A practical guide to acute pain management in children

Abstract

In the pediatric population, pain is frequently under-recognized and inadequately treated. Improved education and training of health care providers can positively impact the management of pain in children. The purpose of this review is to provide a practical clinical approach to the management of acute pain in the pediatric inpatient population. This will include an overview of commonly used pain management modalities and their potential pitfalls. For institutions that have a pediatric acute pain service or are considering initiating one, it is our hope to provide a useful tool to aid clinicians in the safe and effective treatment of pain in children. Keywords Pediatric acute pain • Pain assessment • Acute pain service • Opioid • Multimodal management Approach to pain Effective pain management is ideally practiced in a multidisciplinary model focusing on patient-centered care. The World Health Organization (WHO) [1] analgesic ladder provides a strong foundation for the treatment of pain that can be built upon to reflect more modern thinking and techniques around pain management (Fig. 1). Some of these modifications are presented in an updated WHO ladder with guiding principles on post-operative management of acute pain [2], which advocates 5 recommendations for the correct use of analgesics: (1) use the oral form of medication whenever possible, (2) analgesics should be given at regular intervals, (3) analgesics should be administered based on the severity of pain assessed using a pain intensity scale, (4) medication dosing should be tailored to the individual patient, and (5) attention to detail should be maintained throughout the prescription of pain medications. The acute pain service The acute pain service (APS) is a specialized, multidisciplinary inpatient team consulted to assist with management of severe pain. Within our institution, this team consists of a pediatric anesthesiologist, pediatric anesthesia fellow, clinical nurse specialist, and pediatric psychiatrist. The APS works in collaboration with the patient's primary care team, bedside nurse, family, and pharmacists to provide a patient-centered multi-modal pain plan. Generally, the APS is consulted to assist in pain management when either a patient's analgesic needs have grown beyond standard opioid dosing (Table 1) that their primary service is comfortable prescribing, or there is anticipated need for APS involvement for postoperative patients. Postoperative patients who automatically require APS management in our institution include those with an indwelling regional or neuraxial block catheter, patients who have received a single-shot peripheral nerve block, patients with a patient-controlled analgesia (PCA) technique, or patients receiving a Ketamine infusion.

Challenges and ways for pain assessment of children in the primary health care

“…Routine check-ups for pain are the most essential and efficacious ways for the assessment and management of pain using the regular and standardized approaches, regardless of the age of the child or other parameters. 4,33 Dantas et al conducted a study on a Brazillian cohort that was sedated and/or mechanically ventilated for pain assessment. 34 The authors reported that the regular use of standard ordinary parameters as legs, face, activity, crying, controllability, in addition to other body parameters should be optimized for pain assessment in the pediatric intensive care unit.…”

Journal of anesthesia, history, current status, and future direction

“…Editorial board members coordinate articles that provide cutting-edge information on hot topics in the field of anesthesiology. For instance, six invited review articles were published between 2019 and 2020, highlighting pediatric pain management [ 3 ], labor analgesia [ 4 ], neurotoxicity of general anesthesia [ 5 ], postoperative immune rejection in transplant patients [ 6 , 7 ], and neurobiology of abnormal pain [ 8 ]. We are delighted to see that these reviews have attracted much scientific attention from our readers.…”

Developing a Framework to Support the Delivery of Effective Pain Management for Children: An Exploratory Qualitative Study

“…e child's and parents' individual context should be considered to ensure that an individualised plan is developed to meet that particular child's needs at that time. Tailored or individualised pain management for children needs to encompass tailored analgesic medication [30] and nonpharmacological approaches that manage anxiety and pain [31,32].…”

“…However, a lack of communication, information provision, and poor negotiation of roles can result in missed opportunities for nurses to work in partnership with parents [11]. Sometimes, information provision can be inconsistent, resulting in parents having sufficient information about some aspects (e.g., the surgical procedure) but not others (e.g., pain medication) [31]. Clearly empowerment can only really be achieved with consistent and high-quality information that supports parents' expectations of good care and gives them the confidence to complain about poor pain management [10,34].…”