Abstract
By Leora Kuttner, Ph.D. Bethel, CT: Crown House Publishing Company LLC., 2010, 389 pages, $49.99.
The book, A Child in Pain: What Health Professionals Can Do to Help, is an incredible resource for clinicians and medical professionals who treat children in pain. Dr. Leora Kuttner, a world authority on pediatric pain, captures reader attention from the start and maintains engagement throughout the book. Dr. Kuttner deconstructs the mysteries of pain and boils down the complexities inherent in pain management and care in a way that is easily understood and interesting. Using the bio-psycho-social model, Dr. Kuttner addresses the biological, psychological, social, and physical aspects of pain, and provides a comprehensive overview of this important topic in medicine and humanity. Her book illustrates practical approaches for pain assessment and gives examples of appropriate care plans successfully implemented for children of different ages and with a variety of medical problems.
The book is organized in three parts: Part one focuses on how to address, communicate, and assess a child in pain; part two presents various pain treatment methods and its efficacy; and part three concentrates on pain and anxiety management.
In part one, Dr. Kuttner begins with the reminder there is no cookbook solution for managing such dynamic and individual experiences: “Pain is the only condition which the patient is the diagnostician.” Dr. Kuttner emphasizes the imperative of regarding the child as an important collaborator in their care as well as the caregiver and this idea is repeated as an important tenant to overall pain management throughout the book. The author offers a variety of tools that can be used to assist clinicians with appropriate diagnostics and care planning including specific words, phrases, and concepts useful in understanding what the child is expressing. These tools provide great assistance to the medical professional who must be careful to convey messages about what is going on in a way that will allay patient fear or anxiety and ensure trust and cooperation. Additionally, Dr. Kuttner explains Dr. Ronald Melzack's “bottom-up approach” theory of pain that allows clinicians to consider aspects he or she would not have considered in their clinical practice prior to dealing with a child in pain.
Dr. Kuttner sets the stage for part two with the following, “it is not that we don't know what to do when a child is in pain. We do, but we don't always do it.” This section begins with a brief review of what we know about existing physical and pharmacological pain treatment methods and then expands on this knowledge with a shift in perspective from what is typically presented in traditional pain texts. Specifically, the author gives the reader an in-depth introduction to the mind body connection and pain perception, especially regarding chronic pain. The reader learns the benefits of cognitive-behavioral pain-relieving methods such as distraction, thought-stopping, hypnosis, and imagery as well as creative therapies of music, art, and play. There is also mention of biofeedback and acceptance and commitment therapies, both useful in children with chronic pain. The tools in this chapter give the reader a concrete set of ideas of what to do according to the age and development of the child.
Part three of the book addresses emotions and the important role they play in perceiving pain and helping healing. In particular, this section focuses on anxiety management in various pediatric clinical settings such as the pediatrician's office, a dental practice, and in the hospital. The author gives practical advice to managing anxiety which in turn can lead to better pain management. The successes of such techniques are supported by pediatric patient anecdotes. A 12-year-old boy's quote illustrates how important it is to address this aspect before doing anything else, “The first time I go to a doctor or dentist for anything, I get them to tell me all about it first. Then I check and find out if they are lying. It's best to know.”
Overall this book provides the reader with a solid foundation for understanding the basic physiology of how pain works in the human body, the role of pain in children's growth and development, and how to share this knowledge with children when they hurt. The book includes innovative illustrations that are unique in providing a new way to conceptualize both pain theories and our current interventions. In addition, the book offers practical tools and frameworks for addressing the complexities of pain that will be helpful to medical professionals as they navigate through difficult clinical scenarios. The author highlights her diversity of experience with stories and direct quotes from children across the developmental cycle. While this makes the book extremely authentic and original, we would caution that this is also an indication for more research and attention toward the subject of pain for this specific population.
“Knowing is not enough, we must apply; willing is not enough, we must do.” Goethe