Pediatric Pain and Postoperative Management

2016 ◽  
Author(s):  
Elizabeth A.M. Frost
Keyword(s):  
Chronic Pain ◽  
Pain Management ◽  
Depressive Disorders ◽  
Mental Health Problems ◽  
Pediatric Population ◽  
Postoperative Management ◽  
Pediatric Pain ◽  
Key Words Complications ◽  
Regional Pain Syndromes ◽  
Complex Regional Pain Syndromes

Both assessment and management of pain in children present challenges for perioperative physicians, including surgeons, anesthesiologists, intensivists, and pediatricians, among others. Several reports have indicated that pediatric pain is undertreated postoperatively compared with pain in adults, resulting in both severe physical consequences, such as the development of chronic pain and complex regional pain syndromes, and significant psychological distress, such as nightmares and reversal of learned behavior. Moreover, chronic pain in childhood has been shown to heighten the risk for mental health problems in adulthood. Children with chronic pain (n = 14,790) reported higher rates of lifetime anxiety disorders (21.1% versus 12.4%) and depressive disorders (24.5% vs 14.1%) as adults. Although many evidence-based practice guidelines for pain management in younger people have been developed, adherence is often less than complete. The perioperative physician should be aware of barriers in pediatric pain management and be able to address them, thus improving pain management and patient outcome. Some of the problems in dealing with pediatric pain management include a realization of the controversies as to the age at which children feel pain, how pain can be assessed from the newborn to the adolescent, how the level of education and involvement of parents impact the situation, and a general knowledge of available pain treatments for the pediatric population.  Key words: complications, opioids, pediatrics, postoperative pain, regional techniques

scholarly journals Intravenous Infusions in Chronic Pain Management

2013 ◽  
Vol 3;16 (3;5) ◽  
pp. 231-249
Author(s):  
Boleslav Kosharskyy
Keyword(s):  
Chronic Pain ◽  
Pain Management ◽  
The United States ◽  
Treatment Modalities ◽  
Sufficient Evidence ◽  
Chronic Pain Management ◽  
Intravenous Infusions ◽  
Regional Pain Syndromes ◽  
Complex Regional Pain Syndromes ◽  
Chronic Pain Conditions

In the United States, millions of Americans are affected by chronic pain, which adds heavily to national rates of morbidity, mortality, and disability, with an ever-increasing prevalence. According to a 2011 report titled Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research by the Institute of Medicine of the National Academies, pain not only exacts its toll on people’s lives but also on the economy with an estimated annual economic cost of at least $560 - 635 billion in health care costs and the cost of lost productivity attributed to chronic pain. Intravenous infusions of certain pharmacologic agents have been known to provide substantial pain relief in patients with various chronic painful conditions. Some of these infusions are better, and although not necessarily the first therapeutic choice, have been widely used and extensively studied. The others show promise, however are in need of further investigations. This article will focus on non-opiate intravenous infusions that have been utilized for chronic painful disorders such as fibromyalgia, neuropathic pain, phantom limb pain, post-herpetic neuralgia, complex regional pain syndromes (CRPS), diabetic neuropathy, and central pain related to stroke or spinal cord injuries. The management of patients with chronic pain conditions is challenging and continues to evolve as new treatment modalities are explored and tested. The following intravenous infusions used to treat the aforementioned chronic pain conditions will be reviewed: lidocaine, ketamine, phentolamine, dexmedetomidine, and bisphosphonates. This overview is intended to familiarize the practitioner with the variety of infusions for patients with chronic pain. It will not, however, be able to provide guidelines for their use due to the lack of sufficient evidence. Key words: Intravenous infusions in chronic pain management, bisphosphonates, phentolamine, ketamine, lidocaine, Dexmedetomidine, chronic pain

scholarly journals Chronic Pediatric Pain in Low and Middle Income Countries

2018 ◽  
Author(s):  
Camila Walters ◽  
Matthew Kynes ◽  
Jenna Sobey ◽  
Tsitsi Chimhundu-Sithole ◽  
Kelly McQueen
Keyword(s):  
Chronic Pain ◽  
Pediatric Population ◽  
Poor Quality ◽  
Health Concern ◽  
Pediatric Pain ◽  
Middle Income ◽  
Middle Income Countries ◽  
Pediatric Patient Population ◽  
Pain Services ◽  
Low And Middle Income

Chronic pain is a serious health concern and potentially debilitating condition, leading to anxiety, depression, reduced productivity and functionality, and poor quality of life. This condition can be even more detrimental and incapacitating in the pediatric patient population. In low and middle income countries (LMICs), pain services are inadequate or unavailable, leaving most of the world's pediatric population with chronic pain untreated. Many of these children in LMICs are suffering without treatment, and often die in pain. Awareness and advocacy for this population must be prioritized. We reviewed the available literature on the chronic pediatric pain burden in LMICs, barriers to treatments, and current efforts to treat these patients.

