Pain prevalence in infants and preschool children in a Colombian hospital

  • José Manuel Quintero-Castellanos a. Pain Unit, Hospital San Rafael de Tunja. Tunja, Colombia. b. Research Postgraduate Program, Universidad Pedagógica y Tecnológica de Colombia. Tunja, Colombia. https://orcid.org/0000-0002-3994-109X
  • Ángela Hernández Pain Unit, Hospital San Rafael de Tunja. Tunja, Colombia.
  • Tania Parra Research Postgraduate Program, Universidad Pedagógica y Tecnológica de Colombia. Tunja, Colombia.
Keywords: Pain, Prevalence, Infant, Child, Preschool, Pain Measurement

Abstract

Introduction: The pain prevalence in hospitalized infants and preschool children has not been accurately identified in high-income countries, and in low and medium-income countries it has not been extensively studied. The assessment instruments are limited.

Objective: To describe the prevalence and management of pain in infants and preschool children during the first 24 hours of hospitalization in a third level institution in Colombia, using the CRIES scale.

Methods: An observational study was conducted during the first 24 hours of hospitalization. Demographic information was recorded, pain was assessed at admission, after 4, and 24 hours using the CRIES scale. Pharmacological therapy was also documented.

Results: 250 children between one month and 5 years old were studied. The pain prevalence at admission was 12 %. The pain prevalence per subgroups was higher among the surgical patients, as compared to the clinical patients (35.9 % vs. 7.6 %). The pharmacological analysis revealed that 70.8 % of patients received treatment; the most widely used medications were oral acetaminophen and intravenous dipyrone.

Conclusions: Pain prevalence was lower than the levels described for the general pediatric population. This result may be due to the sensitivity of the CRIES instrument, or to a particular pain behavior. Further studies are needed to identify the sensitivity of the assessment instruments in early life and to accurately investigate any associated phenomena.

References

IASP. Pain terms a current list with definitions and notes on usage. Pain. 1986;24:S215-21. doi: http://www.doi.org/10.1016/0304-3959(86)90113-2

Aydede M. Does the IASP definition of pain need updating? Pain Reports. 2019;4(5):1-7. doi: http://www.doi.org/10.1097/PR9.0000000000000777

Friedrichsdorf SJ, Goubert L. Pediatric pain treatment and prevention for hospitalized children. PAIN Reports. 2020;5(1):e804. doi: http://www.doi.org/10.1097/pr9.0000000000000804

Shomaker K, Dutton S, Mark M. Pain prevalence and treatment patterns in a us children’s hospital. Hosp Pediatr. 2015;5(7):363-70. doi: http://www.doi.org/10.1542/hpeds.2014-0195

Twycross A, Collis S. How well is acute pain in children managed? A snapshot in one english hospital. Pain Manag Nurs. 2013;14(4):e204-15. doi: http://www.doi.org/10.1016/j.pmn.2012.01.003

Walther-Larsen S, Pedersen MT, Friis SM, et al. Pain prevalence in hospitalized children: a prospective cross-sectional survey in four Danish university hospitals. Acta Anaesthesiol Scand. 2017;61(3):328-37. doi: http://www.doi.org/10.1111/aas.12846

Vejzovic V, Bozic J, Panova G, Babajic M, Bramhagen AC. Children still experience pain during hospital stay: A cross-sectional study from four countries in Europe. BMC Pediatr. 2020;20(1):4-9. doi: http://www.doi.org/10.1186/s12887-020-1937-1

Friedrichsdorf SJ, Postier A, Eull D, et al. Pain outcomes in a US children’s hospital: A prospective cross-sectional survey. Hosp Pediatr. 2015;5(1):18-26. doi: http://www.doi.org/10.1542/hpeds.2014-0084

Taylor EM, Boyer K, Campbell FA. Pain in hospitalized children: A prospective cross-sectional survey of pain prevalence, intensity, assessment and management in a Canadian pediatric teaching hospital. Pain Res Manag. 2008;13(1):25-32. doi: http://www.doi.org/10.1155/2008/478102

