Abstract

My PhD project mainly focused on understanding how a child or adolescent copes with pain associated with a disease, intended in a broader sense (i.e. procedures, treatments and disease-related). I tried to prove an innovative perspective that can help understand the wide variation in children’s pain experience, by considering intra-interpersonal influences, contextual factors, and intrapsychic factors that focus on needs, defenses, and self-structure. Overall, the whole project involved three pediatric units in Italy: the pediatric wards of Trento and Rovereto hospitals and the pediatric clinic of San Gerardo hospital, Monza (Milan). This doctoral thesis has achieved five goals: 1. Providing a selective overview on current relevant topics in the pediatric pain research and state of the art regarding the existing models of pediatric pain. 2. Developing a multi-dimensional protocol with an intra-method design for the assessment of pediatric pain in several chronic illnesses (cystic fibrosis, rheumatic diseases, cancer), by using also a battery of projective tests (drawings) to screen the emotional adjustment. 3. Validating the protocol by extending the methodology of projective drawings’ scoring with a control group and adding other assessment variables on a single cohort of patients (with malignant hematologic cancer) to test the new model that I developed. Quantitative analysis phase preceded qualitative analysis phase within the same framework to yield a parallel mixed analysis. 4. Planning specific training modules about pain management, starting from a bottom-up process concerning the local health professionals’ needs. I investigated these training needs through a series of open-ended questions, analyzed by a thematic analysis method. 5. Evaluate treatment’s feasibility, acceptability, and satisfaction of a problem-solving skills training for parents of children who have received an intensive pain rehabilitation from one pediatric pain rehabilitation program (Seattle Children's Hospital). I provided a methodological contribute within the mixed-method approach (statistical analysis and grounded theory). The results presented and their implications, are discussed in a clinical perspective since the rationale of this dissertation is that effective pain assessment must be multidimensional, multidisciplinary and at the same time feasible and practical to meet each pediatric patient’s needs.