Research improves hospitals’ approach to children’s pain in Thailand

March 04, 2013
Stephen Dale
More than 200 global health researchers gathered in Ottawa to share research results from the 7-year Teasdale-Corti Global Health Research Partnership. Canadian and Thai researchers focused on treating children’s pain.
Research that has enabled hospitals in Thailand to better treat children’s pain provides a valuable model for other countries grappling with this emotional issue.
“This problem is everywhere in the world,” says Dr Allen Finley, professor of anesthesia and psychology at Halifax’s Dalhousie University. “There are equal problems with pain management in children in Canada. It’s a Canadian problem, a Thai problem, and an international problem.”
Dr Finley recalls being drawn to this field over 20 years ago, after his first haunting encounter with a pediatric patient whose pain was inadequately controlled. Over time, international conferences brought him into contact with colleagues in Thailand whose first-hand experiences had similarly convinced them of the need for new approaches.
“As an anesthesiologist I had many consultations with physicians who weren’t really sure how to deal with children in pain,” remembers Dr Wimonrat Sriraj, an anesthesiology professor at Thailand’s Khon Kaen University. “That showed me that I had to learn more myself.”   
Canadian-Thai collaboration
Support from the Global Health Research Initiative’s Teasdale Corti program allowed Canadian and Thai specialists to launch a collaborative research project intended to improve the way several hospitals in Eastern Thailand deal with children’s pain.
Canada’s Global Health Research Initiative is a partnership between IDRC, the Canadian International Development Agency, and the Canadian Institutes of Health Research.
Dr Finley stresses that the research didn’t aim to determine how children’s pain could be better managed — this is already widely known — but rather how hospital routines could be changed so that appropriate pain management became possible.
Communication is key
A big part of the problem, he says, is that the particular ways that children talk about their pain requires nurses and doctors to have specialized training and more time to assess a child’s real level of pain.
They need to be aware, for example, that children are more likely to withdraw rather than cry if their pain is constant. They are also likely to under-report their pain if they believe it could lead to negative consequences like getting an injection, having to stay longer in the hospital, or creating problems for their parents. And younger children lack the mental capacity to describe their pain numerically — on a scale of 1 to 10 — as is standard practice for adults.
There are ways of overcoming these barriers. Younger patients can point to drawings of faces to communicate their pain levels.  And medical staff can reassure children that pain medication will make them feel better without creating other problems. They also need to be able to read the signs of unreported pain.
But these are more time-consuming processes and “if you have two or three nurses looking after 40 patients on a night shift, it’s pretty hard for them to spend a significant amount of time with one child,” comments Dr Finley.
Overcoming obstacles

Despite the obstacles, the research team helped the hospitals improve procedures.

“Many workshops were done for nurses and physicians about pediatric pain management,” recounts Dr Sriraj. Hospital administrators and nurses themselves were also canvassed about ways to free up nurses’ time so they could properly diagnose children’s pain. Meanwhile, hospitals brought new pain management guidelines to the forefront of doctors’ and nurses’ routines.
As a result, “we have evidence that children’s pain scores are going down,” reports Dr Sriraj. “Children are more likely to get the pain management they need.”
Local results, global model
These advances have a global significance in both practical and more abstract ways, Dr Finley believes. He points out that the World Health Organization has proposed that pain management be recognized as a human right, an idea that’s especially applicable to children, given their vulnerability and low capacity to speak for themselves. 
Not treating children’s pain also has negative practical consequences. For example, there is evidence that enduring untreated pain as a child physiologically alters the nervous system, creating more susceptibility to pain later in life. 
Less tangible — but equally real — is that untreated pain in children causes great suffering for family members and debilitating stress for nursing staff. “Seeing a child in pain takes a significant emotional toll,” says Dr Finley.
Stephen Dale is an Ottawa-based writer.

Learn more about the Global Health Research Initiative

Read more about this project: Improving management of pediatric pain in urban and rural Thailand

Read more about research supported by the Teasdale-Corti Global Health Research Partnership