Call for more research on pain in children

Press, 7 September 1989, Page 9

Call for more research on pain in children

by

MAVIS AIREY

“Pain isn’t a problem for children. We shouldn’t be spending government money on it,” said an assessor when Patricia McGrath applied for a grant.

A doctor of sensory psychology who has spent more than a decade on pain research in the United States and Canada, she finds this sort of attitude still sadly common, even in the medical professions. One reason is that it is a relatively new field of research. The pain clinic for children she helped to set up at the University of Western Ontario in the mid-1980s was the first of its kind in North America. As well as the clinical aspects of pain management for children with diseases such as cancer, the clinic has made a serious effort to understand how children’s attitudes to pain, coping strategies and perceptions change as they mature.

Dr McGrath is now director of Canada’s Child Health Research Institute. This year she completed a book on pain in children, and was invited to New Zealand to address the Pain Society conference in Invercargill last month.

While in Christchurch she met with members of Pain Action in New Zealand (P.A.1.N.Z.) and talked with children with chronic pain and their parents.

“It is probably only in the last two decades that pain in adults had begun to receive the attention it warrants,” she says. “Even by the early 1980 s, very little had been done about pain in children.”

She well remembers seeing a documentary at about that time which showed that children were’ “horrendously undermedicated” compared with adults. She has also

seen polls of nurses and anaesthetists showing that many surgical procedures, from circumcisions to major surgery, are done on infants without pain relief.

She blames four myths. • That children, and infants in ' particular, have immature nervous systems and so don’t feel pain very much.

.• That they recover quickly so don’t need drugs.

• Fears of narcotic addiction are too great to warrant giving potent analgesics.

• That children cannot accurately describe the location or intensity of pain, so you can’t tell when they are overmedicated or not.

“The old idea about pain is very simplistic and very wrong,” she says. “The old idea that pain is proportional to tissue damage has the corollary

that pain is a symptom of disease and only exists if there is disease and tissue damage. Therefore treatment is only designed once you have a clear idea of what the tissue damage is. “So two children having the same injection for the same thing will have the same pain — that’s not true,” she insists. Similarly, those giving treatments might be aware that each procedure causes pain, but they do not realise that cumulative pain can be caused by repeated medical procedures.

“It was only in the 1970 s that we found out that pain is very complicated, and very modifiable. That takes time to filter through to medical practice,” she says. . “Things are changing, but we still need to go further. More research is needed, and more publication.”

She says fewer than 10 per cent of medical and nursing schools have information about the neurology of pain or the psychology of pain control on their curricula.

“I think many hospitals don’t subscribe to any of the three pain journals — even though there’s probably not a human being alive who doesn’t come out of hospital having had some pain.” Margaret Moon, the Christchurch psychologist and physiotherapist hosting Dr McGrath, agrees that the situation is similar in New Zealand.

“There is still very little coverage of pain in the syllabuses of nursing and medical schools.”