A postmodern, narrative approach to pediatric pain consultation

Melodie Marie Ryan-Rose (2000)

In the traditional disease model, psychological and social factors have been viewed as reactions to disease and trauma, and thus have been considered of secondary importance in understanding children's pain. However, during the past decade, unprecedented attention focused on the special pain problems of infants, children, and adolescents has led to significant advances in understanding how children experience pain. Knowledge obtained from the fields of psychoneuroimmunology and behavioral medicine has resulted in the recognition that no single factor in isolation--pathophysiological, psychological, or social--can adequately explain the severity, maintenance, and exacerbation of children's acute and chronic pain. This knowledge has rendered unidirectional pain models too narrow in scope and, therefore, obsolete. Over the past several years, reductionistic models of pediatric pain, have gradually been replaced by multilevel, interactive conceptual formulations. Although new, more comprehensive pediatric pain models have recently been proposed, similar conceptual advances related to the development of more compatible models of pediatric consultation have failed to emerge at a commensurate rate. The traditional leaning of many pediatric psychologists has been to utilize modernist, reductionistic behavioral and cognitive-behavioral models of consultation, which tend to focus largely on individual behavior and intrapersonal functioning. Although such models have been employed successfully for many types of child behavior problems, there has been a gradual acknowledgment of the inherent limitations of the narrow constructs proposed by these models. To more effectively address the multidimensional nature of children's pain, this dissertation proposes a postmodern, narrative approach to pediatric pain consultation; a conceptual model which seeks to broaden the existing paradigm in which current pediatric consultation models are embedded. A more holistic approach, which combines theories that are consistent with both modern and postmodern epistemologies, is suggested as a means of achieving this objective. Narrative practices, such as externalization of the problem and the use of playful communication, form the clinical underpinnings of this approach. It is suggested that successful participation of children in all aspects of pain and symptom management can be enhanced through the use of these methods which are more congruent with children's natural medium of expression, play, and their preference for displacement of anxiety provoking material.