Department of Pediatrics, University of Florida, Gainesville, Florida 32608, USA.
J Palliat Med. 2010 Feb;13(2):171-8. doi: 10.1089/jpm.2009.0265.
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.
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.
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.
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.
尽管研究已经证实，儿科疼痛治疗不足，但仍不清楚谁应该对其治疗承担主要责任。本研究询问了儿科医生，他们认为谁应该治疗疼痛，以及应该如何评估和管理疼痛。
我们向 800 名美国儿科医生随机发送了一份关于儿科慢性疼痛和姑息治疗的邮件和在线调查，并对 303 名回复者进行了描述性和多变量分析。
大多数儿科医生回复者为白人、非西班牙裔（55.8%），且从业 10 年以上（68.0%）。只有三分之一的儿科医生（32.3%）认为治疗慢性疼痛是他们的主要责任；大多数人认为疼痛专家（58.1%）、其他专家（39.6%）或临终关怀提供者（26.1%）应该负责。在疼痛评估方面，大多数报告使用家长（87.1%）或患者（84.2%）的口头报告，有一半（49.5%）使用疼痛日记，但多变量分析显示，住院儿科医生使用这些方法的可能性显著较低。对乙酰氨基酚和非甾体抗炎药（NSAIDs）是治疗疼痛的常用药物（分别为 61.7%和 66.9%），19.3%的医生报告在其治疗实践中从未或很少开间歇性阿片类药物。多变量分析显示，医生的素质没有一致的预测阿片类药物处方的使用。
我们的研究结果表明，儿科医生在慢性疼痛管理方面的理论方法更加协作，而不是独立的。未来的研究必须检验，如果儿科医生能够从补充疼痛教育、更加重视临床指导以及提高对临终关怀的认识中受益，是否可以将他们纳入儿童疼痛管理团队。
