Dados do Trabalho

Título

RECOGNITION OF PAIN IN CHILDREN WITH NEUROLOGICAL DISEASES BY PEDIATRIC DOCTORS

Introdução

Pain is an individual somatic and subjective experience associated with pathological processes. When not identified early and well-managed, it can result in negative physical and emotional experiences. In neurological patients, recognizing pain is challenging due to the absence of verbalization, motor deficits, and cognitive impairments, making its identification complex. Therefore, the use of scales is an important tool for measuring and managing pain. Additionally, the knowledge of healthcare professionals about the existence and application of these scales is necessary as a good health practice.

Objetivo

Objective to understand the knowledge of pediatricians in the state of Bahia from 2022 to 2023 regarding pain scales and their applicability in patients with neurological impairments.

Método

This is a descriptive and observational study, with a questionnaire developed by the researchers and applied online. The variables considered were: age group, origin, year of graduation, place of education, existence of subspecialty, place of practice, whether they received information about pain assessment, involvement in a multidisciplinary trained team, method of pain assessment, whether the method used is the same for children with or without neurological pathologies, knowledge about the use of pain scales (Visual Scale, Verbal Numeric Scale, Behavioral Scale, McGill Inventory, FLACC, rFLACC, ICDDN), therapies addressed in the last six months, and pain reassessment after interventions.

Resultados

Based on this study, it was observed that among the pediatricians surveyed, there is a lack of knowledge about recognizing pain in pediatric patients with neurological diseases, as well as a scarcity of objectivity, standardization, and application of pain scales already established and recommended in the scientific literature.

Conclusão

This lack of clarity and consistency in pain assessment makes managing this condition complex due to its subjective nature, resulting in significant difficulties in providing adequate care and effectively resolving pain, which can lead to inadequate assistance with negative repercussions for the patient.

