Abstract
G Allen Finley talks to Roshaine Gunawardana, Commissioning Editor: Dr Allen Finley is a pediatric anesthesiologist who has worked for over 20 years in pain research and management. He is Professor of Anesthesia and Psychology at Dalhousie University (NS, Canada), and holds the inaugural Dr Stewart Wenning Chair in Pediatric Pain Management at the IWK Health Centre in Halifax. He has published over 100 papers in peer-reviewed journals and has lectured widely, with more than 230 invited presentations on six continents. He started the PEDIATRIC-PAIN e-mail discussion list in 1993, bringing together pain researchers and clinicians from over 40 countries. His own research and educational projects have recently taken him to Jordan, Thailand, China, Brazil and elsewhere. His main interest is pain service development and advocacy for improved pain care for children around the world, and he is co-leader of the ChildKind International Initiative.
Q What originally led to your interest in pain research and how did this develop into a specific interest in pediatric anesthesiology?
I first went into anesthesia and my focus on pediatric anesthesia came during my residency. I had some underlying interest in pain throughout my training; however, there was no formal program for education in pain management at that time. My epiphany came after I had been practicing pediatric anesthesia for a few years, when I gave a general anesthetic to a 4-year-old girl with terminal neuroblastoma in 1989. Discussions with the pediatricians led to me taking over her pain care for the next 6 weeks until she passed away comfortably. This changed my life. I had increasing involvement with pain management for children with cancer over the next couple of years, and then expanded to all types of pain as my colleagues recognized the need for specialized care in this area.
Concurrent with these clinical events, I was fortunate to begin research collaborations with Dr Patrick McGrath, a leader in the field, who had just moved to Halifax. We brought complementary skills and opportunities to the table, resulting in a long and productive shared research program. I benefited greatly from his experience and the many outstanding students who came to work with him.
Q Having worked in this area for more than 20 years, what are the major developments you have seen?
The biggest change has been the increase in awareness of the prevalence and importance of children‘s pain. There have been some advances in treatment approaches; however, the biggest improvements have been in routine, evidence-based pain assessment and the recognition that clinicians have a responsibility to prevent and manage pain. There is still a lot of work to do in this area; however, the transformation in the past 20 years has been dramatic.
Q You began the PEDIATRIC-PAIN email discussion list in 1993. What was the purpose behind this and how has it evolved since initiation?
Many of the clinicians and researchers working in pediatric pain were struggling, as they were often the only person in their institution with that focus and interest. The PEDIATRIC-PAIN list was designed, and continues to serve, as a forum to share ideas, questions and concerns about clinical problems and research methods. The membership fluctuates, but there are generally about 800 subscribers in 30–40 countries, some of whom have been there since the beginning. Many disciplines are represented and postings may range from “How do I deal with this patient who has…?” to “What is the best measurement technique for a research study on…?” to “How do I convince my hospital director to implement pain management policies?”
Q One main focus of your time is ‘advocacy for improved pain management for children in both developing and developed countries.‘ What are the main issues associated with the provision of pain management to children in both developing and developed countries and how can these be addressed?
The largest barriers to comprehensive pain prevention and treatment are not lack of knowledge or techniques, but the failure to apply the knowledge that we have. Initiatives, such as ChildKind International Citation[1], will supply incentives and resources to help hospitals develop policies and protocols, and change their internal culture to make children‘s pain a priority.
Q More generally, what do you see as the most pressing needs in the field of pediatric pain management in the present day and what directions will your research be taking in the next few years?
The greatest need is to translate our current knowledge into practice, to apply what we already know. We will be continuing to work on knowledge translation, both here in Canada, and around the world.
Q What advances would you hope to see in this specific area of pain research in the future?
We will have made true advances when no child has a painful procedure without appropriate analgesia beforehand, whether that is a topical anesthetic, systemic analgesic or skillful distraction and nonpharmacological techniques. Any episode of untreated pain should be regarded as an adverse event and trigger a systems evaluation to prevent similar occurrences in the future. All children and families should be able to come into a hospital or clinic knowing that their pain reports will be treated seriously and dealt with as efficiently and effectively as possible.
Financial & competing interests disclosure
GA Finley has no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.
No writing assistance was utilized in the production of this manuscript.
Reference
- ChildKind International. www.childkindinternational.org