Book Review

A valuable resource for psychologists working in pediatric pain

Chapters on pediatric pain management in: Clinical handbook of psychological consultation in pediatric medical settings.

Carter BD, Kullgren KA, editors (2020). Cham, Switzerland: Springer, 552 pp. ISBN 978-3030355982 (Softcover: $199.99 USD; Hardcover: $279.99 USD; eBook: $149.00 USD). Link

Reviewed by Jennifer Corser, Amy Parkinson and Holly Waring

printable version (PDF)

This handbook is part of the Issues in clinical child psychology online book series written for consultation-liaison pediatric psychologists working in integrated medical settings. Given the increased presence of psychology in pediatric clinical settings, this handbook meets a need to provide evidence-based guidance and resources to support consultant-liaison psychologists in their work with children and families. The handbook addresses topics across pediatric medical and social settings including managing referrals, assessments and planning interventions. It comprises 38 chapters and is divided into 3 sections. Part I: Pediatric consultation-liaison psychology: models, roles, settings and practice provides an overview of various roles that a consultation-liaison psychologist may play and considers the challenges that individuals may face across diverse settings (e.g. mitigating the impact of inpatient hospitalisation for children and families). Part II: Clinical conditions and interventions discusses frequently seen major pediatric conditions (e.g. eating disorders, burn injuries) in individual chapters, each written by practicing clinical experts. Finally, Part III: Cross-cutting issues in consultation-liaison practice addresses issues such as managing distressed parents and advocacy. The handbook is available as an online resource, viewable as individual chapters with shortcuts to relevant sections. This makes it highly accessible to a working clinician wishing to reference a specific topic quickly. It is also downloadable in full as a PDF.

Fitting with the interests of the Pediatric Pain Letter readership, we have focused this review on chapters which address pain or related content. These chapters comprise three chapters: The problem of pain: acute pain and procedures; The problem of pain: chronic pain and Somatic symptom and related disorders. Each chapter provides information pertinent to pediatric psychologists of all levels of training. Chapters follow a general pattern of medical background; brief literature review of current research; adaptation to relevant clinical populations; clinical formulation; and considerations of relevant patient, provider, and systemic factors. Chapter authors have helpfully provided additional relevant resources which may be useful in clinical practice such as a handout concerning coping strategies for young people with somatic symptom and related disorders.

The problem of pain: acute pain and procedures by MacKenzie, Tutelman and Chambers

Acute pain procedures are common in pediatric clinical settings, necessitating clinician knowledge of assessment and management of acute pain. Meeting this clinical need, this chapter provides an overview of tools for assessment and management of acute pain in children and young people, noting the impact of childhood pain experiences, and outlining best practice.

The pain assessment section is a particularly strong aspect of this chapter, providing a clear and easy to navigate table of relevant pain assessment tools for different age groups based on high-quality evidence. Additionally, the authors provide a clear and thorough justification for the importance of pain assessment and link to effective pain management for children and young people.

Inclusion of a case study featuring a young girl with sickle cell disease provides an example of the written material guiding the clinician through a realistic scenario of pediatric acute pain from referral to post-procedural pain management. Of additional benefit is the inclusion of relevant accessible resources for clinicians to incorporate into their own pediatric pain management practice such as the It doesn’t have to hurt YouTube video which focuses on providing pain management strategies in acute pain settings. On reflection, perhaps the authors could have extended the discussion of the key features of psychological support, particularly improving coping and communication skills, and education around pain management strategies, although this remains a helpful section of the chapter.

A final feature of this chapter is the addition of the Consideration for special population section demonstrating inclusivity for neurodiverse children, particularly those with intellectual or developmental disabilities and autism spectrum disorder. Although common in the population, they are often excluded in the literature. This section critically reviews the research available, providing evidence-based recommendations for clinical practice.

The problem of pain: chronic pain by Foxen-Craft, Williams and Scott

As this chapter highlights, pediatric chronic pain conditions are disabling and can profoundly impact children and young people’s functioning, quality of life, and psychological well-being. Adopting a family-focus throughout, the authors helpfully acknowledge the wider social context of pediatric chronic pain.

This chapter provides a clear explanation of the physiological mechanisms involved in pediatric chronic pain as well as the multidirectional relationships among emotions, cognitions and pain-related functioning. The authors also helpfully outline various biopsychosocial variables and health habits which should be considered by consultant-liaison psychologists as part of their formulation of patients suffering chronic pain conditions.

A key strength of this chapter is a focus on patient and family resistance to psychology-based interventions and a compelling review of the evidence in their support. Helpfully, this chapter provides important advice for psychologists, supporting them to increase patient and family buy-in to psychology-based interventions, fundamental to successful engagement and improved outcomes.

Whilst much of this chapter focuses on the role of consultant-liaison psychologists within an inpatient setting, there is a well-considered section concerning their role in the patient’s transition to outpatient care. This highlights the importance of communication across different clinical settings to ensure optimal pain management for children and young people.

Somatic symptom and related disorders by Williams, Zahka and Kullgren

Placing somatic symptoms and related disorders as central to the intersection of medicine and psychology, this chapteropens with thorough evidence-based understanding of somatic symptom and related disorders (SSRD), providing clarity even for those who are unfamiliar with these conditions. Individual and family buy-in for psychological approaches to SSRD can be difficult because of implications of mind-body dualism (“it’s all in your head”) and diagnostic uncertainty (“we don’t know what’s wrong with you”). Accordingly, this chapter devotes a section to evidence-based principles of best practice for patient and family engagement. Notably, the authors encourage the use of a positive diagnosis such as functional disorder and list five key points to consider when communicating the diagnosis.

Consistent with other chapters, this chapter continues with pragmatic information on assessment, intervention, and adaptation. A key strength of this chapter is the inclusion of example phrasing to empower psychologists to effectively support children and young people with SSRD. The authors include models, metaphors and analogies to aid explanations for patients and families and to help normalise the symptoms. There is a strong focus on improving function and mood via cognitive behavioral therapy, and the authors integrate a biopsychosocial approach throughout. Importantly, additional resources are supplied for families and schools who support children with SSRD to ensure continuity of care for the child outside of the clinical setting.

The chapter concludes with a complete case study to illustrate each stage of the previously described consultation, including an evaluation highlighting salient points to emphasise examples of successful care. Helpful handouts are provided as appendices including a fact sheet and signposting to relevant websites and resources.

Concluding remarks 

These three chapters provide a comprehensive overview of pediatric pain outlining the roles, challenges, and opportunities of consultant-liaison psychologists in inpatient and outpatient settings. There is a consistent theme of approaching pediatric pain from a biopsychosocial perspective, acknowledging the importance of family and school systems in the support of children and young people who experience pain. Chapters are rich with high quality evidence-based resources and illustrated with relevant case studies. Overall, this is an extremely valuable resource providing evidence-based information to support pediatric consultant-liaison psychologists and trainees in this practice context with assessment and intervention of children presenting with acute and chronic pain conditions in a variety of medical settings.

Cite as: Corser J, Parkinson A, Waring H. A valuable resource for psychologists working in pediatric pain. Book review of chapters on pediatric pain management in: Clinical handbook of psychological consultation in pediatric medical settings. Pediatric Pain Letter 2022;24(3):24-26. ppl.childpain.org