Assessing knowledge, attitude and practice of community pharmacists on the pain management and implications in UAE children
Main Article Content
Keywords
Pediatric pain, Children pain, Community pharmacists, Knowledge, Attitudes, UAE
Abstract
Objective: There are concerns with the optimal management of pain in children, with sub-optimal management negatively impacting on physical, emotional social functioning, exacerbated by pain in children being multi-modal. Community pharmacists across countries play an important role in managing pain in patients including children’s pain. Consequently, the objective of this study is to assess knowledge, attitudes and practices (KAP) of pain management in children among community pharmacists in UAE. Methods: A cross-sectional study was conducted using a structured questionnaire that was developed and piloted. The final questionnaire, which comprised two parts, had acceptable validity and internal consistency. Results: 867 out of 922 community pharmacists took part in UAE (94% response rate) and were visited by trained researchers. The most from independent pharmacies (53.9%) and having more than 10 years of experience (68.9%). The overall KAP score was 70%, with gender, pharmacy type, years of experience, educational level and position significantly associated with KAP. Encouraging knowledge areas included pain is one of the vital signs in children (88.6%), the intensity of pain should be rated by a pharmacist before discussing treatment options (92.2%) and the choice of treatment should depend on issues including intensity and duration (87.2%). Areas of concern included the contents of the WHO analgesic ladder (32.0%) and children may sleep in spite of severe pain (42.9%). Conclusion: There were areas of good knowledge of pain management among community pharmacists in UAE. Areas of concern including knowledge of the WHO analgesic ladder need to be addressed as part of future educational input during training and post qualification.
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References
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3. Shah P, Siu A. Considerations for neonatal and pediatric pain management. Am J Health Syst Pharm. 2019;76(19):1511-20. ttps://doi.org/10.1093/ajhp/zxz166
4. Hridya RV, Geeta MG, Geetha P, et al. Opioids for Pediatric Pain Management. Indian Pediatr. 2022;59(2):114-6.
5. Ogunyinka I, Yusuff K, Erah PO, et al. Community Pharmacists’ Knowledge and Attitudes Towards Pediatric Pain Management in Nigeria. Risk Manag Healthc Policy. 2021;14:4595-607. https://doi.org/10.2147/RMHP.S329387
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9. Forgeron PA, King S, Stinson JN, et al. Social functioning and peer relationships in children and adolescents with chronic pain:A systematic review. Pain Res Manag. 2010;15(1):27-41. https://doi.org/10.1155/2010/820407
10. Logan DE, Simons LE, Kaczynski KJ. School functioning in adolescents with chronic pain: the role of depressive symptoms in school impairment. J Pediatr Psychol. 2009;34(8):882-92. https://doi.org/10.1093/jpepsy/jsn143
11. Hinze V, Karl A, Ford T, et al. Pain and suicidality in children and adolescents: a longitudinal population-based study. Eur Child Adolesc Psychiatry. 2022. https://doi.org/10.1007/s00787-022-01963-2
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22. Jones CA, Hoehler FK, Frangione V, et al. Safety and Efficacy of the FLECTOR (Diclofenac Epolamine) Topical System in Children with Minor Soft Tissue Injuries: A Phase IV Non-randomized Clinical Trial. Clin Drug Investig. 2022;42(1):43-51. https://doi. org/10.1007/s40261-021-01101-x
23. Godman B, Haque M, Islam S, et al. Rapid Assessment of Price Instability and Paucity of Medicines and Protection for COVID-19 Across Asia: Findings and Public Health Implications for the Future. Front Public Health. 2020;8:585832. https://doi.org/10.3389/fpubh.2020.585832
24. Marković-Peković V, Grubiša N, Burger J, et al. Initiatives to Reduce Nonprescription Sales and Dispensing of Antibiotics:Findings and Implications. J Res Pharm Pract. 2017;6(2):120-5. https://doi.org/10.4103/jrpp.JRPP_17_12