Birnie KA, Chambers CT, Fernandez CV., et al. Hospitalized children continue to report undertreated and preventable pain. Pain Res Manag. 2014;19(4):198-204. doi: http://www.doi.org/10.1155/2014/614784

Cummings EA, Reid GJ, Finley GA, McGrath PJ, Ritchie JA. Prevalence and source of pain in pediatric inpatients. Pain. 1996;68(1):25-31. doi: http://www.doi.org/10.1016/S0304-3959(96)03163-6

Merkel SI, Voepel-Lewis TSJ, Malviya S. The FLACC: A behavioral scale for scoring postoperative pain in young children. Pediatr Nurs. 1997;23(3):293-7.

Reinoso-Barbero F, Lahoz Ramn AI, Durn Fuente MP, Campo Garca G, Castro Parga LE. Escala LLANTO: Instrumento español de medición del dolor agudo en la edad preescolar. An Pediatr. 2011;74(1):10-4. doi: http://www.doi.org/10.1016/j.anpedi.2010.08.005

Tibaduiza D, Ulloa LC, López CA, Rodríguez Torres V. Evaluación de la validez de la escala llanto para dolor en neonatos y menores de cinco años. [Internt]. [Citado 17 Nov 2020]. Disponible en: http://repository.urosario.edu.co/handle/10336/10696

Goodman JE, McGrath P. The epidemiology of pain in children and adolescents: a review. Pain. 1991;46(3):247-64. doi: http://www.doi.org/10.1016/0304-3959(91)90108-a

American Academy of Pediatrics. The assessment and management of acute pain in infants, children, and adolescents. Pediatrics. 2001;108(3):793-7. doi: http://www.doi.org/10.1542/peds.108.3.793

Ellis JA, O’Connor BV, Cappelli M, Goodman JT, Blouin R, Reid CW. Pain in hospitalized pediatric patients: How are we doing? Clin J Pain. 2002;18(4):262-9. doi: http://www.doi.org/10.1097/00002508-200207000-00007

Manworren RC, Stinson J. Seminars in pediatric neurology pediatric pain measurement, assessment and evaluation. Nurs Chair Child Heal Nurse Pract. 2017;23(3):189-200. doi: http://www.doi.org/10.1016/j.spen.2016.10.001

Snidvongs S, Nagaratnam M, Stephens R. Assessment and treatment of pain in children. Br J Hosp Med. 2008;69(4):211-3. doi: http://www.doi.org/10.12968/hmed.2008.69.4.28975

Ghai B, Makkar JK, Wig J. Postoperative pain assessment in preverbal children and children with cognitive impairment. Paediatr Anaesth. 2008;18(6):462-77. doi: http://www.doi.org/10.1111/j.1460-9592.2008.02433.x

Brattberg G. Do pain problems in young school children persist into early adulthood? A 13-year follow-up. Eur J Pain. 2004;8(3):187-99. doi: http://www.doi.org/10.1016/j.ejpain.2003.08.001

Victoria NC, Murphy AZ. Exposure to early life pain: Long term consequences and contributing mechanisms. Curr Opin Behav Sci. 2016;7(2015):61-8. doi: http://www.doi.org/10.1016/j.cobeha.2015.11.015

Williams MD, Lascelles BDX. Early neonatal pain-a review of clinical and experimental implications on painful conditions later in life. Front Pediatr. 2020;8:30. doi: http://www.doi.org/10.3389/fped.2020.00030

Bawa M, Mahajan JK, Aggerwal N, Sundaram J, Rao KLN. Barriers to pediatric pain management in children undergoing surgery: A survey of health care providers. J Pain Palliat Care Pharmacother. 2015;29(4):353-8. doi: http://www.doi.org/10.3109/15360288.2015.1082010

Schlegelmilch M, Punja S, Jou H, et al. Observational study of pediatric inpatient pain, nausea/vomiting and anxiety. Children. 2019;6(5):65. doi: http://www.doi.org/10.3390/children6050065