Referências

1 Peirce D, Brown J, Corkish V, Lane M, Wison S. Instrument validation process: a case study using the Paediatric Pain Knowledge and Attitudes Questionnaire. J Clin Nurs. 2016;25(11-12):1566-75.
2 Pasin S, Avila F, Cavatá T, Hunt A, Heldt E. Cross-cultural translation and adaptation to Brazilian Portuguese of the paediatric pain profile in children with severe cerebral palsy. J Pain Symptom Manage. 2013;45(1):120-8. doi: https://doi. org/10.1016/j.jpainsymman.2012.01.013
3 Faccioli SC, Tacla MT, Rossetto EG, Collet N. O manejo da dor pediátrica e a percepção da equipe de enfermagem à luz do Modelo Socio comunicativo da Dor. BrJP. 2020;3(1):37-41. International Association for the Study of Pain (IASP). Pain terms: a list with definitions and notes on usage. Recommended by the IASP subcommittee on taxonomy. Pain. 1979;6(3):249
4 Freund D, Bolick BN. CE: assessing a child’s pain. Am J Nurs. 2019;119(5):34-41. doi: http://doi.org/10.1097/01.NAJ.0000557888.65961.c6
5 Hauer J, Houtrow AJ, Section on Hospice and Palliative Medicine. Council on Children with Disabilities. Pain assessment and treatment in children with significant impairment of the central nervous system. Pediatrics. 2017;139(6):e20171002. doi: http://doi.org/10.1542/peds.2017-1002
6 Cascella M, Bimonte S, Saettini F, Muzio MR. The challenge of pain assessment in children with cognitive disabilities: features and clinical applicability of different observational tools. J Paediatr Child Health. 2019;55(2):129-35. doi: http://doi. org/10.1111/jpc.14230 7.
7 Pedersen LK, Rahbeka O, Nikolajsenc L, Møller-Madsena B. Assessment of pain in children with cerebral palsy focused on translation and clinical feasibility of the revised FLACC score. Scand J Pain. 2015;9(1):49-54. doi: http://doi.org/10.1016/j. sjpain.2015.06.005
8 Candido LK, Tacla MTGM. Assessment and characterization of pain in children: the use of quality indicators. Rev Enferm UERJ. 2015;23(4):526-32. 11. Linhares MBM, Oliveira NCAC, Doca FNP, Marinez FE, Carlotti APP, Finley GA. Assessment and management of pediatric pain based on the opinions of health professionals. Psychol Neurosci. 2014;7(1):43-53.
9 Shah P, Siu A. Considerations for neonatal and pediatric pain management. Am J Health Syst Pharm. 2019;76(19):1511-20. doi: https://doi.org/10.1093/ ajhp/zxz166
10 Merkel S, Voepel-Lewis T, Shayevitz JR, Malviya S. The FLACC: a behavioral scale for scoring postoperative pain in young children. Pediatric nurs. 1997 [cited 2019 Sep 10];23(3):293-7. Available from: https://www.researchgate. net/publication/13998379_The_FLACC_A_Behavioral_Scale_for_Scoring_ Postoperative_Pain_in_Young_Children
11 Morone NE, Weiner. DK. Pain as the 5th vital sign: exposing the vital need for pain education. Clin Ther. 2013;35(11):1728-3212. Novak I, Hines M, Goldsmith S, Barclay R. Clinical prognostic messages from systematic review on cerebral palsy. Pediatrics. 2012;130(5):e1285-e1312. doi: https://doi.org/10.1542/peds.2012-0924
12 Cohen M, Quintner J, van Rysewyk S. Reconsidering the International Association for the Study of Pain definition of pain. Pain Rep. 2018;(2):e634.
13 Werber A, Marschall U, L’hoest H, et al. Opioid therapy in the treatment of chronic pain conditions in Germany. Pain Phys. 2015;18:E323---31.
14 Molloy AR, Nicholas MK, Cousins MJ. Role of opioids in chronic non-cancer pain. Med J Aust. 1997;167:9---10.
15 Silveira KA, Lima VL, Pereira KM. Estresse, dor e enfrentamento em crianças hospitalizadas: análise de relações com o estresse do familiar. Rev SBPH. 2018 [citado 2019 out 10];21(2):5-21. Disponível em: http://pepsic.bvsalud.org/scielo. php?script=sci_arttext&pid=S1516-08582018000200002&lng=pt
16 Bussoti EA, Guinsburg R, Pedreira MLG. Cultural adaptation to Brazilian Portuguese of the face, legs, activity, cry, consolability revised (rFLACC) scale of pain assessment. Rev Latino-Am Enfermagem. 2015;23(4):651-9. doi: http://doi. org/10.1590/0104-1169.0001.2600
17 Blasi DG, Candido LK, Tacla MTGM, Ferrari RAP. Avaliação e manejo da dor na criança: percepção da equipe de enfermagem. Semina Ciênc Biol Saúde. 2015;36(1 Supl.):301-10. doi: http://doi.org/10.5433/1679-0367.2015v36n1Suplp301.
18 Bittencourt B, Breigeiron MK, Flores FS, Pasin SS. Complementaridade de instrumentos de mensuração de dor em crianças com comprometimento do sistema nervoso central. Rev Gaúcha Enferm. 2021;42:e20200379. Doi: https://doi.org/10.1590/1983-1447.2021.20200379
19 Sedrez ES, Monteiro JK. Pain assessment in pediatrics. Rev Bras Enferm. 2020;73(Suppl 4):e20190109. doi: http://dx.doi.org/10.1590/0034-7167-2019-0109
20 Corgozinho  MM, Barbosa  LO, Araújo IP, Araújo GTF. Dor e sofrimento na perspectiva do cuidado centrado no paciente. Rev. Bioét. vol.28 no.2 Brasília Abr./Jun. 2020. Doi:10.1590/1983-8042202028286. https://www.scielo.br/j/bioet/a/3tJx6369mSFQDc3DXy5F8jM/?format=pdf&lang=pt
21 Sedrezl Elisa da Silva, Monteiro Janine Kieling. Avaliação da dor em pediatria. Revista Brasiliera de Enfermagem, 2020;73. http://dx.doi.org/10.1590/0034-7167-2019-0109
22 Lucia Ortiz, Inigo de Noriega, Diagnosis and management of paediatric pain, An Pediatr (Barc). 2019;91(2):71-72. http://creativecommons.org/licenses/by-nc-nd/4.0/
23 Linhares Maria Beatriz Martins, Doca Fernanda Nascimento Pereira. Dor em neonatos e crianças: avaliação e intervenções não farmacológicas. Revista de Ciências médicas e biológicas. v.18. n.1 (2019). https://doi.org/10.9771/cmbio.v18i1.26603
24 Lemos Simone, Ambiel Celia Regina. Dor em pediatria: fisiopatologia, avaliação e tratamento.Revista Saúde e Pesquisa, v. 3, n. 3, p. 371-378, set./dez. 2010 -
25 Bittencourta Betina, Breigeironb Márcia Koja, Floresc Fernanda da Silva, Pasind Simone Silveira. Complementaridade de instrumentos de mensuração de dor em crianças com comprometimento do sistema nervoso central. Revista Gaucha de Enfermagem. 2021; 42.https://doi.org/10.1590/1983-1447.2021.20200379
26 Batalha, Luis; Mendes, Vera. Adaptação cultural e validação da versão portuguesa da Escala Face, Legs, Activity, Cry, Consolability – Revised (FLACC-R). Revista de Enfermagem Referência, Portugal, v.3, n. 11, p.7-17, 31 dez. 2013
27 Okada Massako, Teixeira Manoel Jacobsen,Miyagi Karina Takesaki . Tratamento da dor em pediatria. Rev. Méd. São Paulo., v. 80, n. 1, p. 157-169, 2001.
28 SLOVER, R.; COY, J.; DAVIDS, H. R. Advances in the management of pain in children: acute pain. Adv. Ped., v. 56, n. 1, p. 341-358, 2009
29 OPAS. Mapa de evidências e efetividade clínica das Medicinas Tradicionais, Complementares e Integrativas para Dor Crônica. São Paulo, 2022
30 Rigotti MA, Ferreira AM. Intervenções de enfermagem ao paciente com dor. Arq Ci-ênc Saúde. 2005;12(1):50-4.