25. Cadogan CA, Hughes CM. On the frontline against COVID-19: Community pharmacists’ contribution during a public health crisis. Res Social Adm Pharm. 2021;17(1):2032-5. https://doi.org/10.1016/j.sapharm.2020.03.015
26. Hedima EW, Adeyemi MS, Ikunaiye NY. Community Pharmacists: On the frontline of health service against COVID-19 in LMICs.Res Social Adm Pharm. 2021;17(1):1964-6. https://doi.org/10.1016/j.sapharm.2020.04.013
27. Chowdhury M, Stewart Williams J, Wertheim H, et al. Rural community perceptions of antibiotic access and understanding of antimicrobial resistance: qualitative evidence from the Health and Demographic Surveillance System site in Matlab,Bangladesh. Glob Health Action. 2019;12(sup1):1824383. https://doi.org/10.1080/16549716.2020.1824383
28. Tabeefar H, Chang F, Cooke M, et al. Community pharmacists and chronic pain: A qualitative study of experience, perception,and challenges. Can J Pain. 2020;4(3):29-39. https://doi.org/10.1080/24740527.2020.1749516
29. Perrot S, Cittée J, Louis P, et al. Self-medication in pain management: The state of the art of pharmacists’ role for optimal Over-The-Counter analgesic use. Eur J Pain. 2019;23(10):1747-62. https://doi.org/10.1002/ejp.1459
30. Hahn KL. The roles of pharmacists in pain management. J Pain Palliat Care Pharmacother. 2009;23(4):414-8.31. Mishriky J, Stupans I, Chan V. Expanding the role of Australian pharmacists in community pharmacies in chronic pain management - a narrative review. Pharm Pract. 2019;17(1):1410. https://doi.org/10.18549/PharmPract.2019.1.1410
32. Mishriky J, Stupans I, Chan V. The role of the pharmacist in low back pain management: a narrative review of practice guidelines on paracetamol vs non-steroidal anti-inflammatory drugs. Pharm Pract. 2020;18(3):2075. https://doi.org/10.18549/PharmPract.2020.3.2075
33. Peirce D, Corkish V, Lane M, et al. Nurses’ Knowledge and Attitudes Regarding Pediatric Pain Management in Western Australia.Pain Manag Nurs. 2018;19(6):707-17. https://doi.org/10.1016/j.pmn.2018.03.002
34. Adenekan AT, Owojuyigbe AM, Aaron OI, et al. Impact of Pain Management Workshop on the Knowledge and Attitude of Healthcare Workers and Opioid Utilization in a Nigerian Teaching Hospital. West Afr J Med. 2019;36(3):232-8.
35. Oreagba IA, Ogunleye OJ, Olayemi SO. The knowledge, perceptions and practice of pharmacovigilance amongst community pharmacists in Lagos state, south west Nigeria. Pharmacoepidemiol Drug Saf. 2011;20(1):30-5. https://doi.org/10.1002/pds.2021
36. Lawshe C. A quantitative approach to content validity. Pers Psychol. 1975;28:563-75.
37. Polit DF, Beck CT, Owen SV. Is the CVI an acceptable indicator of content validity? Appraisal and recommendations. Res Nurs Health. 2007;30(4):459-67. https://doi.org/10.1002/nur.20199
38. Emirates News Agency. UAE has over 2000 private pharmacies, 4000 professionals. 2010 Available at URL: http://wam.ae/en/details/1395228626943
39. Wennberg P, Möller M, Sarenmalm EK, et al. Evaluation of the intensity and management of pain before arrival in hospitalamong patients with suspected hip fractures. International Emergency Nursing. 2020;49:100825. https://doi.org/10.1016/j.ienj.2019.100825
40. dela Cruz AM, Bernstein IH, Greer TL, et al. Self-rated measure of pain frequency, intensity, and burden: psychometric
properties of a new instrument for the assessment of pain. J Psychiatr Res. 2014;59:155-60. https://doi.org/10.1016/j.jpsychires.2014.08.003
41. Dufault MA, Sullivan M. A collaborative research utilization approach to evaluate the effects of pain management standardson patient outcomes. J Prof Nurs. 2000;16(4):240-50. https://doi.org/10.1053/jpnu.2000.4593
42. Wiffen PJ, Cooper TE, Anderson AK, et al. Opioids for cancer-related pain in children and adolescents. Cochrane Database SystRev. 2017;7(7):Cd012564. https://doi.org/10.1002/14651858.CD012564.pub2
43. Cooper TE, Fisher E, Gray AL, et al. Opioids for chronic non-cancer pain in children and adolescents. Cochrane Database SystRev. 2017;7(7):Cd012538. https://doi.org/10.1002/14651858.CD012538.pub2
44. Roberts E, Delgado Nunes V, Buckner S, et al. Paracetamol: not as safe as we thought? A systematic literature review of observational studies. Annals of the rheumatic diseases. 2016;75(3):552-9.
