Chapter 30

Pain Assessment and Management

in Children

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Assessment of Acute Pain

Medical procedures Surgical and orthopedic procedures Medical treatments Injury Infection Exacerbation of disease-related pain

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Assessment of Acute Pain (Cont.)

Pain intensity Types of measures to assess child’s pain Behavioral

• Distress behaviors Physiologic Self-report

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Assessment of Acute Pain (Cont.)

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Assessment of Acute Pain (Cont.)

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Assessment of Acute Pain (Cont.)

Behavioral pain measures FLACC CHEOPS TPPPS, PPPRS, PPPM COMFORT FACES OUCHER Numerical rating scale Visual analog scale

See Table 30-1

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Assessment of Acute Pain (Cont.)

Global judgment of improvement and of satisfaction with treatment

Adverse events and symptoms Physical recovery Emotional response

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Assessment of Chronic and Recurrent Pain

Pain that persists for 3 months or longer than the expected period of healing Complex regional pain syndrome Chronic daily headache Multidirectional rating scale

• Physical functioning• Emotional functioning• Social functioning• School functioning

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Assessment of Chronic and Recurrent Pain (Cont.)

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Pain Assessment in Specific Populations

Children with communication and cognitive impairment Noncommunicating Children’s Pain Checklist Pain indicators for communicatively impaired

children Cultural differences Children with chronic illness and complex

pain

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Pain Assessment in Specific Populations (Cont.)

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Pain Management Nonpharmacologic management

Distraction Relaxation Guided imagery Cutaneous stimulation Containment and swaddling Nonnutritive sucking Kangaroo care

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Pain Management (Cont.)

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Pain Management (Cont.)

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Complementary and alternative medicine Biologically based Manipulative treatments Energy based Mind-body techniques Alternative medical systems

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Pain Management (Cont.)

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Pharmacologic management Acetaminophen Nonsteroidal anti-inflammatory drugs Opioids Coanalgesia or adjuvant analgesia Patient-controlled analgesia Epidural analgesia

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Pain Management (Cont.)

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Pain Management (Cont.)

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Pharmacologic management Transmucosal and transdermal analgesia Monitoring side effects Evaluation and effectiveness of pain regimen

Consequences of untreated pain Physiologic indicators Behavioral indicators

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Pain Management (Cont.)

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Pain Management (Cont.)

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Pain Management (Cont.)

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Pain in primary care Teething Immunizations and vaccinations Common childhood illnesses

Painful and invasive procedures Circumcision Open wounds

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Common Pain States

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Postoperative pain Associated with surgery Combination of medications

Burn pain Multiple components Difficult and challenging to control

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Common Pain States (Cont.)

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Recurrent headaches Tension, dental braces, weakness of eye muscles,

sinusitis, epilepsy, sleep apnea, injury Recurrent abdominal pain

Common in children Pain associated with sickle cell disease

ED visits for opioid treatment

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Common Pain States (Cont.)

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Cancer Most prevalent symptom is pain

Pain and sedation in end-of-life care Comfort can be relief with a combination of opioids and adjuvant analgesics

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Common Pain States (Cont.)

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Which factor is an important consideration in understanding the pain experience in children?

A. Children cannot tell where they hurt.B. Children may not admit having pain.C. Narcotics are dangerous drugs for children.D. Children’s sensitivity to pain is less than that of adults.

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Question