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February 1997
Prevalence and source of pain in pediatric inpatients
Cummings EA, Reid GJ, Finley GA, McGrath PJ, Ritchie JA;
Pain 68: 25-31, 1996
[ see abstract below ]
Systematic attention to the provision of appropriate analgesia for infants and children has been a relatively recent phenomenon. Over the last 20 years, epidemiological studies of pain and analgesic use have focused on specific patient groups such as postoperative patients or those with cancer.
These investigators from the IWK-Grace Health Centre in Halifax, Nova Scotia interviewed parents (of patients less than 5 years of age) and children (over 5) of all inpatients (except those in the neonatal ICU or psychiatry ward) in a major tertiary care pediatric center on each of 3 survey days. Subjects (parents or children) were asked them to rate the intensity of the patient's pain, identify its source, and describe their perceptions of the help (pharmacologic and non-pharmacologic) received for the pain.
Half of the patients interviewed had experienced clinically significant pain in the 24 hours previous to the survey, and more than half of those reporting pain due to their disease, surgery or headache had not received ANY analgesic medication. Children with acute illness were at greater risk for pain than those with chronic diseases; however, medical patients had a risk of pain equal to that of surgical patients.
Most children reported that their mother or a nurse helped them manage their pain; however almost one fourth said that no one had helped them. Pills were the most frequently reported source of pharmacological help with the pain, while talk and touch were the most helpful non-pharmacological strategies.
While the incidence of clinically significant pain reported in this study is lower than that in previous reports, it is still higher than it should be. The authors make a number of excellent recommendations for the assessment and treatment of pain in pediatric settings and emphasize the importance of hospital-wide commitments to becoming as close to pain free as possible.
Return to the Current Literature Review Front Page, or read the abstract:
ABSTRACT
Our knowledge of the prevalence and sources of pain within hospital is limited. The present study is an epidemiological investigation of pain in a pediatric hospital. All children who were inpatients in a tertiary care hospital (excluding Neonatal ICU and psychiatry patients) and one parent per child were potential subjects. Interviews were conducted on three weekdays.
Parent interviews were used for children less than 5 years of age (n = 102); child interviews were used for children age 5 years and over (n = 98). Subjects reported the intensity and source of the worst, usual and current pain during the past 24 h. and help received for pain. Medical and demographic variables and analgesics prescribed and administered were obtained from the medical record.
Forty-nine percent of subjects reported clinically significant levels of worst pain. Twenty-one percent of subjects had clinically significant levels of usual pain. Causes of pain were variable and included disease, surgery, and intravenous lines (IV). Pain intensity was not significantly related to age, gender, patient type (medical, surgical), or diagnostic category. Children were given significantly less modification than was prescribed, regardless of their reported pain level.
Nurses, mothers, and 'no-one' were frequently reported as helping with pain. Medications and non-pharmacological methods were reported as helpful in managing pain. Many children endure unacceptable levels of pain during hospitalization. Pain prevention and management must be more aggressive. Pain assessment should be approached with the same attention as vital signs. Improvements in analgesic prescription and administration practices and non-pharmacological pain control methods are needed.
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