45. Kanabar DJ. A clinical and safety review of paracetamol and ibuprofen in children. Inflammopharmacology. 2017;25(1):1-9.https://doi.org/10.1007/s10787-016-0302-3
46. Mu PF, Chen YC, Cheng SC. The effectiveness of non-pharmacological pain management in relieving chronic pain for children and adolescents. JBI Libr Syst Rev. 2009;7(34):1489-543. https://doi.org/10.11124/01938924-200907340-00001
47. Srouji R, Ratnapalan S, Schneeweiss S. Pain in children: assessment and nonpharmacological management. Int J Pediatr. 2010;2010:474838. https://doi.org/10.1155/2010/474838
48. Rabbitts JA, Fisher E, Rosenbloom BN, et al. Prevalence and Predictors of Chronic Postsurgical Pain in Children: A Systematic Review and Meta-Analysis. J Pain. 2017;18(6):605-14. https://doi.org/10.1016/j.jpain.2017.03.007
49. Zernikow B, Smale H, Michel E, et al. Paediatric cancer pain management using the WHO analgesic ladder--results of a prospective analysis from 2265 treatment days during a quality improvement study. Eur J Pain. 2006;10(7):587-95. https://doi.org/10.1016/j.ejpain.2005.09.002
50. Mishra S, Bhatnagar S, Singh M, et al. Pediatric cancer pain management at a regional cancer center: implementation of WHO
Analgesic Ladder. Middle East J Anaesthesiol. 2009;20(2):239-44.
51. Evans S, Djilas V, Seidman LC, et al. Sleep Quality, Affect, Pain, and Disability in Children With Chronic Pain: Is Affect a Mediator or Moderator? J Pain. 2017;18(9):1087-95. https://doi.org/10.1016/j.jpain.2017.04.007
52. Kleiber C, Harper DC. Effects of distraction on children’s pain and distress during medical procedures: a meta-analysis. Nurs Res. 1999;48(1):44-9. https://doi.org/10.1097/00006199-199901000-00007
2. Scott LE, Crilly J, Chaboyer W, et al. Paediatric pain assessment and management in the emergency setting: the impact of a paediatric pain bundle. Int Emerg Nurs. 2013;21(3):173-9. https://doi.org/10.1016/j.ienj.2012.08.004
3. Shah P, Siu A. Considerations for neonatal and pediatric pain management. Am J Health Syst Pharm. 2019;76(19):1511-20. ttps://doi.org/10.1093/ajhp/zxz166
