A paediatric pain management team at Temple Street Children's Hospital aims to take the sting out of children's pain, writes Danielle Barron
ALTHOUGH PAIN relief for adults in hospital is something of a given, the necessity of adequate pain management for children is something that has only been acknowledged in the past decade.
A dedicated and formalised paediatric pain management service in Temple Street Children's Hospital aims to bring a smile to the faces of children suffering from both acute and chronic pain.
Consultant anaesthetist Dr Kay O'Brien had spent some years operating a similar service in Glasgow. Upon her return to Ireland in 1999, she recognised the deficit in appropriate pain management services for children here at the time, and decided to set up a programme in Temple Street to fulfil that need.
Apart from the obvious financial investment, including the purchase of new equipment and the acquisition of nursing staff, there also had to be a willingness among the wards and departments to embrace the unprecedented programme, explains O'Brien.
"It was a brand-new initiative and credit must be given to Rita O'Shea, our director of nursing, for allowing it to happen," she says.
O'Brien has now lectured nationally and internationally on pain management in children, in an effort to raise its profile. Together with Ger Murray and Bevan Ritchie, pain nurse specialists, she works to provide children with as comfortable an experience as possible during their hospital stay.
"Ten years ago children would have probably received 20 per cent of the painkillers that an adult would have received for the same procedure," says O'Brien. "It is an important right of children and we've had to fight to get it recognised as such.
"It is now checked as one of their vital signs, along with heart rate, blood pressure, etc," adds Ritchie.
This shift in the ideology is evident in that what was previously known as the Department of Anaesthesia is now known as the Department of Anaesthesia, Intensive Care and Pain Medicine, says Murray.
Dr Kevin Carson is the director of the department, and specialises in taking care of children who are suffering from chronic pain. According to Carson, chronic pain experienced by a child can have long-term consequences. "It is far-reaching. In a child who has pain at 10-years-old, the effects can persist for a whole lifetime unless we can effect a return to normality," he says.
Pain can also have a psychological component, explains Carson.
"This has to be treated by a psychologist, along with the actual pain, in order to effect a cure," he says.
"Physiotherapy is an important tool of treatment and the radiology department also plays an important role in diagnosis and ruling out any organic causes of pain. It is a team approach to pain management," says Carson.
Patient-controlled analgesia, whereby the child can administer their own pain medication via a button on a pump is used in most cases, except with much younger children, mainly the under-fives, explains O'Brien.
"Once children have been going to school for a year, we find that they can manage this quite easily, because children are quite smart.
"A six-year-old is able to control their own pain management to quite a large degree," says O'Brien.
The success of the programme means the team has seen more than 200 patients to date, says Murray. "In the first year we had 127 patients on pumps. There were nearly 400 patients last year and this year we expect to have seen almost 500," she says.
"Each of those patients is reviewed three times a day for a number of days, so each patient involves a huge amount of work," adds O'Brien.
According to O'Brien, the delicate balance between analgesia and safety means that this regular monitoring is necessary, as certain drugs may be more toxic in a child and may cause more side-effects.
"The major focus is on patient safety," adds Murray. The regular monitoring of patients also allows them to administer epidurals to children on the wards, she adds.
Education is also an important factor of the programme, for both children and their families. "With children, very often the whole family becomes involved in their pain behaviour. It doesn't just affect the child, it can affect the whole family," says Carson.
In addition to medication, distraction therapies and play specialists are employed to make the hospital experience as painless as possible, for both parents and children, explains O'Brien.
Feedback has been extremely positive, especially with children who may have to undergo repeat procedures, says O'Brien.
"We have parents and kids who come back asking for what they had the last time because they were so comfortable. This is something that we are very proud of, as this is the proof that it works," she says.