Thursday, 8 October 2015

Pain management in children

Roger Watson, Editor

Pain in children needs particular attention as some children may have difficulty in describing their pain and may not understand why they are in pain.  Also, there are pharmacological issues to be taken into account with children in terms of dosage and frequency of administration of analgesia.

As this UK study by Beckett et al. (2105) titled: 'A mixed-method study of pain management practice in a UK children’s hospital: identification of barriers and developing strategies to maintain effective in-patient paediatric pain management' and published in Nursing Open states: 'UK paediatric acute pain services vary. Although comprehensive pain management guidelines exist, consensus on the best model of care is lacking.'  And, despite the evolution of specialist acute pain services (APSs), 'their overall efficacy is unknown.'

The study looked at pain management practices over two weeks in one hospital with children who were inpatients and interviews were held with staff.  Referrals and non-referrals to the APS were studied and all were made appropriately.  The authors report that: 'Acute Pain Services cases experienced higher pain levels, were more likely to have long term conditions, longer hospital stay and repeat admissions.'  These data and the interviews suggest that APSs are effective but that they are likely to become overburdened as they are often viewed as a generic pain advise service.  Therefore, despite the success of the APS studied, the authors conclude: 'However, without forward planning and simultaneous investment in training there is a risk that pain becomes increasingly specialized, that responsibility for managing other forms of difficult-to-treat pain becomes blurred and that front-line staff lack the ability to provide timely effective care.'

Reference

Beckett K, Henderson EM, Parry S, Stoddart P, Fletcher M (2015) A mixed-method study of pain management practice in a UK children’s hospital: identification of barriers and developing strategies to maintain effective in-patient paediatric pain management Nursing Open doi: 10.1002/nop2.33

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