Psychosocial interventions for pediatric pain management

2021 ◽  
pp. 531-546
Author(s):  
Kristen Uhl ◽  
Laura A. Wright ◽  
Rachael M. Coakley ◽  
Deirdre E. Logan
Keyword(s):  
Chronic Pain ◽  
Pain Management ◽  
Problem Solving ◽  
Practical Problem ◽  
Psychosocial Interventions ◽  
Cognitive Behavior ◽  
Pediatric Pain ◽  
Empirically Supported ◽  
Hands On ◽  
Behavior Strategies

Cognitive behavior therapy (CBT) is the most commonly researched and empirically supported psychotherapy treatment for the management of pediatric pain. CBT is a brief, goal-oriented psychotherapy treatment using a hands-on, practical problem-solving approach. It is based on the concept that thoughts, feelings, and behaviors are causally interrelated. This chapter offers an overview of CBT and its application to pain management, describes specific cognitive behavior strategies commonly used for pediatric acute and chronic pain problems, presents the empirical evidence supporting these approaches, and highlights key considerations and emerging directions in the use of CBT and related treatments for pediatric pain.

Improving pediatric experience of pain during vaccinations: a quality improvement project

2019 ◽  
Vol 32 (6) ◽  
pp. 1034-1040
Author(s):  
Terri MacDougall ◽  
Shawna Cunningham ◽  
Leeann Whitney ◽  
Monakshi Sawhney
Keyword(s):  
Quality Improvement ◽  
Clinical Practice ◽  
Pain Management ◽  
Practice Guidelines ◽  
Pediatric Population ◽  
Lessons Learned ◽  
Pediatric Pain ◽  
Topical Anesthetic ◽  
Content Type ◽  
Pain Scores

Purpose The purpose of this paper is to share lessons learned from a quality improvement (QI) project that studied pediatric pain assessment scores after implementing additional evidence-based pain mitigation strategies into practice. Most nurses will acknowledge they implement some practices to mitigate pain during injections. Addressing pain during vaccination is important to prevent needle fear, vaccine hesitancy and health care avoidance. The aim of this project was to reduce pain as evidenced by pain scores at the time of vaccination at the North Bay Nurse Practitioner-Led Clinic (NBNPLC). Design/methodology/approach The design for this study was quasi-experimental utilizing descriptive statistics and QI tools. The NBNPLC utilized the model for improvement to test change ideas. A validated observation tool to assess pain during vaccination with the pediatric population (revised Face Legs Activity Cry and Consolability) was used to test changes. The team deliberately planned improvements according to best practice guidelines to optimize use of strategies to mitigate pain during injections. QI tools and leadership skills were utilized to improve the pediatric experience of pain during vaccinations. Parents and clinicians provided qualitative and quantitative feedback to the project. Findings Nurses tested pain assessment tools and agreed to use a validated tool to assess pain during vaccinations. Parents agreed to use of topical anesthetic during vaccinations. Improved pain scores during vaccinations were demonstrated with the use of topical anesthetic. Parents agreed to use of standardized sucrose solution during vaccination. Reduced pain scores were observed with the use of standardized sucrose water. To sustain implementation of the guideline, a nursing documentation form was devised with nurses agreeing to ongoing use of the form. Research limitations/implications This is a QI project that examined the intricacies of moving clinical practice guidelines into clinical practice. The project validates guidelines for pain management during vaccinations. Leaders within clinics who want to improve pediatric pain during vaccinations will find this paper helpful as a guide. Practical implications Pain management in the pediatric population will be touched on in the context of parental expectations of pain. QI tools, lessons learned and suggestions for nurses will be outlined. Leadership plays an influential role in translating practice guidelines into practice. Originality/value This paper outlines how organizational supports were instrumental to give clinicians time to deliberately challenge practice to improve quality of care of children during vaccinations.

