Pain hurts but it can be managed, says SickKids expert

The study was published in the April 4 advance online edition of the Canadian Medical Association Journal(CMAJ)

The painful procedures that hospitalized children experience are usually for diagnosing or treatment purposes. “Pain can be distressing for both children and parents,” says Dr. Bonnie Stevens, Associate Chief of Nursing at The Hospital for Sick Children (SickKids) and lead investigator of the study. “Pain has both short term consequences like an increased heart rate, crying and disruptions to feeding and sleeping, but also more long-term effects like anxiety, fear and distrust. One poorly managed pain experience can have behavioural and psychological effects that can lead to increased responses to pain and avoidance of medical procedures later in life. ”  

The study focused on the frequency of painful procedures, the pain management strategies used and the influence of the hospital unit on pain management. The researchers studied 3,822 children under the age of 18 in eight paediatric hospitals across Canada. 

Some of the painful procedures include; insertion and removal of intravenous lines, oral or nasal suctioning, and skin pricks for blood sampling.  

The researchers found about 80 per cent of the children had some type of pain management documented in their chart in the previous 24 hours. However, less than one third of the painful procedures were associated with documented pain relief. “This means that it is possible for children who experience an average of six painful procedures per day, only one or two may be accompanied by a pain management strategy,” says Stevens, who is also Professor in the Faculty of Nursing and Medicine at the University of Toronto.  “The goal is to minimize the consequences of pain for the patient and family through effective pain management techniques.”  

There are three types of pain management interventions: pharmacological, physical and psychological. Pharmacological interventions were administered most frequently, followed by physical techniques such as body positioning and hot or cold compress. There are also psychological interventions, like distraction.

“It’s unrealistic to say that we can eliminate all painful procedures for children in hospitals, but we can work to minimize the pain and its consequences,” explains Stevens. “The next step is to develop and implement interventions that will decrease pain intensity and increase patient and parent satisfaction.”

Dr. Bonnie Stevens is also the Signy Hildur Eaton Chair of Paediatric Nursing Research and Director of the University of Toronto Centre for the Study of Pain.