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Acute Pain | Chronic Pain | General

Acute and postoperative pain in children

Clinical bottom line

In a Swedish nationwide survey 17% of children had moderate or severe pain postoperatively, and 31% in children with non-postoperative acute pain it was moderate or severe. Organisation problems were the major cause identified, together with more education about pain for doctors and nurses. There was a dramatic correlation between poor pain relief and small numbers of children treated.


Reference

M Karling et al. Acute and postoperative pain in children: a Swedish nationwide survey. Acta Paediatrica 2002 91: 660-666.

Study

This was a questionnaire survey for the whole of Sweden in 1996. All anaesthesia, ENT, surgery, paediatric surgery, orthopaedic, general paediatric and plastic surgery departments were sent questionnaires to sample both nurse and physician perspectives of acute pain in children. The response rate was 75%.

Results

The responses indicated that 6,344 children had undergone surgery in the previous month (out of an 18 years and under population of 2.02 million). Of these, 73% were estimated to have had some pain, and 23% of those with pain (17% of the total) had moderate to severe pain.

In individual departments, the percentage of children with moderate to severe pain despite treatment varied from 0% to 100%. There was a major effect of number of children treated in the month (Table 1). There were also 766 cases of non-postoperative acute pain, and in this case 31% had moderate to severe pain despite treatment.

Table 1: Size of department and children with moderate or severe pain

Children treated in previous month

Percent with moderate or severe pain (range)

More than 200

0-10

100-200

0-35

50-100

0-50

Less than 50

0-100

About half doctors and nurses thought pain could be managed better. Reasons for inadequate management most often mentioned were inadequate prescription, children's anxiety, and parents' fears. Pain assessments were regularly performed in 43% of departments, and 74% of departments had access to a doctor who worked at least part time on pain management. Doctors and nurses overwhelmingly (85% or more) reported a need for more information and education on pain physiology, assessment and pharmacology of analgesics.

Comment

Sweden is a country that many of us look to for the quality of its healthcare. If Sweden can have such a high proportion of children with moderate or severe pain, then that bodes ill for countries where healthcare organisation is less well organised.

An yet this nationwide survey demonstrated that the deficiencies were mostly organisational. It wasn't lack of time. The most dramatic observation was the powerful correlation between the number of children treated and the proportion with poor pain relief.

This is a very useful and detailed paper that should be read by anyone with an interest in pain relief in acute settings, in children or adults.