Managing pain in children: How far have we come in the past 20 years? Where do we need to get to?

imageIn October it was 20 years since the first Pediatric Pain Letter ( was published. Over the years this publication has disseminated a huge about of information about pain in children. Despite this, and other work in the area, children continue to experience unrelieved moderate to severe pain while in hospital (Kozlowski et al. 2014, Twycross & Finley 2013). In 2015 we published a review of the literature looking at nurses’ postoperative pain management practices (Twycross et al. 2015). We concluded that nurses’ assessment and management of children’s pain is still not always consistent with published guidelines. Results of studies looking at the reasons for this were inconclusive with contradictory results. Many of the studies included were of low quality or chart audits meaning that data was probably incomplete. We suggested that research needs to be carried out to examine the impact of organisational factors on nurses’ pain care practices and that intervention studies are needed to determine the most effective strategies to support and improve nurses’ pain care for children.

However, all is not doom and gloom. In a look back at the past two decades in paediatric pain ( several experts reflected on what they see as the greatest achievements in this area. These include the fact that:

  • (Most) people now realise that children (including neonates) experience as much, if not more, pain than adults in a similar situation
  • We have the ability to offer a variety of options for managing procedural pain
  • We have an increased understanding of neurobiology which can guide treatment decisions

But with children continuing to experience unnecessary pain there is still work to do. So what do I think we will see when we look back in another 20 years? I hope that in 2036:

  • Children and parents will be involved in discussions about their pain management and decision-making, with children’s self-reports of pain being believed
  • We will be using the treatment options available to us to ensure that children’s procedural pain is managed effectively and that there will be no need for campaigns such as #itdoesn’thavetohurt.
  • Parents will be challenging healthcare professionals who aren’t managing their children’s pain effectively.

In 20 years time, as I look back at over 40 years of working in the area of paediatric pain, I hope I see the evidence we have produced consistently used in practice. Who knows maybe I’ll even be writing a Blog reflecting on the progress we have made. Watch this space!

Professor Alison Twycross

Head of Department for Children’s Nursing, London South Bank University @alitwy


Kozlowski LJ, Kost-Byerley S, Colantuoni E, Thompson CB, Vasquenza KJ, Rothman SK, Billett C, White ED, Yaster M & Monitto CL (2014): Pain prevalence, intensity, assessment and management in a hospitalized pediatric population. Pain Management Nursing 15, 22-35.

Twycross A & Finley GA (2013): Children’s and parents’ perceptions of postoperative pain management: A mixed methods study. Journal of Clinical Nursing 22, 3095–3108.

Twycross A, Forgeron P & Williams A (2015): Paediatric nurses’ post-operative pain management practices in hospital settings: A narrative review. International Journal of Nursing Studies 52, 836-863.


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