According to research, children recovering at home from surgery often don't receive enough pain medication, but many of the studies conducted so far have been small or methodologically inconsistent. To elicit a clearer picture of the problem, researchers in California followed 261 children ages two to 12 years recovering at home after tonsillectomy and adenoidectomy, for two weeks each, in order to compare the rate of analgesic administration with the children's level of pain. Parents were instructed to rate their child's pain every four to six hours using the Bieri Faces Scale and, when it reached 3 or higher on the scale, give acetaminophen plus codeine; they were also asked to rate the children's pain using three other pain-rating scales and report those scores to the pediatric nurse researchers on the four days of data collection.

After leaving the postanesthesia care unit, all of the children spent 24 hours in the hospital, where all but two received pain medication (those receiving medication scored highly enough on the pain-rating scales to warrant it). However, on the children's first day home, even though 86% of them were rated by their parents as experiencing significant pain, nearly a quarter (24%) received no pain medication or just one dose. On the second day at home, two-thirds of the children experienced significant pain, yet 41% received no more than one dose of painkiller. Overall, 23% of all children received three or fewer doses of painkiller during their entire two-week recovery at home. "Despite clinical guidelines, many children continue to experience unnecessary postoperative pain," the authors write.

Researchers have attempted to determine why parents often don't administer analgesia when it's clearly indicated. One study, by Zisk and colleagues (in the April 2007 issue of Anesthesia and Analgesia), found that parents with less education and those with more sociable children give fewer painkillers, whereas highly conscientious parents and parents with impulsive children give more painkillers. Some parents may not give pain medication to young children because they fear drug dependence, or they don't recognize the symptoms of pain; some view pain medication as a last resort. And sometimes children have trouble swallowing medication, especially after surgery involving the throat. A better understanding of the discrepancy between high pain scores and low rates of analgesic administration by parents could spare children unnecessary pain and lower medical costs incurred by unscheduled visits to the pediatrician's office or the ED.

Carol Potera