4. Hridya RV, Geeta MG, Geetha P, et al. Opioids for Pediatric Pain Management. Indian Pediatr. 2022;59(2):114-6.
5. Ogunyinka I, Yusuff K, Erah PO, et al. Community Pharmacists’ Knowledge and Attitudes Towards Pediatric Pain Management in Nigeria. Risk Manag Healthc Policy. 2021;14:4595-607. https://doi.org/10.2147/RMHP.S329387
6. Drendel AL, Kelly BT, Ali S. Pain assessment for children: overcoming challenges and optimizing care. Pediatr Emerg Care. Pope N, Tallon M, McConigley R, et al. Experiences of acute pain in children who present to a healthcare facility for treatment:a systematic review of qualitative evidence. JBI Database System Rev Implement Rep. 2017;15(6):1612-44. https://doi.org/10.11124/JBISRIR-2016-003029
8. Fisher E, Villanueva G, Henschke N, et al. Efficacy and safety of pharmacological, physical, and psychological interventions for the management of chronic pain in children: a WHO systematic review and meta-analysis. Pain. 2022;163(1):e1-e19. https://doi.org/10.1097/j.pain.0000000000002297
9. Forgeron PA, King S, Stinson JN, et al. Social functioning and peer relationships in children and adolescents with chronic pain:A systematic review. Pain Res Manag. 2010;15(1):27-41. https://doi.org/10.1155/2010/820407
10. Logan DE, Simons LE, Kaczynski KJ. School functioning in adolescents with chronic pain: the role of depressive symptoms in school impairment. J Pediatr Psychol. 2009;34(8):882-92. https://doi.org/10.1093/jpepsy/jsn143
11. Hinze V, Karl A, Ford T, et al. Pain and suicidality in children and adolescents: a longitudinal population-based study. Eur Child Adolesc Psychiatry. 2022. https://doi.org/10.1007/s00787-022-01963-2
12. Jastrowski Mano KE. School Anxiety in Children and Adolescents with Chronic Pain. Pain Res Manag. 2017;2017:8328174.https://doi.org/10.1155/2017/8328174
13. Williams G, Howard RF, Liossi C. Persistent postsurgical pain in children and young people: prediction, prevention, and management. Pain Rep. 2017;2(5):e616. https://doi.org/10.1097/PR9.0000000000000616
14. Liossi C, Howard RF. Pediatric Chronic Pain: Biopsychosocial Assessment and Formulation. Pediatrics. 2016;138(5). https://doi. org/10.1542/peds.2016-0331
15. Verghese ST, Hannallah RS. Acute pain management in children. J Pain Res. 2010;3:105-23. https://doi.org/10.2147/jpr.s4554 16. Wong C, Lau E, Palozzi L, et al. Pain management in children: Part 1 - Pain assessment tools and a brief review of nonpharmacological and pharmacological treatment options. Can Pharm J. 2012;145(5):222-5. https://doi.org/10.3821/145.5.cpj222
17. WHO. Guidelines on the management of chronic pain in children. 2020. Available at URL: https://www.who.int/publications/i/item/9789240017870
18. King S, Chambers CT, Huguet A, et al. The epidemiology of chronic pain in children and adolescents revisited: a systematic review. Pain. 2011;152(12):2729-38. https://doi.org/10.1016/j.pain.2011.07.016
19. Groenewald CB, Essner BS, Wright D, et al. The economic costs of chronic pain among a cohort of treatment-seeking adolescents in the United States. J Pain. 2014;15(9):925-33. https://doi.org/10.1016/j.jpain.2014.06.002
20. Patel T, Chang F, Mohammed HT, et al. Knowledge, Perceptions and Attitudes toward Chronic Pain and Its Management: A Cross-Sectional Survey of Frontline Pharmacists in Ontario, Canada. PLoS One. 2016;11(6):e0157151. https://doi.org/10.1371/journal.pone.0157151