Torio C. Paediatric pain-related conditions impact healthcare expenditures. Evid Based Med. 2015;20(6):229. doi: http://www.doi.org/10.1136/ebmed-2015-110207

DANE. Estimaciones de Población 2005-2017 Departamentos [internet]. 2017 [citado 2020 jun. 20]. Disponible en: https://www.dane.gov.co/index.php/estadisticas-por-tema/demografia-y-poblacion/proyecciones-de-poblacion

Doca FNP, Costa ÁL, Finley GA, Linhares MBM. Pain in pediatric inpatients: Prevalence, characteristics, and management. Psychol Neurosci. 2017;10(4):394-403. doi: http://www.doi.org/10.1037/pne0000094

Wong DL, Baker C. Pain in children: Comparison of assessment scales. Pediatr Nurs. 1988;14(1):9-17. doi: http://www.doi.org/10.1016/j.ijporl.2015.11.003

Harrison D, Joly C, Chretien C, et al. Pain prevalence in a pediatric hospital: Raising awareness during Pain Awareness Week. Pain Res Manag. 2014;19(1):24-30. doi: http://www.doi.org/10.1155/2014/737692

Crellin DJ, Harrison D, Santamaria N, Babl FE. Systematic review of the face, legs, activity, cry and consolability scale for assessing pain in infants and children: Is it reliable, valid, and feasible for use? Pain. 2015;156(11):2132-51. doi: http://www.doi.org/10.1097/j.pain.0000000000000305

Suraseranivongse S, Santawat U, Kraiprasit K, Petcharatana S, Prakkamodom S, Muntraporn N. Cross-validation of a composite pain scale for preschool children within 24 hours of surgery. Br J Anaesth. 2001;87(3):400-5. doi: http://www.doi.org/10.1093/bja/87.3.400

Thrane SE, Wanless S, Cohen SM, Danford CA. The assessment and non-pharmacologic treatment of procedural pain from infancy to school age through a developmental lens: A synthesis of evidence with recommendations. J Pediatr Nurs. 2016;31(1):e23-32. doi: http://www.doi.org/10.1016/j.pedn.2015.09.002

Velázquez C, Rajah C, Nosisi Y, Joerg S. An audit of paediatric pain prevalence, intensity, and treatment at a South African tertiary hospital. Pain Reports. 2019;4(6):1-7. doi: http://www.doi.org/10.1097/PR9.0000000000000789

Kozlowski LJ, Kost-Byerly S, Colantuoni E, et al. Pain prevalence, intensity, assessment and management in a hospitalized pediatric population. Pain Manag Nurs. 2014;15(1):22-35. doi: http://www.doi.org/10.1016/j.pmn.2012.04.003

Linhares MBM, Doca FNP, Martínez FE, et al. Pediatric pain: Prevalence, assessment, and management in a teaching hospital. Brazilian J Med Biol Res. 2012;45(12):1287-94. doi: http://www.doi.org/10.1590/S0100-879X2012007500147

Stevens BJ, Harrison D, Rashotte J, et al. Pain assessment and intensity in hospitalized children in Canada. J Pain. 2012;13(9):857-65. doi: http://www.doi.org/10.1016/j.jpain.2012.05.010

Stevens BJ, Abbott LK, Yamada J, et al. Epidemiology and management of painful procedures in children in Canadian hospitals. CMAJ. 2011;183(7):403-10. doi: http://www.doi.org/10.1503/cmaj.101341

Stinson J, Yamada J, Dickson A, Lamba J, Stevens B. Review of systematic reviews on acute procedural pain in children in the hospital setting. Pain Res Manag. 2008;13(1):51-7. doi: http://www.doi.org/10.1155/2008/465891

King S, Chambers CT, Huguet A, et al. The epidemiology of chronic pain in children and adolescents revisited: A systematic review. Pain. 2011;152(12):2729-38. doi: http://www.doi.org/10.1016/j.pain.2011.07.016

