Epidemiology and management of painful procedures in children in Canadian hospitals

Stevens, Bonnie; Abbott, Laura K.; Yamada, Janet; Harrison, Denise; Stinson, Jennifer; Taddio, Anna; Barwick, Melanie; Latimer, Margot; Scott, Suzanne; Rashotte, Judy; Campbell, Fiona; Finley, G. Allen

doi:10.1503/cmaj.101341

Cited by 276 publications

(253 citation statements)

References 25 publications

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“…15,16 Most pediatric pain is preventable or treatable, yet its management in the ED continues to be suboptimal. 2,10,11,17 The importance of adequate analgesia is well recognized. The World Health Organization and multiple professional pain societies mandate that optimal pain management should be a fundamental human right.…”

Section: Ré Sumémentioning

confidence: 99%

Reported practice variation in pediatric pain management: a survey of Canadian pediatric emergency physicians

Ali

Chambers

Johnson

et al. 2014

CJEM

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Objectives: To describe pediatric emergency medicine (PEM) physicians' reported pain management practices across Canada and explore factors that facilitate or hinder pain management. Methods: This study was a prospective survey of Canadian pediatric emergency physicians. The Pediatric Emergency Research Canada physician database was used to identify participants, and a modified Dillman's Total Design Survey Method was used for recruitment.Results: The survey response rate was 68% (139 of 206). Most physicians were 31 to 50 years old (82%) with PEM training (56%) and had been in practice for less than 10 years (55%). Almost all pain screening in emergency departments (EDs) occurred at triage (97%). Twenty-four percent of physicians noted institutionally mandated pain score documentation. Ibuprofen and acetaminophen were commonly prescribed in the ED for mild to moderate pain (88% and 83%, respectively). Over half of urinary catheterizations (60%) and intravenous (53%) starts were performed without any analgesia. The most common nonpharmacologic interventions used for infants and children were pacifiers and distraction, respectively. Training background and gender of physicians affected the likelihood of using nonpharmacologic interventions. Physicians noted time restraints to be the greatest barrier to optimal pain management (55%) and desired improved access to pain medications (32%), better policies and procedures (30%), and further education (25%). Conclusions: When analgesia was reported as provided, ibuprofen and acetaminophen were most commonly used. Both procedural and presenting pain remained suboptimally managed. There is a substantial evidence practice gap in children's ED pain management, highlighting the need for further knowledge translation strategies and policies to support optimal treatment. RÉ SUMÉObjectifs: L'é tude visait à dé crire les pratiques, dé claré es par les inté ressé s, en matiè re de prise en charge de la douleur en mé decine d'urgence pé diatrique (MUP), au Canada, et à examiner les facteurs qui facilitent ou, au contraire, entravent le traitement de la douleur. Mé thodes: Il s'agit d'une enquê te prospective, mené e parmi des urgentologues pé diatres au Canada. La base de donné es du Groupe de Recherche en Urgence Pé diatrique du Canada pour les mé decins a servi à repé rer les sujets é ventuels, et une version modifié e de la Dillman's Total Design Survey Method a é té utilisé e aux fins de participation. Ré sultats: Le taux de ré ponse à l'enquê te a atteint 68% (139 participants sur 206). La plupart des mé decins é taient â gé s de 31 à 50 ans (82%) avaient reç u une formation en MUP (56%) et pratiquaient depuis moins de 10 ans (55%). Le dé pistage de la douleur au service des urgences (SU) se faisait presque toujours au moment du triage (97%). Vingtquatre pour cent des mé decins ont fait é tat d'une documentation obligatoire sur l'é valuation de la douleur dans leur é tablissement. L'ibuprofè ne et l'acé taminophè ne (88% et 83%, respectivement) é taient souvent prescr...

