Acute pain management in children: a survey of Italian pediatricians

Abstract Background Current guidelines recommend assessing and relieving pain in all children and in all instances; yet, in clinical practice, management is frequently suboptimal. We investigated the attitude of Italian family pediatricians towards the evaluation and treatment of different types of acute pain in children aged 7–12 years. Methods This is a cross-sectional study based on a 17-question survey accessible online from October 2017 to October 2018. Responders had to describe cases of children suffering from any type of acute pain among headache, sore throat, musculoskeletal/post-traumatic pain, and earache. Children’s characteristics, pain assessment modalities and therapeutic approaches were queried. The following tests were used: Z-proportion to evaluate the distribution of categorical data; chi-squared and Kruskall-Wallis to explore data heterogeneity across groups; Mann-Whitney for head-to-head comparisons. Results Overall, 929 pediatricians presented 6335 cases uniformly distributed across the types examined. Pain was more frequently of moderate intensity (42.2%, P < 0.001) and short duration (within some days: 98.4%, P < 0.001). Only 50.1% of responders used an algometric scale to measure pain and 60.5% always prescribed a treatment. In children with mild-moderate pain (N = 4438), the most commonly used first-line non-opioids were ibuprofen (53.3%) and acetaminophen (44.4%). Importantly, a non-recommended dosage was prescribed in only 5.3% of acetaminophen-treated cases (overdosing). Among the misconceptions emerged, there were the following: i) ibuprofen and acetaminophen have different efficacy and safety profiles (when choosing the non-opioid, effectiveness weighted more for ibuprofen [79.7% vs 74.3%, P < 0.001] and tolerability for acetaminophen [74.0% vs 55.4%, P < 0.001]); ii) ibuprofen must be taken after meals to prevent gastric toxicities (52.5%); ibuprofen and acetaminophen can be used combined/alternated for persisting mild-moderate pain (16.1%). In case of moderate-severe pain not completely controlled by opioids, ibuprofen and acetaminophen were the most used add-on medications, with ibuprofen being much more prescribed than acetaminophen (65.2% vs 23.7%, respectively) overall and in all pain types. Conclusions Several gaps exist between the current practice of pain assessment and treatment and recommendations. Further efforts are needed to raise awareness and improve education on the possible exposure of the child to short- and long-term consequences in case of suboptimal pain management.

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Knowledge, attitudes, and practices of Cameroonian physicians with regards to acute pain management in the emergency department: a multicenter cross-sectional study

BMC Emergency Medicine ◽

10.1186/s12873-019-0260-3 ◽

2019 ◽

Vol 19 (1) ◽

Author(s):

Paul Owono Etoundi ◽

Junette Arlette Metogo Mbengono ◽

Ferdinand Ndom Ntock ◽

Joel Noutakdie Tochie ◽

Dominique Christelle Anaba Ndom ◽

...

Keyword(s):

Emergency Department ◽

Pain Management ◽

Acute Pain ◽

Cross Sectional Study ◽

Sectional Study ◽

Acute Pain Management ◽

Cross Sectional ◽

Attitudes And Practices ◽

Knowledge Attitudes And Practices

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Acute and Chronic Pain Learning and Teaching in Medical School—An Observational Cross-Sectional Study Regarding Preparation and Self-Confidence of Clinical and Pre-Clinical Medical Students

Medicina ◽

10.3390/medicina55090533 ◽

2019 ◽

Vol 55 (9) ◽

pp. 533 ◽

Cited By ~ 2

Author(s):

Kacper Lechowicz ◽

Igor Karolak ◽

Sylwester Drożdżal ◽

Maciej Żukowski ◽

Aleksandra Szylińska ◽

...

