by adolescents with recurrent pain problems seeking support from the school nurse, even if they perceive a need for support (Nilsson et al, ).…”

“…These results argue for the need to develop methods to support school nurses in working with a person‐centred approach in a long‐term perspective, based on the core concepts of listening to the narrative, establishing a partnership and a jointly agreed‐on health plan to understand each adolescent's individual situation (Ekman et al, ). In a trustful relationship, in which both adolescents (Golsäter et al, ; Nilsson et al, ) and school nurses (Hilli & Wasshede, ; Nilsson et al, ) argue for, it is possible to build a relationship allowing the adolescent to be an active partner and use his or her own resources in collaboration with the school nurse's professional knowledge, in line with a person‐centred approach (Ekman et al, ). To create opportunities to work using a person‐centred approach, school nurses need more knowledge, as well as time and structures, to work with adolescents with recurrent pain problems and to promote health in the school organization.…”

“…However, even though the nurses understood that recurrent pain has different reasons, they stated the importance of ruling out whether there is a medical condition causing the pain. To further be able to capture the cause of adolescents' pain problems, the nurses in Høie et al (), Rosvall and Nilsson () and Nilsson, Rosvall, and Jonsson () identified the importance of creating a trustful relationship with the adolescents. The need for a trustful relationship with the school nurse has also been described by adolescents with recurrent pain problems as an important factor (Nilsson et al, ; Rosvall & Nilsson, ).…”

“…To further be able to capture the cause of adolescents' pain problems, the nurses in Høie et al (), Rosvall and Nilsson () and Nilsson, Rosvall, and Jonsson () identified the importance of creating a trustful relationship with the adolescents. The need for a trustful relationship with the school nurse has also been described by adolescents with recurrent pain problems as an important factor (Nilsson et al, ; Rosvall & Nilsson, ). In a study by Golsater Sidenvall Lingfors and Enskar (), adolescents describe health visits according to the health monitoring programme as an opportunity to build a trustful relationship with trust the school nurse.…”