While the true magnitude of the problem of inadequate and undertreated children's pain may not be known, the use of high technology and aggressive pharmacological management promise adequate pain control for children. However, findings from a recent study suggested that children's post-operative pain may not be controlled despite the use of state-of-the-art technology and aggressive pharmacological therapy. The purpose of this study was to determine the extent to which selected variables predicted children's and adolescents' self-report of pain intensity and observed pain behaviors following surgery for spinal fusion. The predictor variables included: severity of operative procedure, post-operative use of opioids, ketorolac, and sedatives, prior experience with pain, pain tolerance, sex, and age.

Supported by the tenets of the Gate Control Theory, the predictor variables provided a multi-dimensional model for examining physiological and psychological factors thought to influence pain perception. A series of multiple regression equations examined relationships between the predictor and criterion variables over a four day post-operative course. Findings revealed no consistent pattern of relationships among the variables over time. Four potential influences on post-operative pain in children were identified. The constructs "age" and "severity of operative procedure" accounted for a small portion of the variance across the first three post-operative days. "Pain tolerance" contributed to the variance in pain scores only on day four. The amount of morphine via "PCA" entered into the MR equation on each of the four post-operative days, however, accounting for only a small portion of the variance. The variables "sex" and "prior experience with pain" held no predictive value in this study. Overall, the R Square values suggested that age, pain tolerance, and severity of operative procedure have the greatest potential for future investigation.

This study expanded the knowledge base for nursing by undermining the argument that children's pain can be effectively managed with pharmacological regimens alone, and by supporting the premise that children's pain may not be relieved despite aggressive pharmacological therapy using state-of-the-art technology. This research advocates for the use of a diversity of pharmacological and non-pharmacological therapies so that pain following spinal fusion can be managed from a more holistic perspective.