31 NIH. National Center for Complementary and Integrative Health. Pain: Considering Complementary Approaches (eBook), 2019. Disponível em: https://files.nccih.nih.gov/s3fs-public/Pain-eBook-2019_06_508.pdf

32 Zisk-Rony RY, Lev J, Havin H. Nurses’ report of in-hospital pediatric pain assessment: examining challenges and perspectives. Pain Manag Nurs. 2015; 16(2):112-20. DOI: https://doi.org/10.1016/j.pmn.2014.05.003

33 Czarnecki ML, Salamon KS, Thompson JJ, Hainsworth KR. Do barriers to pediatric pain management as perceived by nurses change over time? Pain Manag Nurs. 2014;15(1): 292-305.DOI:https://doi.org/10.1016/j.pmn.2012.12.003

34 Friedrichsdorf SJ, Andrea P, Eull D, Weidner C, Foster L, Gilbertet M, et al. Pain Out-comes in a US Children’s hospital: A prospective cross-sectional survey. Hosp Pedi-atr. 2015;5(1):18-26. DOI: https://doi.org/10.1542/hpeds.2014-0084

35 Carvalho JA, Souza DM, Flávia F, Amatuzzi E, Pinto MCM, Rossato LM. Pain man-agement in hospitalized children: A cross-sectional study. Rev Esc Enferm USP. 2022;56:e20220008. https://doi.org/10.1590/1980-220X-REEUSP-2022-0008en

36 Wuni A, Salia SM, Ibrahim MM, Iddriss I, Nyarko BA, Seini SN, et al. Evaluating Knowledge, Practices, and Barriers of Paediatric Pain Management among Nurses in a Tertiary Health Facility in the Northern Region of Ghana: A Descriptive Cross-Sectional Study. Pain Res Manag. 2020;2020:8846599. DOI: https://doi.org/10.1155/2020/8846599

37 Friedrichsdorf SJ, Andrea P, Eull D, Weidner C, Foster L, Gilbertet M, et al. Pain Out-comes in a US Children’s hospital: A prospective cross-sectional survey. Hosp Pedi-atr. 2015;5(1):18-26. DOI: https://doi.org/10.1542/hpeds.2014-0084

Palavras Chave

Pain; neurological impairments; rFLACC