1. Pain Assessment and Management in Children
Chapter 30
Pain Assessment and Management
in Children
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2. Assessment of Acute Pain
Medical procedures
Surgical and orthopedic procedures
Medical treatments
Injury
Infection
Exacerbation of disease-related pain
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3. Assessment of Acute Pain (Cont.)
Pain intensity
Types of measures to assess child’s pain
Behavioral
Distress behaviors
Physiologic
Self-report
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4. Assessment of Acute Pain (Cont.)
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5. Assessment of Acute Pain (Cont.)
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6. Assessment of Acute Pain (Cont.)
Behavioral pain measures
FLACC
CHEOPS
TPPPS, PPPRS, PPPM
COMFORT
FACES
OUCHER
Numerical rating scale
Visual analog scale
See Table 30-1
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7. Assessment of Acute Pain (Cont.)
Global judgment of improvement and of satisfaction with treatment
Adverse events and symptoms
Physical recovery
Emotional response
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8. Assessment of Chronic and Recurrent Pain
Pain that persists for 3 months or longer than the expected period of healing
Complex regional pain syndrome
Chronic daily headache
Multidirectional rating scale
Physical functioning
Emotional functioning
Social functioning
School functioning
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9. Assessment of Chronic and Recurrent Pain (Cont.)
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10. Pain Assessment in Specific Populations
Children with communication and cognitive impairment
Noncommunicating Children’s Pain Checklist
Pain indicators for communicatively impaired children
Cultural differences
Children with chronic illness and complex pain
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11. Pain Assessment in Specific Populations (Cont.)
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12. Pain Management Nonpharmacologic management Distraction Relaxation
Guided imagery
Cutaneous stimulation
Containment and swaddling
Nonnutritive sucking
Kangaroo care
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13. Pain Management (Cont.)
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14. Pain Management (Cont.)
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15. Pain Management (Cont.)
Complementary and alternative medicine
Biologically based
Manipulative treatments
Energy based
Mind-body techniques
Alternative medical systems
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16. Pain Management (Cont.)
Pharmacologic management
Acetaminophen
Nonsteroidal anti-inflammatory drugs
Opioids
Coanalgesia or adjuvant analgesia
Patient-controlled analgesia
Epidural analgesia
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17. Pain Management (Cont.)
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18. Pain Management (Cont.)
Pharmacologic management
Transmucosal and transdermal analgesia
Monitoring side effects
Evaluation and effectiveness of pain regimen
Consequences of untreated pain
Physiologic indicators
Behavioral indicators
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19. Pain Management (Cont.)
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20. Pain Management (Cont.)
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21. Common Pain States Pain in primary care
Teething
Immunizations and vaccinations
Common childhood illnesses
Painful and invasive procedures
Circumcision
Open wounds
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22. Common Pain States (Cont.)
Postoperative pain
Associated with surgery
Combination of medications
Burn pain
Multiple components
Difficult and challenging to control
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23. Common Pain States (Cont.)
Recurrent headaches
Tension, dental braces, weakness of eye muscles, sinusitis, epilepsy, sleep apnea, injury
Recurrent abdominal pain
Common in children
Pain associated with sickle cell disease
ED visits for opioid treatment
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24. Common Pain States (Cont.)
Cancer
Most prevalent symptom is pain
Pain and sedation in end-of-life care
Comfort can be relief with a combination of
opioids and adjuvant analgesics
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25. Question
Which factor is an important consideration in understanding the pain experience in children?
A. Children cannot tell where they hurt.
B. Children may not admit having pain.
C. Narcotics are dangerous drugs for children.
D. Children’s sensitivity to pain is less than that of adults.
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