[Prevalence of pain in hospitalised paediatric patients in Spain]

The management of paediatric acute pain in Spain in 2021: Results of a national survey among paediatric anaesthesiologists

OBJECTIVE

To improve knowledge about routine clinical practice in the management of paediatric acute pain in Spain.

METHODS

A telematic survey was conducted via the Internet on a representative sample of healthcare professionals involved in the management of paediatric acute pain (specifically anaesthesiologists) in Spain. The survey included 28 questions about their usual clinical practice in the assessment and treatment of acute pain, and also training and organisational aspects in paediatric acute pain.

RESULTS

The survey was completed during March 2021 by 150 specialists in anaesthesiology. The respondents widely experienced in the management of acute paediatric pain (mean years of experience: 14.3: SD: 7.8), essentially in acute postoperative pain (97% of cases). Although 80% routinely used validated paediatric acute pain assessment scales, only 2.6% used specific scales adapted for patients with cognitive impairment. Most of the respondents routinely used analgesic drugs such as paracetamol (99%) or metamizole (92%), but only 84% complemented these drugs with a loco-regional blocking technique or other non-steroidal anti-inflammatory drugs (62%). Furthermore, only 62.7% acknowledged having received specific training in paediatric acute pain, only 45% followed hospital institutional protocols, and a scant 28% did so through paediatric pain units.

CONCLUSIONS

The survey identified important points for improvement in the training and organisation of acute pain management in Spanish paediatric patients.

Clinical differences in a multidisciplinary pediatric pain unit between primary and secondary chronic pain

INTRODUCTION

Chronic pain affects an important part of the pediatric population in developed countries. secondary chronic pain (SCP) can have a well-defined medical cause, but primary chronic pain (PCP) can have an unknown etiology. In Spain, there is as yet no information on the clinical differences between patients treated in multidisciplinary units.

METHODS

Retrospective analysis of the clinical records of patients seen in 2018 at the Children's Chronic Pain Unit in University La Paz Hospital.

RESULTS

A total of 92 patients were included, (age between 3 and 19 years), with a mean age of 12.4 (SD = 4.1) years, mostly female (55%), with a mean duration of pain of 11.3 (SD = 10.4) months. A comparison of patients with PCP (n = 31) and SCP (n = 61) showed that both groups, on average, presented intense pain (X = 5.9; SD = 2.2; range = 0-10), with similar duration and functional repercussions, although PCP was less likely to be associated with neuropathic descriptors than SCP (p = 0.040), and was more extensive (p < 0.001). Both groups received similar treatment, based on rehabilitation, psychotherapy, invasive techniques and analgesic medication, although patients in the PCP group received less analgesic medication (gabapentinoids and opioids) than the SCP (p = 0.011).

CONCLUSION

Patients treated in a multidisciplinary Child Pain Unit for PCP or SCP present a very similar clinical profile, though with differences in the number and type of analgesic drugs used. This shows the importance of etiologic diagnosis for adequate pharmacological treatment.

The Treatment of Pediatric Pain in Spain: A Survey Study

Pain is a common experience among children and adolescents, and pain management in this population is a challenge to clinicians. The aims of this study were to increase our understanding of current practices in the management of both acute and chronic pediatric pain in Spain, explore potential barriers to ideal practices, and identify professional needs as perceived by healthcare professionals. A total of 277 healthcare professionals took part, all of whom had wide experience in managing children and adolescents with pain (M [SD] age = 44.85, [10.73]; 75% women). Participants had to respond to a web-based survey with 50 questions related to pain education, organizational characteristics of their pain programs (including the characteristics of the patients treated), and current practices in the assessment and treatment of children and adolescents with pain. Almost all the participants (93%) acknowledged important gaps in their training, and only 47% reported that they had received specific education on the management of pediatric pain during their undergraduate and postgraduate studies. A third (31%) were members of multidisciplinary teams, and almost all (99%) understood that protocols to guide the management of pain in young people were necessary. However, only a few of them used a protocol to assess and treat (56% and 48%, respectively) acute and chronic pain (24% and 23%, respectively). The data also showed that a lack of pain education, coordination of professionals, and guidelines was perceived as an important barrier in the care provided to children and adolescents with pain in Spain. The findings of this study can now be used by healthcare professionals in Spain interested in managing pediatric pain, as well as policymakers concerned to improve the education of professionals and the care given to young people with pain.