Acute and postoperative pain in children: a Swedish nationwide survey.
Many studies demonstrate inadequate pain treatment in children. The aim of this nationwide survey was to evaluate the prevalence of acute and postoperative pain in children; extent of, and reasons for, inadequate pain therapy; therapy methods; pain-management structure; and the need for education of healthcare professionals. Questionnaires concerning these points were sent to all departments in Sweden involved in the treatment of children. The response rate was 75% (299/ 395). Answers from physicians and nurses showed that, despite treatment, moderate to severe pain occurred in 23% of patients with postoperative pain and 31% of patients with pain of other origin. Postoperative pain seemed to be a greater problem in units where children were treated along with adults and in departments where fewer children were treated. According to 45% of physicians and nurses, treatment of pain could often or always be managed more efficiently. Pain assessments were performed regularly in 43% of all departments, but pain measurement was less frequent; 3% of the departments had no formal organization for pain management; and 15% never or infrequently used potent opioids. Educational needs were high. Insufficient pain treatment seemed to be mostly related to organizational aspects, such as inadequate prescriptions. Anxiety in children or parents also contributed to ineffective pain treatment. Swedish treatment practices for the management of pain in children roughly follow the published guidelines, but many improvements are still necessary.


CONCLUSIONS
Acute pain in children is still undertreated in Swedish hospitals. This seems to be related mainly to organizational aspects.
Karling
M
M
Department of Anaesthesia and Intensive Care, University Hospital of Northern Sweden, Umeå. mats.karling@vll.se
Renström
M
M
Ljungman
G
G
D000208:Acute Disease; D000698:Analgesia / Q000706:statistics & numerical data*; D000700:Analgesics / Q000008:administration & dosage*; D018712:Analgesics, Non-Narcotic / Q000008:administration & dosage; D000701:Analgesics, Opioid / Q000008:administration & dosage; D001291:Attitude of Health Personnel; D002648:Child; D002675:Child, Preschool; D004363:Drug Utilization; D005260:Female; D019538:Health Care Surveys; D006776:Hospitals, Pediatric; D006801:Humans; D008297:Male; D020380:Needs Assessment; D010146:Pain / Q000175:diagnosis / Q000188:drug therapy; D010147:Pain Measurement; D010149:Postoperative Pain / Q000175:diagnosis* / Q000188:drug therapy*; D010818:Practice Patterns, Physicians'; D012720:Severity of Illness Index; D013548:Sweden; D016896:Treatment Outcome
D000700:Analgesics; D018712:Analgesics, Non-Narcotic; D000701:Analgesics, Opioid