PEDIATRIC PAIN ASSESSMENT

PAIN ASSESSMENT

� Get detailed assessment

� History of primary illness

� Description of pain

� Experience with pain medications

� Use of non-pharmacologic approaches

� Parent personal experience with pain meds

� Social & spiritual factors

PAIN ASSESSMENT TOOLS: SCALES DO NOT ALWAYS REPRESENT MULTIDIMENSIONAL ASPECT OF

PAIN

BIRTH - 2 YEARS

Pain Perception� Neonates as young as 24-

weeks feel pain

� Ascending nerve tracts develop earlier than the pain inhibiting nerve tracts meaning that neonates may experience a greater intensity of pain than that neonates may experience a greater intensity of pain than older children

� Neonates exposed to repeated painful stimuli show increasing sensitivity

� Neonatal/Infant Pain Scale (NIPS)

BIRTH - 2 YEARS (CONTINUED)

Cognition

� No “understanding” of pain and unable to provide a self-report

� 12 to 18 months, beginning of reasoning and language (1- or 2-word statements) language (1- or 2-word statements)

� Major cognitive processing through senses (eyes, ears, hands)

� CHEOPS (1-7 years)� Looks at types of pain behavior: cry, facial, verbal,

torso, touch and legs.

2 - 4 YEARS

� CNS fully developed

� Development of autonomy continues

� Significant language developmentdevelopment

� Limited logic and reasoning

� Self-centered thought process

� Visual analog (Wong-Baker Faces)

7 - 11 YEARS

�Logic and reasoning

far more developed

� Imagination and

creativitycreativity

�Finalism and concept

of death

�Number pain scale

(scale 1-10)

Adolescents (11+ years)Adolescents (11+ years)

� Cognitively adults� Same pain assessment methods as adults

� Abstract thinking and understanding hypothetical situations

� Emotional needs� Include them in the process

� Respect their privacy

� Respect their pain reports

FACES SCALE

Bieri, 1990Bieri, 1990

NON-VERBAL CHILDREN

� FLACC Scale

Pain Assessment

� Hospitals should use a standard pain scale for the

various age groups to allow continuity.

� Self report scores (e.g. numerical rating scale) can

mislead. A score of 4 may denote severe pain to mislead. A score of 4 may denote severe pain to

one adolescent while 8 may be severe to another.

� Pain can be worsened by anxiety, depression and

spiritual crisis. We must consider this in our

assessment.

References

� Bieri D, Reeve RA, Champion GD, Addicoat L, Ziegler JB. The Faces Pain Scale for the self-assessment of the severity of pain experienced by children: development, initial validation, and preliminary investigation for ratio scale properties. Pain. 1990; 41(2):139-50.

� Friedrichsdorf SJ, Kang TI. The management of pain in � Friedrichsdorf SJ, Kang TI. The management of pain in children with life-limiting illnesses. Pediatric clinics of North

America. 2007; 54: 645-672.

� Tomlinson D, Baeyer CL, Stinson JN, Sung L.A systematic review of Faces scales for the self-report of pain intensity in

children. Pediatrics. 2010; 126: e1168.