Effective pain management strategies for common pediatric conditions
DOI:
https://doi.org/10.18203/2394-6040.ijcmph20232502Keywords:
Analgesia, Sedation, Pain assessment, Pediatric acute painAbstract
Pain management in neonates, infants, and children is a complex and challenging aspect of healthcare, with a high prevalence of undertreatment. Efforts have been made to improve pain assessment and implement effective interventions. Pharmacological approaches include non-opioid analgesics, opioids, and adjuvant analgesics, while non-pharmacological interventions involve physical techniques and cognitive behavioral strategies. Pediatric pain management requires considering developmental stages, individual variability, and emotional factors. Accurate pain assessment, weight-based dosing, and involving parents are crucial. Minimizing procedural pain and addressing psychosocial aspects contribute to better outcomes. Comprehensive pain management is necessary to prevent long-term consequences and enhance recovery. However, there is a persistent gap between evidence-based guidelines and clinical practice, indicating the need for further education and training. Implementation of pain management protocols and multidisciplinary approaches involving healthcare providers, psychologists, physical therapists, and educators are essential. By adopting these strategies, healthcare providers can improve the quality of life for pediatric patients, reduce the burden on the healthcare system, and mitigate the long-term impact of untreated pain.
References
Twycross AM, Chorney JM, McGrath PJ, Finley GA, Boliver DM, Mifflin KA. A Delphi study to identify indicators of poorly managed pain for pediatric postoperative and procedural pain. Pain Res Management. 2013;18(5):e68-74.
Mitchell A, Boss BJ. Adverse effects of pain on the nervous system of newborns and young children: a review of the literature. J Neurosci Nursing. 2002;34(5):228.
Grunau RE, Holsti L, Peters JW. Long-term consequences of pain in human neonates. Paper presented at: Seminars in Fetal Neonatal Med. 2006;1.
American Pain Society Task Force on Pain in InfantsChildren, Adolescents. The assessment and management of acute pain in infants, children, and adolescents. Pediatr Springfield. 2001;108(3):793-7.
Vargas-Schaffer G. Is the WHO analgesic ladder still valid?: Twenty-four years of experience. Canadian Family Physician. 2010;56(6):514-7.
King S, Chambers CT, Huguet A. The epidemiology of chronic pain in children and adolescents revisited: a systematic review. Pain. 2011;152(12):2729-38.
Fuss S, Pagé MG, Katz J. Persistent pain in a community-based sample of children and adolescents: Sex differences in psychological constructs. Pain Res Management. 2011;16(5):303-9.
Roth-Isigkeit A, Thyen U, Stoven H, Schwarzenberger J, Schmucker P. Pain among children and adolescents: restrictions in daily living and triggering factors. Pediatrics. 2005;115(2):e152-62.
Petersen S, Hägglöf BL, Bergström EI. Impaired health-related quality of life in children with recurrent pain. Pediatrics. 2009;124(4):e759-67.
Eccleston C, Bruce E, Carter B. Chronic pain in children and adolescents. Nursing Children and Young People. 2006;18(10).
Abu-Saad HH, Bours GJ, Stevens B, Hamers JP. Assessment of pain in the neonate. Paper presented at: Seminars perinatol. 1998.
Ramelet A-S, Abu-Saad HH, Rees N, McDonald S. The challenges of pain measurement in critically ill young children: a comprehensive review. Aust Critical Care. 2004;17(1):33-45.
Fuller BF. Infant behaviors as indicators of established acute pain. J Specialists Pediatr Nurs. 2001;6(3):109-15.
Finley GA, McGrath PJ. Measurement of pain in infants and children. In: LWW. 1998.
Crellin D, Sullivan TP, Babl FE, O’sullivan R, Hutchinson A. Analysis of the validation of existing behavioral pain and distress scales for use in the procedural setting. Pediatr Anesthesia. 2007;17(8):720-33.
Van Dijk M, de Boer JB, Koot HM, Tibboel D, Passchier J, Duivenvoorden HJ. The reliability and validity of the COMFORT scale as a postoperative pain instrument in 0 to 3-year-old infants. Pain. 2000;84(2-3):367-77.
Tomlinson D, Von Baeyer CL, Stinson JN, Sung L. A systematic review of faces scales for the self-report of pain intensity in children. Pediatrics. 2010;126(5):e1168-98.
Gai N, Naser B, Hanley J, Peliowski A, Hayes J, Aoyama K. A practical guide to acute pain management in children. J Anesthesia. 2020;34:421-33.
Organization WH. Cancer pain relief and palliative care in children. World Health Organization; 1998.
Toms L, McQuay HJ, Derry S, Moore RA, Cochrane Pain P, Group SC. Single dose oral paracetamol (acetaminophen) for postoperative pain in adults. Cochrane Database Systematic Rev. 1996;2019(5).
Litalien C, Jacqz-Aigrain E. Risks and benefits of nonsteroidal anti-inflammatory drugs in children: a comparison with paracetamol. Paediatr Drugs. 2001;3:817-58.
