Barriers to Pediatric Pain Management in Children Undergoing Surgery: A Survey of Health Care Providers

Abstract

The appropriate pain management in neonates and children is lacking. Factors that prevent the execution of proper pain relief vary from center to center. We studied the factors responsible for it in a surgical unit. We conducted a survey at a tertiary-level institute among the resident doctors and nursing staff by means of an informal questionnaire analyzing their basic knowledge. The questions pertained mainly to pain assessment, analgesic usage, role of opioids, and formal training, and the responses so obtained were analyzed under these four headings. Seventy-three percent (22/30) of the residents and 74% (26/35) of the nursing staff knew about pain assessment scoring system in pediatric patients. However, assessment of pain in emergency cases was always done by only 6.6% of the residents. Effect of analgesia on severity of pain was never recorded by 33% (10/30) of the residents. Eighty-six percent (26/30) of the residents and 91% (32/35) of the nursing staff had adequate knowledge about analgesic dosage and interval for routine use. Ten of the 30 (33%) residents believed that analgesic administration in an acute abdomen, before definitive diagnosis, will always mask the symptoms. During a minor procedure, 56% (17/30) of the residents always used analgesia. Only 3.3% (1/30) of residents and 2.8% (1/35) of the nursing staff had received a structured training for pain management. Although, 93% (28/30) of the residents claimed to know about the safety of use of opioids, only 46% (14/30) used them routinely as analgesics. Pain management in surgical neonates and children is often ignored. Lack of formal training, inadequate knowledge, and standard protocols are the barriers in our setup, which may in turn be due to overwhelming attention given to the surgical condition.

Healthcare Providers’ Knowledge and Current Practice of Pain Assessment and Management: How Much Progress Have We Made?

“…HCPs' correct answer rate to questions related to this group of patients was the lowest. Likewise other studies described the ill preparation of HCPs to assess and manage children's pain [15, 16, 27, 50, 54, 55]. …”

“…Mostly what they show was that in general many HCPs, especially nurses, lack adequate knowledge about pain, which led to undertreatment of pain [13, 18–23]. Studies had also shown that HCPs bear misconceptions and myths about pain that impede proper pain management [22, 24–27]. …”

Knowledge and attitudes of pediatric clinicians regarding pediatric pain management

“…Unfortunately, studies have found that many pediatric clinicians focus on the source rather than the symptom (Gaglani, & Gross, 2018; Subhashini, Vatsa, & Lodha, 2009; Twycross, & Dowden, 2009), feeling that in the urgency of saving a life, there is no time to provide effective pain management (Mathews, 2011; Nimbalkar et al, 2014). Many studies have documented that knowledge deficits and negative attitudes of healthcare providers regarding pain management are the most important factors impacting pediatric pain relief care (Mathew et al, 2011; Nimbalkar et al, 2014; Stanley & Pollard, 2013), and that pediatric clinicians' knowledge and attitudes regarding pediatric pain management can affect their willingness to provide such care (Abdulaziz, 2017; Alotabi, Higgins, & Chan, 2019; Alotaibi, Higgins, Day, & Chan, 2018; Bawa, Mahajan, Aggerwal, Sundaram, & Rao, 2015).…”

“…Until now, it has been unclear what factors impact pediatric pain management in Taiwan, some of which possibly result from a lack of education or professional experience. Additionally, there is a lack of credible research into the structural culture and perceptions of pediatric pain management among clinicians (Abdulaziz, 2017; Bawa et al, 2015; Finley, Kristjánsdóttir, & Forgeron, 2009). Thisstudyis in response to the scarcity of studies of the knowledge and attitudes of pediatric clinicians regarding pediatric pain management and the utter lack of investigation into the barriers to such care in Taiwan.…”

Optimizing the treatment of pain and anxiety in pediatric emergencies: the role of accreditation

“…This disparity is exacerbated in general EDs, which treat both adults and children in the same location [7]. Some identified barriers to optimal pain management include lack of or inaccurate pain assessments [8–10], hesitation regarding the use of opioids in children among prescribers [11, 12], and failure to include non-pharmacologic strategies in the treatment of pain. However, interventions targeting improved documentation of pain scores did not translate into improved analgesic treatments [13, 14].…”