Context: Children with profound intellectual and multiple disabilities are at higher risk of
experiencing pain for multiple reasons. Standard self-pain assessment is often compromised
and the challenge of communication with these children can lead to difficulty of pain
evaluation for their healthcare providers and to inefficient pain management.
Objectives: The aims of the study was 1) to explore these children’s paediatricians knowledge
and beliefs regarding pain and their impact on practice, 2) to identify the difficulties that they
may face and the resources they use in this type of care and 3) to investigate how the
individual variables of the physicians are related to the management of these children’s pain.
Method: We conducted a transverse descriptive study by sending a survey to physicians
working in all fields of paediatrics in the canton of Vaud, Switzerland. The questionnaire
explored demographic characteristics of the participants and opinions and knowledge about
pain experience of children with PIMD including physical and psychological experience, its
evaluation and management.
Results: Participation rate was estimated at 25.5% (121/480). For 13 of the 28 questions
concerning opinions and knowledge about pain of children with PIMD there was no consensus
among respondents . Views regarding pain sensitivity as well as pain tolerance and the reasons
for this pain vulnerability were variable. Physicians didn’t report a lack of pain investigation
concerning these children, but a difficulty in perceiving their pain related to the severity of
disability. Principal difficulties were related to communication with these children and lack of
knowledge and personal experience about pain in this population. Assessment tools were
described as more necessary than for ordinary children, even though they were mis-known
and underused. The emotional component of their pain was considered important but not
well understood.
Conclusion: The absence of consensus on the different topics previously discussed can result
in a combination of factors: personal beliefs, difficulties of communication and/or lack of
experience or education regarding the pain of children with PIMD. Paediatricians have an
adequate insight of their limits and a willingness to acquire a better education on the subject.