title: Pediatricians' management practices for chronic pain.
abstract: OBJECTIVE
  While research has established that pediatric pain is undertreated, it is unclear who should have primary responsibility for its management. This study asks pediatricians who they believe should treat pain and how pain should be assessed and managed.
  
  
  METHODS
  We administered a mail and online survey about pediatric chronic pain and palliative care to a random sample of 800 U.S. pediatricians, and performed descriptive and multivariate analyses on 303 respondents.
  
  
  RESULTS
  Most pediatrician responders were white, non-Hispanic (55.8%), and had been in practice 10 or more years (68.0%). Only one third of pediatricians (32.3%) felt it was their primary responsibility to treat chronic pain; most believed pain specialists (58.1%), other specialists, (39.6%), or hospice providers (26.1%) should be responsible. For pain assessments, most report using parent (87.1%) or patient (84.2%) verbal reports and one half (49.5%) use pain diaries, although multivariate analyses showed that inpatient pediatricians were significantly less likely to use these modalities. Acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs) were commonly cited medications to usually or always treat pain (61.7% and 66.9%, respectively) and 19.3% report never or rarely prescribing intermittent opiates in their practice. Multivariate analyses showed that there were no consistent physician qualities that predicted the use of opiate prescriptions.
  
  
  CONCLUSIONS
  Our findings illustrate that pediatricians' theoretical approaches to chronic pain management are more collaborative than independent. Future research must test if pediatricians could benefit from supplemental pain education, increased emphasis on clinical guidance, and an increased awareness of hospice to be included in the pain management team for children.
authors.affiliation: Department of Pediatrics, University of Florida, Gainesville, Florida 32608, USA. lathompson@peds.ufl.edu
authors.forename: Lindsay A
authors.initials: LA
authors.lastname: Thompson
authors.forename: Caprice A
authors.initials: CA
authors.lastname: Knapp
authors.forename: Veronica
authors.initials: V
authors.lastname: Feeg
authors.forename: Vanessa L
authors.initials: VL
authors.lastname: Madden
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Shenkman
mesh_terms: D000328:Adult; D002140:California; D002908:Chronic Disease; D005260:Female; D005431:Florida; D019538:Health Care Surveys; D006801:Humans; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000175:diagnosis / Q000188:drug therapy*; D010147:Pain Measurement; D010372:Pediatrics; D010818:Practice Patterns, Physicians'; D014481:United States; D055815:Young Adult