A multi-site study published in The Journal of Pain showed a wide range of pain intensity scores in hospitalized infants and a significant number of them were found to have moderate to severe pain during their hospital stays.
Researchers at Toronto's Hospital for Sick Children sought to determine the nature and frequency of pain assessments in children being treated in Canadian pediatric hospitals, and also explore institutional factors that may influence pain assessment practices and pain intensity scores.
Eight university-affiliated pediatric healthcare centers participated in the study. Children were eligible for inclusion if they were younger than 18 and hospitalized for more than 24 hours. The medical charts of 3,840 children were evaluated, and the average per-child number of documented pain assessments was 3.3. However, 60 percent of the children were assessed with non-validated pain measures. For those whose pain was assessed with a validated tool, 25 percent had pain scores in the mild range, 22 percent in the moderate range and 11 percent had scores indicating severe pain.
The authors reported that two-thirds of the children studied had a pain assessment performed within a 24-hour period, which is a significant improvement from previous reports. But the documented pain assessments were described as variable and inconsistent and did not adhere to national accreditation guidelines.
It was noted in the article that pain assessment scores should be integrated into clinical decision making. Therefore, making pain relief a priority with a healthcare organization is the key challenge for those who advocate good pain assessment. One concern expressed in the study was the widespread use of self report pain assessments, even in children as young as five years. Self reports are best used in older, verbally competent children.
Fear Avoidance Model Applied to Pediatric Chronic Pain Cases
In another Journal of Pain study, researchers at Children's Hospital in Boston conducted the first examination of the fear-avoidance model in children with chronic pain. The model has been tested extensively in adults. The authors hypothesized it would be a good tool for assessing pediatric pain patients because of its ability to predict pain catastrophizing and pain-related fear.
Three-hundred-fifty children aged 8-17 enrolled in the study and were evaluated for functional disability and depressive symptoms at evaluation and functional disability after one month. Children and their parents completed questionnaires independently, which were designed to measure pain-related fear, pain catastrophizing, pain intensity, functional impairments and depressive symptoms.
The results showed that the fear avoidance model is useful for understanding and predicting functional disabilities in pediatric patients. However, the model provided less guidance for understanding depressive symptoms associated with pain-related fear and catastrophizing in this population.
The investigators also found that shorter duration of pain was associated with higher pain ratings among younger children, but was not a significant predictor in adolescent patients. Adolescents, however, reported higher levels of functional disability after one month than younger subjects. Overall, the findings indicate that fear of pain may play a stronger role in adolescents than younger children, which suggests that focusing on anxiety-related pain responses in adolescents could yield favorable outcomes in helping them resume participation in previously avoided activities.
Regarding treatment implications, the authors reported that results of the study support the use of cognitive behavioral interventions, especially in adolescents with chronic pain, to help reduce pain and associated disability by targeting pain-related fear.
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