Pain Evaluation and Treatment in Children: A Practical Approach

Abstract

Pain is the most common complaint reported by children who access the emergency departments, but despite its frequency and the availability of many international guidelines, it often remains underreported and undertreated. Recently, the American Academy of Pediatrics and the American Pain Society have reiterated the importance of a multidisciplinary approach in order to eliminate pain in children. In all pediatric settings, an adequate assessment is the initial stage in a proper clinical approach to pain, especially in the emergency departments; therefore, an increasing number of age-related tools have been validated. A wide range of analgesic agents are currently available for pain management, and they should be tailored according to the patient’s age, the drug’s pharmacokinetics and the intensity of pain. In order to facilitate the choice of the appropriate drug, a treatment algorithm based on a ladder approach can be used. Moreover, non-pharmacological techniques should be considered to alleviate anxiety and distress in pediatric age. This review aims to offer a simple but intuitive description of the best strategies for pain relief in children, starting with the prompt recognition and quantification of pain through adequate assessment scales, and following with the identification of the most appropriate therapeutic choice among the ones available for pediatric age.

Terminology matters: is the International Association for the Study of Pain definition of pain fully satisfactory for fetuses, neonates, and infants?

“…In light of this evidence, we believe that the International Association for the Study of Pain definition of pain appears to be limited and inadequate to explain fetal-neonatal nociception and pain because noxious stimuli may result in “immediate or long-term ramification” ( 3 ), that is, a more complex network of short term and long term resulting phenomena from the initial trigger of the nociceptive experience. Thus, pain should be quantified more appropriately, perhaps with more sophisticated scales of assessment, to select the most fitting perinatal and neonatal pediatric therapy ( 29 ) synergically with neonatology, perinatology, obstetrics, fetal surgery, fetal anesthesiology, fetal neurobehavior, neuroscience, legal medicine, and medical bioethics ( 13 ). This is a tedious task, however, pain is necessary to be analyzed sociologically, and ethically, besides theology and medicine.…”

Pediatric Surgeons’ Approaches to Postoperative Analgesia in Türkiye

“…Acetaminophen and NSAIDs are often used as first-line treatment for mild to moderate pain in pediatric patients because they have fewer side effects. [12] However, the use of regional anesthesia methods has recently increased in pediatric patients because they reduce opioid-dependent side effects and provide early recovery. [13] In this survey study, in which we investigated regional anesthesia methods as a part of multimodal analgesia in pediatric cases in Türkiye, we found that regional analgesia is not yet sufficiently applied.…”

Predictors of triage pain assessment and subsequent pain management among pediatric patients presenting to the emergency department

“…The first category included children aged 6 years and above. Evidence supports that children in this age group can quantify their pain either on a numerical or visual analogue scale [ 23 – 25 ]. The second group included infants and young toddlers (≤ 2 years).…”