Temperament and Pain Response: A Review of the Literature

Manon Ranger, PhD Student, MSc, RN; Marsha Campbell-Yeo, PhD Student, MN, NNP, RN

Disclosures

Pain Manag Nurs. 2008;9(1):2-9. 

In This Article

Nursing Implications

All of the authors cited in this literature review agree that we must use the findings from studies recognizing a relationship between pain response and temperament to improve patient care in the clinical settings. For children, visits to the hospital, experiencing painful procedures, staying in unfamiliar settings, and having to undergo operations and painful treatments causes a great deal of anxiety and distress. These stressful and usually unpleasant events may lead to life-long alterations in pain response. It is our obligation to better understand how our patients experience these episodes and to appropriately intervene to allow more positive outcomes to occur. Thus, to prepare a child and their parents for these events, nurses need to consider certain aspects particular to their patient's personality, such as coping style, emotional development, and temperament (Bournaki 1997, Brome et al 1998, Helgadôttir and Wilson 2004, Lee and White-Traut 1996). Based on the results from their study, Schechter et al. (1991) recommended that the preparation of children undergoing painful procedures be revisited to allow individualization of the care based on temperament and other personality traits of the child and family. Some authors specifically recommend that in situations where children experience pain, health care professionals could possibly change the demands of the environment to better fit the patient's temperament. Because a child's particular behavior style affects how he or she reacts to pain, it is imperative that nurses adjust their interventions to focus on their patient's individual needs and aim to attain "goodness of fit" (Lee and White-Traut 1996, Ruddy-Wallace 1989). Many nurses possibly know this and are aware that it is important to individualize their treatment plans to better suit their patients' specific needs. What is lacking in the literature is strong evidence to support general recommendations for daily clinical practice. From the present review, it appears that temperament is an important factor, but no study has looked at the effectiveness of specific interventions to guide practice, and this is the direction that future research should aim.

Although these authors have given certainly significant recommendations, these are quite general overviews. Is it realistic to think that these findings could be applied to the daily practice of nurses and health care professionals? Knowing that the assessment and treatment of pain still remains problematic, can we add the evaluation of more factors, such as temperament, to this already neglected task? In addition, is it feasible to do this kind of assessment in various clinical settings? What kind of training resources would nurses need to be able to evaluate the temperament? The aim of future research should be directed toward resolving these issues. No authors from the reviewed studies have addressed this imperative point. The nursing profession has always been concerned with providing the best care by applying evidence-based medicine/nursing and improving their practice through ongoing teaching and knowledge transfer. In fact, knowledge utilization is an essential component of today's nursing practice and health care system but despite advances in knowledge generation the gap in knowledge transfer from research to practice continues (Edgar et al., 2006), thus adding to our already existing issue of inadequate pain management.

A possible avenue for change could be at the academic level. To increase awareness, nursing curricula regarding pain management could include content related to the factors, which would include temperament, impacting the individual pain experience. Early on, nursing students need to learn and be aware of the interindividual variations in pain sensitivity, perception, and tolerance. The specific role that temperament can play in this cascade of variables should be emphasized as well. As a result, this could provide novice nurses with a better preparation to undertake their "cornerstone" role in the pain management team approach (McCaffery & Pasero, 1999).

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