Medical student’s research finds pediatric anxiety associated with increased pain
Dozens of scholarly articles have been written about anxiety’s influence on pain perception. Now Lisa Crisalli, a fourth-year student at the Virginia Tech Carilion School of Medicine, has taken that research one step further, narrowing the focus to examine that relationship in children who are undergoing low-risk surgery.
Crisalli wanted to see if higher pediatric anxiety is associated with elevated pain perception. In addition, for very young children, she wanted to determine how parental anxiety would influence perception of pain.
With the help of her research mentor pediatric surgeon Shawn Safford, and the team of doctors, nurses, and staff at Carilion Children’s Pediatric Surgery, Crisalli recruited 128 patients age 18 and under who were undergoing elective operations. These included procedures such as hernia repairs, skin excisions, and gallbladder removals.
Using well-known evaluation tools, patients ages 7-18 were administered a series of surveys to determine their personal anxiety and their pain levels. Surveys were administered at three points in time, together referred to as the perioperative period: the patient’s pre-operative visit, the day of surgery, and their post-operative visit. Patients’ parents also completed surveys evaluating their own anxiety, how much pain they thought their child was experiencing, and if their child had experienced any sort of trauma. The team analyzed the data in two groups: children under 7, and children 7-18 years.
For both age groups, the findings suggest anxiety and trauma play a role in pain perception.
Crisalli found that children between 7 and 18 with higher anxiety reported higher pain throughout the perioperative process. In addition, having a history of trauma was associated with higher pain reported at the pre-operative visit and the day of surgery. Interestingly, there was no association between the type of procedure and the level of pain reported.
“The children who had higher anxiety at their pre-op visit would have a higher pain perception throughout the entire perioperative experience,” Crisalli said. “Somehow their anxiety was being translated into pain reporting, saying they were hurting more.”
In the younger age group, parents with higher anxiety or who reported their child had experienced trauma reported their child to be in significantly more pain at the pre-operative visit.
“As parents often direct the pain management of young children, these findings may identify a new target for improved measures for pain relief and patient outcomes in pediatric surgery.”
Crisalli said one of the most significant findings to come from her research was that children who were nervous may be articulating their feelings as pain.
“The study suggests that we need to be doing more to better understand our pediatric patients, better communicate with them, and find ways that we can be giving them a better experience,” she said.
“One of the most valuable takeaways from this project is that it has provided us a baseline of understanding of children’s anxiety during surgery,” Safford said. “From here, we can look at questions such as: How can we improve that? How can we help? What interventions can we make to reduce their fears?”
Crisalli said one such intervention might be virtual reality headsets that could improve pediatric patients’ anxieties by introducing them to the experience they are about to have.
“A lot of fear is fear of the unknown,” she said. “If we could use something that they think is cool and fun, that might help allay their fears.”
Crisalli’s project has allowed her to weave together not only medicine but also her first love - behavioral science. Graduating from the University of Maryland with a degree in psychology and concentration in neuroscience, she thought she would be a social worker or behavioral counselor, but after taking a job at an inpatient psychiatric hospital, she knew medicine was her calling.
“I love how there is so much room to incorporate psychosocial elements into medicine,” she said. “I wouldn’t be able to do it otherwise. It can be hard to understand what it’s like for a patient if you haven’t been on the other side, but my goal for this project and after medical school is to increase our focus on patients’ emotional needs. By understanding how patients experience these events, we can become better at treating people how we would want our families to be treated. I was fortunate to find a team that is as passionate and determined about this as I am. ”
Virginia Tech Carilion School of Medicine’s dedicated research curriculum was something that attracted Crisalli. After graduation in May, she plans to do her residency program in internal medicine at Georgetown, where she hopes to continue with research as part of her career.
Crisalli is one of eight students in the class of 2020 who received Letters of Distinction for their research project. Each will deliver an oral presentation at the 2020 VTCSOM Medical Student Research Symposium on March 27. The symposium will be virtual with a live stream of the oral presentations available.