Reducing children’s pain during emergency treatment reduces distress, improves recovery
Research at work in hospitals – Pain management
Dr. Samina Ali would like to reduce the OUCH factor in children’s emergency care treatment.
During the course of her research into pain management, the pediatric emergency physician has found that children’s pain is undertreated in hospital emergency departments across Canada. Children are less likely to receive pain medication than adults for the same injuries and intensity of pain. And health care providers are less comfortable treating children than grownups.
Dr. Ali became interested in pediatric pain management in her early days as an emergency physician. About 80 per cent of the young patients she saw were in pain, and the tests and examinations they underwent, inflicted more discomfort.
“It seemed wrong to me not to do everything we could to reduce the children’s pain,” says Dr. Ali, who juggles her clinical practice at the Stollery Children’s Hospital with teaching as an associate professor in pediatrics at the University of Alberta.
She undertook two major studies on pain management, one based on a national survey of pediatric emergency doctors and another based on a provincial survey of emergency department administrators.
The studies showed that painful procedures, such as spinal taps, IV insertions, urinary catheterizations and even suturing are often performed on children without adequate pain treatment. The studies also indicated that pain treatment in emergency departments varies considerably and that many doctors and other health care providers underuse simple, inexpensive pain remedies. Encouraging parents to hold their babies during painful procedures rather than holding them down on a hospital bed, for example; using freezing creams before inserting IVs; breastfeeding and swaddling.
Dr. Ali has embarked on a new study that is looking at the effectiveness of two common painkillers — ibuprofen and oral morphine — in managing the pain of children with suspected fractures in the emergency department. The study, appropriately titled OUCH, is a large clinical trial involving 500 youngsters that will test the use of the two pain relievers, both alone and in combination, specifically in children. The study marks a step in the right direction for pediatric drug research.
In Canada, few drugs given to children, including common prescription medications such as antibiotics and painkillers, have been tested or approved for children’s use. An influential report recently commissioned by Health Canada (Improving Medicines for Children in Canada) points to the “unnecessary risk of harm” that this creates for children. Lacking reliable information on drug use for children, doctors have to guess at appropriate dosages and hope that the medications they are prescribing — which have been developed for and tested on adults — will work for their young patients.
Dr. Ali wants to ensure that children get safe, appropriate treatment and that their pain is minimized. “We know that untreated or undertreated pain in childhood has negative short and long-term effects,” she says. “It can slow down recovery and prolong hospitalization. It increases the distress of future medical procedures and can affect the pain threshold in adulthood. The preventative benefits of using therapies that are safe and effective are tremendous.”
Through the generous support of the Stollery Children’s Hospital Foundation, WCHRI was able to provide subsidized expert data management and informatics resources to assist Dr. Ali in her research work.