Fifth Edition: Causalgia, RSD, CRPS Impairment Evalaution

2001 ◽  
Vol 6 (4) ◽  
pp. 1-4, 11, 12
Author(s):  
Leon H. Ensalada
Keyword(s):  
Chronic Pain ◽  
Daily Living ◽  
Reflex Sympathetic Dystrophy ◽  
Detailed Examination ◽  
Functional Evaluation ◽  
Evaluation Measures ◽  
Pain Syndromes ◽  
Regional Pain Syndromes ◽  
Complex Regional Pain Syndromes ◽  
Regional Sympathetic Blockade

Abstract In the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Fifth Edition, the methods for rating impairment to causalgia, reflex sympathetic dystrophy (RSD), and complex regional pain syndromes (CRPS) differ from the approaches found in previous editions. Methods for evaluating impairment due to causalgia, RSD, and CRPS can be described as having anatomic or functional bases. The physical evaluation determines the anatomic impairment and is based on history and a detailed examination; the functional evaluation measures the individual's performance of the activities of daily living (ADL). Chapter 13 of the AMA Guides, Fifth Edition, considers causalgia and RSD in Section 13.8, Criteria for Rating Impairments Related to Chronic Pain, and defines chronic pain as the diagnoses of causalgia, posttraumatic neuralgia, and reflex sympathetic dystrophy. In contradistinction to Chapters 16 and 17 and the Glossary, the new term CRPS is not used here. Chapter 16 considers CRPS, RSD (now CRPS I), and causalgia (now CRPS II) and notes that, “contrary to previous suggestions, regional sympathetic blockade has no role in the diagnosis of CRPS.” Chapter 17 uses a functional approach for assessing impairment due to causalgia, RSD, and CRPS. Pending further guidance, evaluators should ensure that their methods for rating lower extremity impairments due to causalgia, RSE, and CRPS are internally consistent.

scholarly journals Long-Term Neuropsychological Effects of Opioid Use in Children: A Descriptive Literature Review

2014 ◽  
Vol 2;17 (2;3) ◽  
pp. 109-118 ◽  
Author(s):  
Gaurav Jain
Keyword(s):  
Pain Management ◽  
School Readiness ◽  
Pediatric Population ◽  
The United States ◽  
Cognitive Status ◽  
Cochrane Library ◽  
Negative Consequences ◽  
Pediatric Pain ◽  
Opioid Use

Background: Use of opioids in the management of pain and its consequences in children presents a substantial challenge. A significant concern in pediatric pain management is the longterm neuropsychological consequences of opioids. Objectives: The authors aim to provide a descriptive review of the current literature surrounding the neuropsychological impact of opioid use in children, along with possible extrapolations from their use in adults and animal models. Study Design: Systematic review of published literature. Setting: Various universities in the United States. Methods: The electronic review for papers published between January 1992 and December 2012 was conducted using Medline/Pubmed, PsychInfo, CINAHL, the Cochrane Library database, and Google Scholar. Results: Findings assessing pediatric pain patients treated with opioids demonstrated no significant differences in intelligence, behavior, vocabulary, or motor skills. One study reported a decrease in a visuo-constructional ability, which measured higher order executive function. Studies from prenatal illicit opioid exposure found poorer performance on measures of language, verbal ability, mathematics, reading, impulse control, and school readiness skills. The literature from adult prescribed opioid users has mixed results. Some showed impairment in the neuropsychological domains of memory, decision-making, attention, concentration, information processing, psychomotor speed, visual special skills, and hand-eye coordination, while others found no differences or revealed improved perceptual-cognitive status, possibly due to the removal of pain as a stressor. Limitations: Very few studies looked into the long term neuropsychological and cognitive effects of the opioids in pediatric population. In an attempt to extrapolate from other groups, this review also included literature from adult patients, prenatal opioid exposure, and animal studies. Conclusion: Opioid medications have the potential to produce long-lasting neuropsychological side effects. However, given the negative consequences of untreated pain, the potential benefit may offset their risk. More studies are needed to clarify this complex interaction. Key words: Chronic pain management, infants, children, pediatrics, long term neurocognitive effects, opioid medication

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