21. Sleed M, Eccleston C, Beecham J, et al. The economic impact of chronic pain in adolescence: methodological considerations and a preliminary costs-of-illness study. Pain. 2005;119(1-3):183-90. https://doi.org/10.1016/j.pain.2005.09.028
22. Jones CA, Hoehler FK, Frangione V, et al. Safety and Efficacy of the FLECTOR (Diclofenac Epolamine) Topical System in Children with Minor Soft Tissue Injuries: A Phase IV Non-randomized Clinical Trial. Clin Drug Investig. 2022;42(1):43-51. https://doi. org/10.1007/s40261-021-01101-x
23. Godman B, Haque M, Islam S, et al. Rapid Assessment of Price Instability and Paucity of Medicines and Protection for COVID-19 Across Asia: Findings and Public Health Implications for the Future. Front Public Health. 2020;8:585832. https://doi.org/10.3389/fpubh.2020.585832
24. Marković-Peković V, Grubiša N, Burger J, et al. Initiatives to Reduce Nonprescription Sales and Dispensing of Antibiotics:Findings and Implications. J Res Pharm Pract. 2017;6(2):120-5. https://doi.org/10.4103/jrpp.JRPP_17_12
25. Cadogan CA, Hughes CM. On the frontline against COVID-19: Community pharmacists’ contribution during a public health crisis. Res Social Adm Pharm. 2021;17(1):2032-5. https://doi.org/10.1016/j.sapharm.2020.03.015
26. Hedima EW, Adeyemi MS, Ikunaiye NY. Community Pharmacists: On the frontline of health service against COVID-19 in LMICs.Res Social Adm Pharm. 2021;17(1):1964-6. https://doi.org/10.1016/j.sapharm.2020.04.013
27. Chowdhury M, Stewart Williams J, Wertheim H, et al. Rural community perceptions of antibiotic access and understanding of antimicrobial resistance: qualitative evidence from the Health and Demographic Surveillance System site in Matlab,Bangladesh. Glob Health Action. 2019;12(sup1):1824383. https://doi.org/10.1080/16549716.2020.1824383
28. Tabeefar H, Chang F, Cooke M, et al. Community pharmacists and chronic pain: A qualitative study of experience, perception,and challenges. Can J Pain. 2020;4(3):29-39. https://doi.org/10.1080/24740527.2020.1749516
29. Perrot S, Cittée J, Louis P, et al. Self-medication in pain management: The state of the art of pharmacists’ role for optimal Over-The-Counter analgesic use. Eur J Pain. 2019;23(10):1747-62. https://doi.org/10.1002/ejp.1459
30. Hahn KL. The roles of pharmacists in pain management. J Pain Palliat Care Pharmacother. 2009;23(4):414-8.31. Mishriky J, Stupans I, Chan V. Expanding the role of Australian pharmacists in community pharmacies in chronic pain management - a narrative review. Pharm Pract. 2019;17(1):1410. https://doi.org/10.18549/PharmPract.2019.1.1410
32. Mishriky J, Stupans I, Chan V. The role of the pharmacist in low back pain management: a narrative review of practice guidelines on paracetamol vs non-steroidal anti-inflammatory drugs. Pharm Pract. 2020;18(3):2075. https://doi.org/10.18549/PharmPract.2020.3.2075
33. Peirce D, Corkish V, Lane M, et al. Nurses’ Knowledge and Attitudes Regarding Pediatric Pain Management in Western Australia.Pain Manag Nurs. 2018;19(6):707-17. https://doi.org/10.1016/j.pmn.2018.03.002
34. Adenekan AT, Owojuyigbe AM, Aaron OI, et al. Impact of Pain Management Workshop on the Knowledge and Attitude of Healthcare Workers and Opioid Utilization in a Nigerian Teaching Hospital. West Afr J Med. 2019;36(3):232-8.
35. Oreagba IA, Ogunleye OJ, Olayemi SO. The knowledge, perceptions and practice of pharmacovigilance amongst community pharmacists in Lagos state, south west Nigeria. Pharmacoepidemiol Drug Saf. 2011;20(1):30-5. https://doi.org/10.1002/pds.2021
