Assessment and management of pain in children: a decade

Abstract

Introduction – Negligence in pain control is a widely recognized problem. Since 2001, Portugal has developed many initiatives to improve health care practices in this area, such as awareness-raising campaigns, training of health care professionals, and publication of technical guidelines and good practice guides. Some studies on this topic have also been conducted to make a diagnosis of the situation. Aims – This study aimed to characterize the type of care provided in terms of pain assessment and control in children up to 18 years hospitalized in Portugal, and also analyze the evolution of this type of care between 2002 and 2012. Methodology – A descriptive, cross-sectional study with a retrospective review of intermittent records made during a 24-hour period. The sample was randomly selected and included the medical records of children up to 18 years hospitalized in four Portuguese hospitals between August and December 2011. Results – Pain prevalence decreased significantly between 2002 and 2012. The percentage of children without pain increased from 37% to 75%. Recording the assessment of pain intensity and collecting information on the pain history became a common practice in most cases (53% and 64%, respectively), although it was still aimed at the biomedical model of health care. No changes were found in the prevalence of pharmacological interventions (43% vs. 42%), but the implementation of non-pharmacological strategies decreased significantly (72% vs. 15%). Conclusions – Awareness-raising/training sessions conducted within the scope of the policies implemented within the last decade in the area of pediatric pain assessment and control have led to significant gains in the quality of care, and for this reason, the investment should continue.  However, priority should be given to training for the implementation of non-pharmacological intervention strategies and to the development of further research to support the practices.