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Section: Ré Sumémentioning

confidence: 99%

Reported practice variation in pediatric pain management: a survey of Canadian pediatric emergency physicians

Ali

Chambers

Johnson

et al. 2014

CJEM

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“…[1][2][3][4][5] For example, hospitalized infants experience a median of 10 (range, 0-51) painful procedures per day. 1 Stevens and colleagues 3 reported that children experienced an average of 6.3 (range, 1-50) painful procedures per day across 32 Canadian inpatient pediatric hospital units. Since the 1980s, researchers have been examining pain in children and reporting negative physiologic, psychological, and emotional consequences associated with untreated pain.…”

mentioning

confidence: 99%

Pediatric Clinical Practice Guidelines for Acute Procedural Pain: A Systematic Review

et al. 2014

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BACKGROUND: Procedural pain assessment and management have been extensively studied through multiple research studies over the past decade. Results of this research have been included in numerous pediatric pain practice guidelines. OBJECTIVE:To systematically review the quality of existing practice guidelines for acute procedural pain in children and provide recommendations for their use. METHODS:A systematic search was conducted on Medline, Embase, CINAHL, PsycINFO, and Scopus from 2000 to July 2013. A gray literature search was also conducted through the Translating Research Into Practice database, Guidelines International Network database, and National Guideline Clearinghouse. Four reviewers rated relevant guidelines using the Appraisal of Guidelines for Research and Evaluation (AGREE) II Instrument. Screening of guidelines, assessment of methodological quality, and data abstraction were conducted by 2 pairs of raters. Disagreements in overall assessments were resolved through consensus. RESULTS:Eighteen guidelines from 4930 retrieved abstracts were included in this study. Based on the AGREE II domains, the guidelines generally scored high in the scope and purpose and clarity of presentation areas. Information on the rigor of guideline development, applicability, and editorial independence were specified infrequently. Four of the 18 guidelines provided tools to help clinicians apply the recommendations in practice settings; 5 were recommended for use in clinical settings, and the remaining 13 were recommended for use with modification. CONCLUSIONS:Despite the increasing availability of clinical practice guidelines for procedural pain in children, the majority are of average quality. More transparency and comprehensive reporting are needed for the guideline development process. Pediatrics 2014;133:500-515

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“…Non-pharmacological techniques are an extremely useful component of multimodal therapy [103][104][105]; unfortunately, they are under-utilised in hospitalised children [106]. The mainstay of acute pain management for children and youths resides in the use of opioid analgesia, but opioid use is associated with a significant side effect profile (see Table 2).…”

Section: Pain Relief -From Analgesics To Alternative Therapiesmentioning

confidence: 99%

A Review of Intravenous Lidocaine Infusion Therapy for Paediatric Acute and Chronic Pain Management

Lauder¹

2017

Pain Relief - From Analgesics to Alternative Therapies

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Pediatric acute and chronic pain experiences involve the interaction of physiological, psychological, behavioural, developmental, pharmacological and situational factors. In the acute perioperative pain setting preventative multimodal analgesia is required to provide comfort and minimise the potential for "wind-up" and central sensitisation. When pain is recurrent, ongoing or chronic some children embark on a downward spiral of decreased physical, psychological and social functioning. The multidisciplinary team management approach is a well-established standard of care for children with complex chronic pain. Intravenous lidocaine has peripheral and central mediated analgesic, anti-inflammatory and anti-hyperalgesic properties. Intravenous lidocaine infusion therapy (IVLT) has been shown to be effective in the management of acute and chronic pain in adults. This chapter will present the rational for IVLT in pediatric pain management with emphasis on preventative multimodal therapy in acute pain and the multidisciplinary treatment approach in chronic pain. Large multi-centre randomised controlled trials are required to provide the evidence-base to confirm that IVLT is indeed an effective and safe treatment option in acute preventative multimodal analgesia and as an adjunct in the multidisciplinary care of chronic pain in the pediatric population. Keywords

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Epidemiology and management of painful procedures in children in Canadian hospitals

Cited by 276 publications

References 25 publications

Reported practice variation in pediatric pain management: a survey of Canadian pediatric emergency physicians

Reported practice variation in pediatric pain management: a survey of Canadian pediatric emergency physicians

Pediatric Clinical Practice Guidelines for Acute Procedural Pain: A Systematic Review

A Review of Intravenous Lidocaine Infusion Therapy for Paediatric Acute and Chronic Pain Management

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