Keyword(s):

Chronic Pain ◽

Pain Management ◽

Medical Students ◽

Acute Pain ◽

Pain Treatment ◽

Cross Sectional Study ◽

Clinical Group ◽

Sectional Study ◽

Cross Sectional ◽

Actual Knowledge

Background and objectives: Adequate pain management is a major challenge of public health. The majority of students graduating from medical schools has insufficient education and experience with patients suffering pain. Not enough is being taught regarding pain in non-verbal patients (children, critically ill in the intensive care unit, demented). Chronic pain is the most difficult to optimize and requires appropriate preparation at the level of medical school. Our aim was to evaluate attitudes, expectations and the actual knowledge of medical students at different levels of their career path regarding the assessment and treatment of acute and chronic pain. Materials and Methods: We performed an observational cross-sectional study that was based on a survey distributed among medical students of pre-clinical and post-clinical years at the Pomeranian Medical University in Szczecin, Poland. The survey included: demographic data, number of hours of formal pain teaching, actual knowledge of pain assessment, and pain treatment options in adults and children. Results: We received responses from 77/364 (21.15%) students and 79.2% of them rated the need to obtain knowledge regarding pain as very important (10/10 points). Post-clinical group declared having on average 11.51 h of acute pain teaching as compared to the 7.4 h reported by the pre-clinical group (p = 0.012). Graduating students also reported having significantly more classes regarding the treatment of chronic pain (6.08 h vs. 3.79 h, p = 0.007). The average level of comfort in the post-clinical group regarding treatment of acute pain was higher than in the pre-clinical group (6.05 vs. 4.26, p = 0.006), similarly with chronic pain treatment in adults (4.33 vs. 2.97, p = 0.021) and with pain treatment in children (3.14 vs. 1.97, p = 0.026). Conclusions: This study shows that education about pain management is a priority to medical students. Despite this, there continues to be a discrepancy between students’ expectations and the actual teaching and knowledge regarding effective pain management, including the vulnerable groups: chronic pain patients, children, and critically ill people.

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Pain in children

10.1093/med/9780198785750.003.0041 ◽

2018 ◽

Author(s):

Julia Wager ◽

Boris Zernikow

Keyword(s):

Chronic Pain ◽

Pain Management ◽

Cancer Pain ◽

Acute Pain ◽

Pain Assessment ◽

Education For All ◽

Special Focus ◽

Assessment And Treatment ◽

Specialized Service ◽

Pain Patients

Pain management in children is a specialized service. Pain aetiology, assessment, and treatment vary at every age from pre-term foetuses at 23 weeks gestation to adolescence. In this chapter of European Pain Management advances in our understanding of pain assessment are reviewed, particularly in the use of developmentally relevant technology. Advances in acute pain, cancer pain, and in chronic pain are also reviewed, with a special focus on innovations in multidisciplinary treatments for chronic pain. There is a need to raise awareness and understanding of the needs of paediatric pain patients, and their family members. Education for all professionals who interact with pain patients is essential, as is the need to invest in specialized pain management services, and professionals, across Europe.

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Pain Prevalence in a Pediatric Hospital: Raising Awareness during Pain Awareness Week

Pain Research and Management ◽

10.1155/2014/737692 ◽

2014 ◽

Vol 19 (1) ◽

pp. e24-e30 ◽

Cited By ~ 29

Author(s):

Denise Harrison ◽

Cynthia Joly ◽

Christine Chretien ◽

Sarah Cochrane ◽

Jacqueline Ellis ◽

...

Keyword(s):

Pain Management ◽

Pain Assessment ◽

Management Practices ◽

Management Strategies ◽

Cross Sectional Study ◽

Infants And Children ◽

Assessment Tools ◽

Pediatric Hospital ◽

Cross Sectional ◽

Pain Scores

BACKGROUND: Despite the evidence and availability of numerous validated pain assessment tools and pain management strategies for infants and children, their use remains inconsistent in clinical practice.OBJECTIVES: To describe the prevalence of pain, pain assessment and pain management practices at a tertiary pediatric hospital in Canada.METHODS: The cross-sectional study design involved a combination of interviews with children and/or caregivers, and chart audits in five inpatient units. Information regarding pain intensity, painful procedures and pain management strategies was obtained from children and/or caregivers by interview. Patient charts were reviewed for information regarding pain assessment, pain scores, and pharmacological and nonpharmacological interventions.RESULTS: Sixty-two children (four days to 17 years of age) participated. Most children or their caregivers (n=51 [84%]) reported that pain was experienced during their hospitalization, with 40 (66%) reporting their worst pain as moderate or severe. Almost one-half reported analgesics were administered before or during their most recent painful procedure. Nineteen (32%) reported sucrose, topical anesthetics or nonpharmacological interventions were used; however, they were documented in only 17% of charts. Pain scores were documented in 34 (55%) charts in the previous 24 h. The majority of the children or their caregiver (n=44 [71%]) were satisfied with pain management at the study hospital.CONCLUSIONS: Most infants and children had experienced moderate or severe pain during their hospitalization. Analgesics were frequently used, and although nonpharmacological strategies were reported to be used, they were rarely documented. Most parents and children were satisfied with their pain management.