Lynch AM, Kashikar-Zuck S, Goldschneider KR, Jones BA. Sex and age differences in coping styles among children with chronic pain. J Pain Symptom Manage. 2007;33(2):208-16. doi: http://www.doi.org/10.1016/j.jpainsymman.2006.07.014

Batoz H, Semjen F, Bordes-Demolis M, Bnard A, Nouette-Gaulain K. Chronic postsurgical pain in children: Prevalence and risk factors. A prospective observational study. Br J Anaesth. 2016;117(4):489-96. doi: http://www.doi.org/10.1093/bja/aew260

Shah P, Siu A. Considerations for neonatal and pediatric pain management. Am J Heal Pharm. 2019;76(19):1511-20. doi: http://www.doi.org/10.1093/ajhp/zxz166

de Leeuw TG, Dirckx M, González Candel A, Scoones GP, Huygen FJPM, de Wildt SN. The use of dipyrone (metamizol) as an analgesic in children: What is the evidence? A review. Paediatr Anaesth. 2017;27(12):1193-201. doi: http://www.doi.org/10.1111/pan.13257

Fieler M, Eich C, Becke K, et al. Metamizole for postoperative pain therapy in 1177 children: A prospective, multicentre, observational, postauthorisation safety study. Eur J Anaesthesiol. 2015;32(12):839-43. doi: http://www.doi.org/10.1097/EJA.0000000000000272

Stamer UM, Stammschulte T, Erlenwein J, et al. Recommendations for the perioperative use of dipyrone: Expert recommendation of the working group on acute pain of the German Pain Society, the scientific working group on pain medicine of the German Society for Anesthesiology and Intensive Care Medicine. Schmerz. 2019;33(4):287-94. doi: http://www.doi.org/10.1007/s00482-019-0389-8

Souki M. Metamizole for postoperative pain therapy. Eur J Anaesthesiol. 2016;33(10):785-6. doi: http://www.doi.org/10.1097/EJA.0000000000000498

Messerer B, Grögl G, Stromer W, Jaksch W. Perioperative systemische schmerztherapie bei kindern. Österreichische interdisziplinäre handlungsempfehlungen zum perioperativen schmerzmanagement bei kindern. Schmerz. 2014;28(1):43-64. doi: http://www.doi.org/10.1007/s00482-013-1384-0

García M, Funes R, Vidal A. Manejo del dolor en Atención Primaria. AEPap (ed) Curso Actual Pediatría. 2016;(3):379-90.

Carlson J, Youngblood R, Dalton JA, Blau W, Lindley C. Is patient satisfaction a legitimate outcome of pain management? J Pain Symptom Manage. 2003;25(3):264-75. doi: http://www.doi.org/10.1016/S0885-3924(02)00677-2

Schwenkglenks M, Gerbershagen HJ, Taylor RS, et al. Correlates of satisfaction with pain treatment in the acute postoperative period : Results from the international PAIN OUT registry. Pain. 2014;155(7):1401-11. doi: http://www.doi.org/10.1016/j.pain.2014.04.021

Andrews RM, Browne AL, Wood F, Schug SA. Predictors of patient satisfaction with pain management and improvement 3 months after burn injury. J Burn Care Res. 2012;33(3):442-52. doi: http://www.doi.org/10.1097/BCR.0b013e31823359ee

How to Cite
1.
Quintero-Castellanos JM, Hernández Ángela, Parra T. Pain prevalence in infants and preschool children in a Colombian hospital . Colomb. J. Anesthesiol. [Internet]. 2021Sep.2 [cited 2021Oct.16];49. Available from: https://www.revcolanest.com.co/index.php/rca/article/view/1000

Downloads

Download data is not yet available.
Published
2021-09-02
How to Cite
1.
Quintero-Castellanos JM, Hernández Ángela, Parra T. Pain prevalence in infants and preschool children in a Colombian hospital . Colomb. J. Anesthesiol. [Internet]. 2021Sep.2 [cited 2021Oct.16];49. Available from: https://www.revcolanest.com.co/index.php/rca/article/view/1000
Section
Original

More on this topic