Consequences of Inadequate Analgesia During Painful Procedures in Children

Weisman, Steven J.; Bernstein, Bruce; Schechter, Neil L.

doi:10.1001/archpedi.152.2.147

Cited by 412 publications

(244 citation statements)

References 11 publications

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“…18 A compelling example of this was demonstrated in young children who, in addition to a local anesthetic, received placebo instead of an oral analgesic agent during initial lumbar puncture and bone marrow aspiration for the evaluation of newly diagnosed cancer. 18 Children who received placebo for the initial procedures reported greater pain and continued to report greater pain and distress during follow-up procedures despite receiving the oral analgesic for the later procedures. 18 Finally, children undergoing dental injections have been found to have increased pain when they feel anxious from previous procedures.…”

Section: Pain Impacts Future Proceduresmentioning

confidence: 99%

Clinical Implications of Unmanaged Needle-Insertion Pain and Distress in Children

2008

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Increasing evidence has demonstrated that pain from venipuncture and intravenous cannulation is an important source of pediatric pain and has a lasting impact. Ascending sensory neural pain pathways are functioning in preterm and term infants, yet descending inhibitory pathways seem to mature postnatally. Consequently, infants may experience pain from the same stimulus more intensely than older children. In addition, painful perinatal procedures such as heel lancing or circumcision have been found to correlate with stronger negative responses to venipuncture and intramuscular vaccinations weeks to months later. Similarly, older children have reported greater pain during follow-up cancer-related procedures if the pain of the initial procedure was poorly controlled, despite improved analgesia during the subsequent procedures. Fortunately, both pharmacologic and nonpharmacologic techniques have been found to reduce children's acute pain and distress and subsequent negative behaviors during venipuncture and intravenous catheter insertion. This review summarizes the evidence for the importance of managing pediatric procedural pain and methods for reducing venous access pain. Pediatrics 2008;122:S130-S133 E LIMINATION OR RELIEF of pain and suffering, whenever possible, is an important responsibility of physicians caring for children, 1 because unmanaged pain can result in a variety of negative long-term consequences. 2 This general precept encompasses the management of pain associated with venipuncture and intravenous (IV) cannulation, routine procedures that may be viewed by many health care professionals, erroneously, as having little significance and impact. Increasing evidence has demonstrated that venous access procedures are an important source of pediatric pain that should be managed proactively. The purpose of this review is to briefly summarize the data demonstrating the importance of managing pediatric procedural pain in general, and venous access pain in particular. GENERAL CONSIDERATIONSUnderstanding of the ontogeny of the pediatric pain experience has increased significantly over the past 2 decades. Accumulating evidence has indicated that pain is perceived earlier in life than had been previously believed. By the middle of the third trimester of human gestation, ascending pain fibers fully connect to the primary somatosensory cortex of the brain. 3,4 Anand's landmark article 5 demonstrated that preterm infants given fentanyl in addition to nitrous oxide had significantly lower hormonal responses to surgery for ligation of the patent ductus arteriosus than did infants who did not receive fentanyl. Neonates who received high-dose sufentanil compared with halothanemorphine had improved survival rates after cardiac surgery, 6 whereas infants in the NICU have been shown to be able to distinguish real from sham heel sticks. 7 These results are consistent with the existence of functioning neural pathways for pain sensation at early times. Descending inhibitory pain pathways, on the other hand, seem to r...

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Section: Pain Impacts Future Proceduresmentioning

confidence: 99%

Clinical Implications of Unmanaged Needle-Insertion Pain and Distress in Children

2008

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“…Pain is the most common complaint of emergency department patients seen in one half to three quarters of all patients [1] [2]. Renal colic is a common presentation (lifetime risk 12% in men, 6% in women) [3].…”

Section: Introductionmentioning

confidence: 99%

Evaluation of the Clinical Efficacy of Intranasal Desmopressin Spray, Parenteral Diclofenac or Their Combination in the Treatment of Acute Renal Pain Caused by Urolithiasis

Al-Dabbagh¹,

Kadhum²,

Alfaiadh³

2017

OJU

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Objectives: To evaluate the efficacy of intranasal desmopressin compared with intramuscular diclofenac and combination of both in the treatment of acute renal pain caused by stone disease. Patients and methods: Ninety patients (51 males and 39 females) presented to our hospital emergency department (Al-Yarmouk Teaching Hospital/Baghdad/Iraq) with the diagnosis of acute renal pain caused by urolithiasis. They were randomized into three equal groups; group A received desmopressin 40 μg intranasally (4 puffs, each puff equivalent to 10 micrograms), group B received intramuscular diclofenac 75 mg and group C received both desmopressin and diclofenac.

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“…[1][2][3] Numerous studies indicate that inadequate pain management during medical care can have many detrimental short and long-term effects, [4][5][6][7] and the World Health Organization has advocated for optimal pain treatment for all. 8 Children's pain in the ED remains poorly managed despite an increase in pain research over the past decade.…”

Section: Introductionmentioning

confidence: 99%

Canadian Emergency Medicine Residents’ Perspectives on Pediatric Pain Management

Ali

Kircher

Meyers

et al. 2015

CJEM

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Background: Under-treatment of children's pain in the emergency department (ED) can have many detrimental effects. Emergency medicine (EM) residents often manage pediatric pain, but their educational needs and perspectives have not been studied. Methods: A novel online survey was administered from May to June 2013 to 122 EM residents at three Canadian universities using a modified Dillman methodology. The survey instrument captured information on training received in pediatric acute pain management, approach to common painful presentations, level of comfort, perceived facilitators, and barriers and attitudes towards pediatric pain. Results: 56 residents participated (46%), 25 of whom (45%) indicated they had not received any training in pediatric pain assessment. All levels of residents reported they were uncomfortable with pain assessment in 0-2 year olds (p = 0.07); level of comfort with assessment increased with years of training for patients aged 2-12 years (p = 0.02). When assessing children with disabilities, 83% of respondents (45/54) indicated they were 'extremely' or 'somewhat' uncomfortable. Sixty-nine percent (38/55) had received training on how to treat pediatric pain. All residents reported they were more comfortable using pain medication for a 9 year old, as compared to a 1 year old (oral oxycodone p < 0.001, oral morphine p < 0.001, IV morphine p = 0.004). The preferred methods to learn about children's pain management were role-modeling (61%) and lectures (57%). The top challenges in pain management were with non-verbal, younger, or developmentally delayed patients. Conclusion: Canadian EM residents report receiving inadequate training in pediatric pain management, and are particularly uneasy with younger or developmentally disabled children. Post-graduate curricula should be adjusted to correct these self-identified weaknesses in children's pain management.

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Consequences of Inadequate Analgesia During Painful Procedures in Children

Cited by 412 publications

References 11 publications

Clinical Implications of Unmanaged Needle-Insertion Pain and Distress in Children

Clinical Implications of Unmanaged Needle-Insertion Pain and Distress in Children

Evaluation of the Clinical Efficacy of Intranasal Desmopressin Spray, Parenteral Diclofenac or Their Combination in the Treatment of Acute Renal Pain Caused by Urolithiasis

Canadian Emergency Medicine Residents’ Perspectives on Pediatric Pain Management

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