Acute paediatric pain management: A survey of doctors’ knowledge, attitudes and reported practices at regional hospitals in KwaZulu-Natal, South Africa

Background

Despite advances in both pharmacological and non-pharmacological pain management, children remain vulnerable to oligoanalgesia. Understanding clinical practices and barriers encountered by treating clinicians is essential to inform targeted interventions. This study aimed to examine knowledge, attitudes and reported practices of doctors managing acute paediatric pain in rural regional hospitals in KwaZulu-Natal, South Africa.

Methods

An electronic survey was distributed between January and February 2024 to doctors working in the departments of Emergency Medicine, Paediatrics, Surgery, and Orthopaedics at three regional hospitals. The survey included both closed- and open-ended questions addressing analgesic choices, awareness of clinical protocols, and perceived barriers to effective pain management. Descriptive statistics were used to summarise overall trends. Post hoc subgroup analyses were conducted using Chi-square and Fisher’s exact tests. Odds ratios were calculated to describe significant associations.

Results

Of 165 clinicians approached, 131 responded (response rate: 80%). Over half (55.7%) reported inadequate training for paediatric pain management, and only 42% were aware of departmental protocols. Paracetamol was the most commonly used analgesic agent. Key barriers included time constraints, limited drug access, and departmental culture. Awareness of departmental paediatric pain protocols was highest (82,9%) in Paediatrics (χ², p<0.001). Paediatric doctors reported significantly greater use of non-pharmacological methods across multiple conditions and procedures. Emergency Medicine respondents more frequently reported opioids for severe abdominal pain (OR=4.24, p<0.001, 95% CI 1.96-9.14). Barriers varied by discipline. Paediatrics cited difficulties with pain assessment, while Orthopaedics primarily reported time and staffing constraints.

Conclusion

Paediatric pain remains common yet inadequately addressed in Southern Africa. This study identifies insufficient training, poor access to analgesia, and departmental practices as key barriers. Context-specific, cost-effective, multimodal strategies and tailored education are needed to improve care. Sustainable progress requires cultural change, better training, and interdisciplinary collaboration to ensure equitable pain management.