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Knowledge, attitudes, and practices of Cameroonian physicians with regards to pain management at the emergency department: a multicenter cross-sectional study

10.21203/rs.2.10155/v1 ◽

2019 ◽

Author(s):

Paul Owono Etoundi ◽

Junette Arlette Metogo Mbengono ◽

Ferdinand Ndom Ntock ◽

Joel Noutakdie Tochie ◽

Dominique Christelle Anaba Ndom ◽

...

Keyword(s):

Emergency Department ◽

Emergency Medicine ◽

Pain Management ◽

Acute Pain ◽

Cross Sectional Study ◽

Sectional Study ◽

Cross Sectional ◽

Attitudes And Practices ◽

Level Of Knowledge ◽

Knowledge Attitudes And Practices

Abstract Introduction: Pain is the most frequent presenting complaint in patients consulting or admitted to the emergency department (ED). Thus, its acute management is often done by physicians working in the ED. These practitioners are often general practitioners and not emergency medicine physicians in resource-poor settings. Hence, a mastery of pain management by these physicians may be important in relieving acute pain. We aimed to assess the knowledge, to determine the attitudes and practices of physicians in the management of pain in EDs of Cameroon. Methods: We carried out a prospective analytic cross-sectional study over four months in the year 2018. We enrolled all consenting physicians who were neither emergency medicine doctors nor anesthesiologists working at the EDs of five tertiary hospitals of Cameroon. Using a 30-item structured questionnaire, data on the knowledge, attitudes, and practices of pain management at the ED by these clinicians were studied. We used an externally validated score to assess the knowledge as either poor, insufficient, moderate or good. Results: A total of 58 physicians were included; 18 interns and 39 general practitioners. Their mean age was 28.6 ± 3 years and their average number of years of practice was 2.9 years. The level of knowledge was rated “poor” in 77.6% of physicians. Being a general practitioner was significantly associated with a poor level of knowledge (p=0.02; OR=5.1). We found a negative and significant correlation between knowledge and years of practice (p=0.04; r2= 0.06). More than three-quarter (82.8%) of participants used a pain scale to evaluate the severity of pain. The most used scale being the Visual Analog scale (56.9%). The most frequently used analgesic was paracetamol (98.3%), although only 3.5% of physicians correctly knew its half-life, delay of onset of action and duration of action. Conclusion: These findings suggest that physicians in EDs of Cameroon have poor knowledge and suboptimal practices in pain management. General practice and a greater number of professional experience seemed to favour these attitudes. Overall, there is an urgent need for refresher courses in acute pain management for physicians working in these resource-limited EDs.

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Assessment of postoperative pain management practices in Cameroon, Ivory Coast and Senegal: A multi-national survey

Tropical Doctor ◽

10.1177/00494755211016115 ◽

2021 ◽

pp. 004947552110161

Author(s):

Oumar Kane ◽

Narcisse Boua ◽

Romuald Hentchoya ◽

Modou Seck ◽

Amy N Fall ◽

...

Keyword(s):

Pain Management ◽

Postoperative Pain ◽

Pain Assessment ◽

Staff Training ◽

Management Practices ◽

Postoperative Pain Management ◽

Cross Sectional Study ◽

Cross Sectional ◽

Treatment Protocols ◽

Management Recommendations

Inadequately controlled postoperative pain impacts patients’ functional recovery and may affect the quality of life after surgery. Our multinational, cross-sectional study conducted online between November 2017 and January 2018 surveyed anaesthetists’ conformity with established postoperative pain control guidelines and looked at pain assessment, dissemination of information to patients, staff training and creation and use of treatment protocols. Of the 170 respondents, only six applied postoperative pain management recommendations. The proportion of respondents who reported regular staff training; the regular provision of pre-operative information to patients; the existence and use of written protocols; and the number conducting at least one pain assessment a day was not just suboptimal, but embarrassingly low.

