Knowledge translation in psychological interventions for pediatric pain: Bridging the gap between research and practice

It is now firmly understood that a child’s response to pain is not simply a direct result of the level of tissue damage, but rather a combination of both physical and psychological variables. Establishing the multiple dimensions of the pain experience has served as an important first step in advancing the role of pediatric psychology in pain management (Kazdin & Kendall, 1998). Subsequent research has built upon this foundation and produced an array of psychological strategies to help children cope with their pain. Many cognitivebehavioral strategies have been deemed effective in managing both acute procedural pain (e.g. distraction, hypnosis, and guided imagery; Uman et al., 2006) and chronic or recurrent pain (e.g. multicomponent cognitive-behavioral treatment packages; Dahlquist & Switkin, 2003). Despite advances in the development of psychological interventions for pediatric pain management, research continues to suggest that evidence-based techniques remain relatively unused in clinical practice, and that children’s pain continues to be undertreated. While part of the problem is the continued use of specific flawed approaches (e.g. reassurance; McMurtry et al., 2006), the majority of research findings indicate that some children are simply not provided adequate management of their pain (Cummings et al., 1996; Ellis et al., 2002) and that many pediatric hospitals continue to use outdated or unsupported pain intervention programs (e.g. O’Byrne et al., 1997). The objective of this commentary is to identify some of the barriers in successfully translating psychological interventions from research to clinical practice, as well as to offer suggestions for bridging this gap. While psychological interventions may vary depending upon the type of pain (e.g. acute, chronic, injury-related, disease-related, postoperative), the purpose of the current commentary is to discuss the lack of knowledge translation for pediatric pain management in general, rather than knowledge translation issues related to specific strategies.