Barriers lead to poor pain control in Latino children after surgery

More than two-thirds of children from low-income Latino families don’t receive adequate pain control when they go home after surgery, according to a study being presented at the ANESTHESIOLOGY™ 2014 annual meeting. Obstacles to appropriate pain management include language barriers, misconceptions about pain management and a preference for alternative therapies, the study found.

Researchers studied 139 Latino families with children who had surgery to remove their tonsils or adenoids. All children had surgery at one hospital and each family’s total income was $30,000 or less per year. Spanish-speaking researchers visited the families at home two and seven days after surgery, asking both parents and children to assess each child’s pain. Seventy percent of both parents and children reported the child had significant pain on the first day after surgery.

To control pain, it is recommended children receive 12 to 18 doses of pain medication during the first three days after surgery. The study found that, on average, parents administered only seven doses during the first three days. Thirty percent of the children received only one dose of pain medication or none at all the first day after they got home.

Researchers also interviewed parents about the child’s experience in the hospital and home. Four themes emerged regarding the reasons for inadequate pain control: lack of knowledge about pain management, including concerns that the child might become addicted or be harmed by the medication; a preference for alternative medicine such as herbal remedies; poor communication or lack of time spent with health care providers, leaving concerns and questions unaddressed; and barriers within the health care system such as a lack of translators and inadequate insurance.

“We need to find innovative solutions to address the problem and ensure that kids get adequate pain relief after surgery,” said Zeev Kain, M.D., lead author of the study and Chancellor’s Professor of anesthesiology and pediatrics, and chair of the department of anesthesiology and perioperative care, University of California, Irvine. “Solutions such as adding more translators and giving families pain medication when they leave the hospital rather than just handing them a prescription may be cost-prohibitive. Instead, we need to look at other alternatives.”