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Knowledge, attitudes, and practices of Cameroonian physicians with regards to acute pain management in the emergency department: a multicenter cross-sectional study

10.21203/rs.2.10155/v2 ◽

2019 ◽

Author(s):

Paul Owono Etoundi ◽

Junette Arlette Metogo Mbengono ◽

Ferdinand Ndom Ntock ◽

Joel Noutakdie Tochie ◽

Dominique Christelle Anaba Ndom ◽

...

Keyword(s):

Emergency Department ◽

Pain Management ◽

Acute Pain ◽

Cross Sectional Study ◽

Sectional Study ◽

Acute Pain Management ◽

Cross Sectional ◽

Attitudes And Practices ◽

Level Of Knowledge ◽

Knowledge Attitudes And Practices

Abstract Introduction: Pain is the most frequent presenting complaint in patients consulting or admitted to the emergency department (ED). Thus, its acute management is often done by physicians working in the ED. These practitioners are often general practitioners and not emergency medicine physicians in resource-poor settings. Hence, a mastery of pain management by these physicians may be important in relieving acute pain. We aimed to assess the knowledge, to determine the attitudes and practices of physicians in the management of pain in EDs of Cameroon. Methods: We cross-sectional study carried out prospectively over four months in the year 2018. We enrolled all consenting physicians who were neither emergency medicine doctors nor anesthesiologists working at the EDs of five tertiary hospitals of Cameroon. Using a validated and pretested structured questionnaire, data on the knowledge, attitudes, and practices of acute pain management at the ED by these clinicians were studied. We used an externally validated score to assess the knowledge as either poor, insufficient, moderate or good. Results: A total of 58 physicians were included; 18 interns and 39 general practitioners. Their mean age was 28.6 ± 3 years and their average number of years of practice was 2.9 years. The level of knowledge was rated “poor” in 77.6% of physicians. Being a general practitioner was significantly associated with a poor level of knowledge (p=0.02; OR=5.1). We found a negative and significant correlation between knowledge and years of practice (p=0.04; r2= 0.06). More than three-quarter (82.8%) of participants used a pain scale to evaluate the severity of pain. The most used scale being the Visual Analog scale (56.9%). The most frequently used analgesic was paracetamol (98.3%), although only 3.5% of physicians correctly knew its half-life, delay of onset of action and duration of action. Conclusion: These findings suggest that physicians in EDs of Cameroon have poor knowledge and suboptimal practices in pain management. General practice and a greater number of professional experience seemed to favour these attitudes. Overall, there is an urgent need for refresher courses in acute pain management for physicians working in these resource-limited EDs.

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Nurses' knowledge and practices regarding pain management in newborns

Revista da Escola de Enfermagem da USP ◽

10.1590/s1980-220x2016034403210 ◽

2017 ◽

Vol 51 (0) ◽

Cited By ~ 7

Author(s):

Taine Costa ◽

Lisabelle Mariano Rossato ◽

Mariana Bueno ◽

Izabela Linha Secco ◽

Natália Pinheiro Braga Sposito ◽

...

Keyword(s):

Pain Management ◽

Pain Assessment ◽

Neonatal Intensive Care ◽

Cross Sectional Study ◽

Study Data ◽

Metropolitan Region ◽

Cross Sectional ◽

Neonatal Pain ◽

Nutritive Sucking ◽

Nurses Knowledge

Abstract OBJECTIVE To analyze nurses' knowledge and practices regarding pain management of newborns admitted to Neonatal Intensive Care Units. METHOD A descriptive and cross-sectional study. Data were collected from 51 nurses based on an adapted questionnaire aimed at evaluating knowledge and practices regarding the management of neonatal pain in six hospitals in Curitiba and its Metropolitan Region. RESULTS For most nurses (86.0%), neonates feel pain. A total of 34.7% of the nurses reported never using pain assessment scales. Pain management was recorded by 84.3% of the nurses. Administered pharmacological measures were Paracetamol and Fentanyl (47.1%) and Morphine (17.6%); while non-pharmacological measures adopted were sweetened solution (68.6%), non-nutritive sucking (58.8%) and positioning (56.9%). CONCLUSION Nurses considered neonatal pain a real event; however, they do not perform pain assessment or treatment of newborns in a systematized way.It is necessary to implement knowledge translation strategiesin order to improve pain management in newborns.