36. Lawshe C. A quantitative approach to content validity. Pers Psychol. 1975;28:563-75.
37. Polit DF, Beck CT, Owen SV. Is the CVI an acceptable indicator of content validity? Appraisal and recommendations. Res Nurs Health. 2007;30(4):459-67. https://doi.org/10.1002/nur.20199
38. Emirates News Agency. UAE has over 2000 private pharmacies, 4000 professionals. 2010 Available at URL: http://wam.ae/en/details/1395228626943
39. Wennberg P, Möller M, Sarenmalm EK, et al. Evaluation of the intensity and management of pain before arrival in hospitalamong patients with suspected hip fractures. International Emergency Nursing. 2020;49:100825. https://doi.org/10.1016/j.ienj.2019.100825
40. dela Cruz AM, Bernstein IH, Greer TL, et al. Self-rated measure of pain frequency, intensity, and burden: psychometric
properties of a new instrument for the assessment of pain. J Psychiatr Res. 2014;59:155-60. https://doi.org/10.1016/j.jpsychires.2014.08.003
41. Dufault MA, Sullivan M. A collaborative research utilization approach to evaluate the effects of pain management standardson patient outcomes. J Prof Nurs. 2000;16(4):240-50. https://doi.org/10.1053/jpnu.2000.4593
42. Wiffen PJ, Cooper TE, Anderson AK, et al. Opioids for cancer-related pain in children and adolescents. Cochrane Database SystRev. 2017;7(7):Cd012564. https://doi.org/10.1002/14651858.CD012564.pub2
43. Cooper TE, Fisher E, Gray AL, et al. Opioids for chronic non-cancer pain in children and adolescents. Cochrane Database SystRev. 2017;7(7):Cd012538. https://doi.org/10.1002/14651858.CD012538.pub2
44. Roberts E, Delgado Nunes V, Buckner S, et al. Paracetamol: not as safe as we thought? A systematic literature review of observational studies. Annals of the rheumatic diseases. 2016;75(3):552-9.
45. Kanabar DJ. A clinical and safety review of paracetamol and ibuprofen in children. Inflammopharmacology. 2017;25(1):1-9.https://doi.org/10.1007/s10787-016-0302-3
46. Mu PF, Chen YC, Cheng SC. The effectiveness of non-pharmacological pain management in relieving chronic pain for children and adolescents. JBI Libr Syst Rev. 2009;7(34):1489-543. https://doi.org/10.11124/01938924-200907340-00001
47. Srouji R, Ratnapalan S, Schneeweiss S. Pain in children: assessment and nonpharmacological management. Int J Pediatr. 2010;2010:474838. https://doi.org/10.1155/2010/474838
48. Rabbitts JA, Fisher E, Rosenbloom BN, et al. Prevalence and Predictors of Chronic Postsurgical Pain in Children: A Systematic Review and Meta-Analysis. J Pain. 2017;18(6):605-14. https://doi.org/10.1016/j.jpain.2017.03.007
49. Zernikow B, Smale H, Michel E, et al. Paediatric cancer pain management using the WHO analgesic ladder--results of a prospective analysis from 2265 treatment days during a quality improvement study. Eur J Pain. 2006;10(7):587-95. https://doi.org/10.1016/j.ejpain.2005.09.002
50. Mishra S, Bhatnagar S, Singh M, et al. Pediatric cancer pain management at a regional cancer center: implementation of WHO
Analgesic Ladder. Middle East J Anaesthesiol. 2009;20(2):239-44.
51. Evans S, Djilas V, Seidman LC, et al. Sleep Quality, Affect, Pain, and Disability in Children With Chronic Pain: Is Affect a Mediator or Moderator? J Pain. 2017;18(9):1087-95. https://doi.org/10.1016/j.jpain.2017.04.007
52. Kleiber C, Harper DC. Effects of distraction on children’s pain and distress during medical procedures: a meta-analysis. Nurs Res. 1999;48(1):44-9. https://doi.org/10.1097/00006199-199901000-00007
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Jairoun AA, Al-Hemyari SS, Shahwan M, Jairoun M, Kurdi A, Godman B. Assessing knowledge, attitude and practice of community pharmacists on the pain management and implications in UAE children. Pharm Pract (Granada) [Internet]. 2022 Jul. 4 [cited 2023 Oct. 2];20(2):2664. Available from: https://pharmacypractice.org/index.php/pp/article/view/2664
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