Less than one-third of painful procedures for children in hospital associated with documented pain relief

Less than one-third of painful procedures performed on children in hospital were associated with documentation of a specific strategy to help manage pain, according to an article in CMAJ (Canadian Medical Association Journal).

Children in hospital experience multiple painful medical procedures daily, yet the use of specific pain management strategies in various hospital units is unknown. Painful procedures can have negative physiological, emotional and behavioural consequences such as greater pain responses to and anxiety toward subsequent painful procedures, which may result in avoidance of procedures, such as vaccination, in the future.

A team of researchers from across Canada sought to determine the frequency of painful procedures, the types of pain management strategies associated with these procedures and the influence of the hospital unit on pain management. The study included 3822 children 18 years of age or younger who were admitted to 32 units in eight university-affiliated paediatric hospitals for more than 24 hours.

Of the 3822 children in the study, 2987 (78.2%) underwent at least one painful procedure within a 24-hour period. Less than one-third of these children (844 or 28.3%) had documented pain management specifically for these painful procedures, although overall 78.1% of the children who underwent a painful procedure had some kind of pain management in the 24-hour period for either their condition or its treatment. Of those who had some type of pain management, interventions included pharmacological (84.8% of patients), physical (26.1%) and psychological (25.0%) therapies; 32.3% had combined interventions.

'Despite an abundance of evidence on effective pain management strategies, only a small proportion of children in our study had interventions specifically linked to the painful procedure,' writes Dr Bonnie Stevens, The Hospital for Sick Children (SickKids), with coauthors.

Children in critical care units (paediatric and neonatal intensive care units) experienced more painful procedures than those in medical and surgical units.

'Although the frequency of painful procedures documented in our study was lower than in previous studies, it remains unacceptably high and varies considerably across patients and types of hospital units,' state the authors.

'Decreases in the number of painful procedures performed and improvement in pain management associated with procedures are essential to relieve pain and suffering and to capitalise on the associated benefits for patients and the decreased use of health care resources,' they conclude.