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Predictors of effective management of acute pain in children within a UK ambulance service: a cross-sectional study

British Paramedic Journal ◽

10.29045/14784726.2019.12.4.3.58 ◽

2019 ◽

Vol 4 (3) ◽

pp. 58-59

Author(s):

Gregory Adam Whitley ◽

Pippa Hemingway ◽

Graham Richard Law ◽

Caitlin Wilson ◽

A. Niroshan Siriwardena

Keyword(s):

Pain Management ◽

Acute Pain ◽

Rating Scale ◽

Cross Sectional Study ◽

Ambulance Service ◽

Effective Management ◽

Sectional Study ◽

Cross Sectional ◽

Second Pain ◽

Clinical Records

Introduction: Pre-hospital pain management in children is poor, with very few children in pain receiving analgesia. Without effective pain treatment, children may suffer long-term changes in stress hormone responses and pain perception and are at risk of developing posttraumatic stress disorder. We aimed to identify predictors of effective management of acute pain in children in the pre-hospital setting.Methods: A retrospective cross-sectional study using electronic clinical records from one large UK ambulance service between 1 October 2017 and 30 September 2018 was performed using multi-variable logistic regression. We included all children < 18 years suffering acute pain. Children with a Glasgow Coma Scale of < 15, no documented pain or without a second pain score were excluded. The outcome measure was effective pain management (abolition or reduction of pain by ≥ 2 out of 10 using the numeric pain rating scale, Wong and Baker FACES® scale or Face, Legs, Activity, Crying and Consolability (FLACC) scale).Results: A total of 2312 patients were included for analysis. Median (IQR) age was 13 (9‐16), 54% were male and the cause of pain was trauma in 66% of cases. Predictors of effective pain management include children who were younger (0‐5 years) compared to older (12‐17 years) (adjusted odds ratio (AOR) 1.57; 95% confidence interval (CI) 1.21‐2.03), administered analgesia (AOR 2.35; CI 1.94‐2.84), attended by a paramedic (AOR 1.39; CI 1.13‐1.70) or living in an area of medium deprivation (index of multiple deprivation (IMD) 4‐7) compared to children in an area of high deprivation (IMD 1‐3) (AOR 1.41; CI 1.10‐1.79). Child gender, type of pain, transport time and clinician experience were not significant.Conclusion: These predictors highlight disparity in effective pre-hospital management of acute pain in children. Qualitative research is needed to help explain these findings.

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A Comparison of Pain Scale on Neonates in a Top Refferal Hospital in Indonesia

Journal Of Nursing Practice ◽

10.30994/jnp.v5i1.163 ◽

2021 ◽

Vol 5 (1) ◽

pp. 126-135

Author(s):

Nenty Septiana ◽

Yeni Rustina ◽

Defi Efendi

Keyword(s):

Pain Management ◽

Pain Assessment ◽

Assessment Tool ◽

Cross Sectional Study ◽

Pain Scale ◽

Assessment Scale ◽

Validity And Reliability ◽

Cross Sectional ◽

Expert Nurses ◽

The Impact

Background: Pain assessment scale in neonates is the cornerstones of pain management so that the impact of pain can be prevented to maximize neonatal growth and development.Purpose: This study aimed to identify the most appropriate pain assessment scale used for neonates in Indonesia.Methods: A cross sectional study design was used in 30 neonates hospitalized using Neonatal Infant Pain Scale (NIPS), Neonatal infant Acute Pain Assessment Scale (NIAPAS) and Pain Assessment Tool (PAT). Pain assessment was performed by nurses (n=30) and expert nurses (n=5) participated in the validation of scales. Statistical analysis using validity (content, construct and concurrent validity) and reliability (inter-rater reliability and internal consistency) test.Results: NIPS instrument have excellent validity, reliability, and feasibility value compared with NIAPAS and PAT.Conclusion: NIPS was shown a valid, reliable, and practical scale for assessing pain in neonates. It allows nurses to identifying pain and help to provide of appropriate pain management

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