Children's self-report of postoperative pain intensity and treatment threshold: Determining the adequacy of medication

Objective: Many studies have shown indirectly that children are undermedicated for postoperative pain. In this study, we used a pain self-report scale to examine this more directly. Methods: We performed a survey with 63 children who were postoperative from minor, uncomplicated surgery. Using the self-report scale, we determined the pain intensity at time of interview, the worst pain experienced postoperatively, and the intensity of pain that the subject felt to warrant pharmacologic intervention (the "treatment threshold"). A subgroup of 48 children was asked to indicate on the scale the intensities that represented mild, moderate, and severe pain. Results: Mean (SD) pain at time of interview was 1.9 (1.7) on the Oa scale. Mean worst postoperative pain was 3.8 (1.8). The mean for treatment threshold was 3.2 (1.8). We found gender differences in regard to the judgments about the intensities representing mild, moderate, and severe pain, with girls rating these lower than did boys. Twenty-five percent of subjects reported pain that was mild, 29% reported moderate pain, and 46% reported severe pain. Conclusions: We found that 51% of subjects were undermedicated for postoperative pain, being required to suffer pain that was above their treatment threshold. By determining each subject's treatment threshold and estimate of moderate pain, we have better defined the intensity at which pain becomes clinically significant.