Camu F, Van de Velde A, Vanlersberghe C. Nonsteroidal anti-inflammatory drugs and paracetamol in children. Acta Anaesthesiol Belgica. 2001;52(1):13-20.
Titchen T, Cranswick N, Beggs S. Adverse drug reactions to nonsteroidal anti‐inflammatory drugs, COX‐2 inhibitors and paracetamol in a paediatric hospital. Bri J Clin Pharmacol. 2005;59(6):718-23.
Rawal N. Postoperative pain treatment for ambulatory surgery. Best Practice Res Clin Anaesthesiol. 2007;21(1):129-48.
Alander SW, Dowd MD, Bratton SL, Kearns GL. Pediatric acetaminophen overdose: risk factors associated with hepatocellular injury. Arch Pediatr Adolescent Med. 2000;154(4):346-50.
Waldman RJ, Hall WN, McGee H, Van Amburg G. Aspirin as a risk factor in Reye's syndrome. JAMA. 1982;247(22):3089-94.
Choo S, Nuelle JA. NSAID use and effects on pediatric bone healing: a review of current literature. Children. 2021;8(9):821.
Kraemer FW, Rose JB. Pharmacologic management of acute pediatric pain. Anesthesiol Clin. 2009;27(2):241-68.
Chiaretti A, Pierri F, Valentini P, Russo I, Gargiullo L, Riccardi R. Current practice and recent advances in pediatric pain management. Eur Rev Med Pharmacol Sci. 2013;17(1):112-26.
Verghese ST, Hannallah RS. Acute pain management in children. J Pain Res. 2010:105-23.
Yaksh TL, Wallace MS. Opioids, analgesia, and pain management. Goodman and Gilman’s the pharmacological basis of therapeutics. 2011:481-526.
Golianu B, Krane EJ, Galloway KS, Yaster M. Pediatric acute pain management. Pediatr Clin N Am. 2000;47(3):559-87.
Li J-X. Combining opioids and non-opioids for pain management: current status. Neuropharmacology. 2019;158:107619.
Berde CB, Lehn BM, Yee JD, Sethna NF, Russo D. Patient-controlled analgesia in children and adolescents: a randomized, prospective comparison with intramuscular administration of morphine for postoperative analgesia. J Pediatr. 1991;118(3):460-6.
Tobias JD. Weak analgesics and nonsteroidal anti-inflammatory agents in the management of children with acute pain. Pediatr Clin N Am. 2000;47(3):527-43.
Ferrara G, Petrillo MG, Giani T. Clinical use and molecular action of corticosteroids in the pediatric age. Int J Molecular Sci. 2019;20(2):444.
Mk G, Ravishankara S, Sudhir MN, Sathya P, Mohan A, Shankarnarayan B. Comparison of local infiltration of ropivacaine, bupivacaine, topical application of sucralfate in the tonsillar fossa on post-tonsillectomy pain. J Otolaryngol. 2014;4(4):105.
Hohl CM, Stenekes S, Harlos MS, Shepherd E, McClement S, Chochinov HM. Methotrimeprazine for the management of end-of-life symptoms in infants and children. J Palliative Care. 2013;29(3):178-85.
Reddy S, Patt RB. The benzodiazepines as adjuvant analgesics. J Pain Symptom Management. 1994;9(8):510-14.
Russell P, von Ungern-Sternberg BS, Schug SA. Perioperative analgesia in pediatric surgery. Curr Opinion Anesthesiol. 2013;26(4):420-7.
El Geziry A, Toble Y, Al Kadhi F, Pervaiz M, Al Nobani M. Non-pharmacological pain management. Pain Management In Special Circumstances. 2018:1-14.
Ahmed MI, Farrell MA, Parrish K, Karla A. Preoperative anxiety in children risk factors and non-pharmacological management. Middle East J Anesthesiol. 2011;21(2):153-64.
Franck LS, Greenberg CS, Stevens B. Pain assessment in infants and children. Pediatr Clin N Am. 2000;47(3):487-12.
McGrath PA. Psychological aspects of pain perception. Arch Oral Biol. 1994;39:S55-62.
Van den Anker J, Reed MD, Allegaert K, Kearns GL. Developmental changes in pharmacokinetics and pharmacodynamics. J Clin Pharmacol. 2018;58:S10-25.
Pancekauskaitė G, Jankauskaitė L. Paediatric pain medicine: pain differences, recognition and coping acute procedural pain in paediatric emergency room. Medicina. 2018;54(6):94.
Manworren RC, Stinson J. Pediatric pain measurement, assessment, and evaluation. Paper presented at: Seminars Pediatr eurol. 2016.
Abdelmoniem SA, Mahmoud SA. Comparative evaluation of passive, active, and passive-active distraction techniques on pain perception during local anesthesia administration in children. J Adv Res. 2016;7(3):551-6.
Ho JW, Khambatta HJ, Pang LM, Siegfried RN, Sun LS. Preemptive analgesia in children: does it exist? Regional Anesthesia Pain Med. 1997;22(2):125-30.