Pain Management in Children: Part 1 — Pain Assessment Tools and a Brief Review of Nonpharmacological and Pharmacological Treatment Options

Age-appropriate pain assessment and management is vital in the care of children with acute pain. Pain in children should be routinely and regularly assessed, documented, treated and reassessed with clear documentation. Poor pain management in the acute and postoperative setting can result in both short- and long-term consequences. The most effective analgesia plans are multimodal. This chapter focuses on the variety of treatment options for pain in the acute setting. Topics covered include age-appropriate pain assessment tools for children; the basics of age-appropriate pain management in children; as well as the role of opioids, nonsteroidal anti-inflammatory drugs, and patient-controlled analgesia in acute and postoperative pain management in children.

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2022 ISFM Consensus Guidelines on the Management of Acute Pain in Cats

Journal of Feline Medicine and Surgery ◽

10.1177/1098612x211066268 ◽

2021 ◽

Vol 24 (1) ◽

pp. 4-30

Author(s):

Paulo V Steagall ◽

Sheilah Robertson ◽

Bradley Simon ◽

Leon N Warne ◽

Yael Shilo-Benjamini ◽

...

Keyword(s):

Pain Management ◽

Acute Pain ◽

Pain Assessment ◽

Multimodal Analgesia ◽

Evidence Base ◽

Pharmacological Therapy ◽

Assessment Tools ◽

Mental Wellbeing ◽

Team Approach ◽

Analgesic Drugs

Practical relevance: Increases in cat ownership worldwide mean more cats are requiring veterinary care. Illness, trauma and surgery can result in acute pain, and effective management of pain is required for optimal feline welfare (ie, physical health and mental wellbeing). Validated pain assessment tools are available and pain management plans for the individual patient should incorporate pharmacological and non-pharmacological therapy. Preventive and multimodal analgesia, including local anaesthesia, are important principles of pain management, and the choice of analgesic drugs should take into account the type, severity and duration of pain, presence of comorbidities and avoidance of adverse effects. Nursing care, environmental modifications and cat friendly handling are likewise pivotal to the pain management plan, as is a team approach, involving the cat carer. Clinical challenges: Pain has traditionally been under-recognised in cats. Pain assessment tools are not widely implemented, and signs of pain in this species may be subtle. The unique challenges of feline metabolism and comorbidities may lead to undertreatment of pain and the development of peripheral and central sensitisation. Lack of availability or experience with various analgesic drugs may compromise effective pain management. Evidence base: These Guidelines have been created by a panel of experts and the International Society of Feline Medicine (ISFM) based on the available literature and the authors’ experience. They are aimed at general practitioners to assist in the assessment, prevention and management of acute pain in feline patients, and to provide a practical guide to selection and dosing of effective analgesic agents.

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Considerations for neonatal and pediatric pain management

American Journal of Health-System Pharmacy ◽

10.1093/ajhp/zxz166 ◽

2019 ◽

Vol 76 (19) ◽

pp. 1511-1520 ◽

Cited By ~ 2

Author(s):

Pooja Shah ◽

Anita Siu

Keyword(s):

Pain Management ◽

Acute Pain ◽

Pain Assessment ◽

Pediatric Patients ◽

Safety Data ◽

Clinical Situation ◽

Assessment Tools ◽

Patient Specific ◽

Pediatric Pain ◽

Unique Challenge

Abstract Purpose Current literature and clinical practice guidelines on pediatric pain management are reviewed. Summary Acute pain is commonly present in neonatal and pediatric patients due to underlying disease states or procedures. Especially in institutions with limited pediatric pain services, it is imperative to describe the appropriate management of pain and pharmacotherapy options that are effective and safe in pediatric patients. Despite the knowledge of pain being an important aspect in the management of children, barriers exist, leading to suboptimal treatment. Addressing these barriers through education of healthcare practitioners, families, and patients will lead to optimizing the patient pain experience. Tools for pain assessment vary depending on the type of pain, the child’s age and understanding of pain, and the clinical situation. Pharmacotherapy options for pain management in neonates and pediatric patients include opioid and nonopioid agents. Efficacy and safety data on the use of medications for the treatment of pain in pediatric patients is described. The delivery of medication encompasses patient-specific factors and preferences. Strategies for opioid stewardship and management of iatrogenic withdrawal pose a unique challenge in pediatric patients. Conclusion The management of acute pain in neonates and pediatric patients should be a priority for all practitioners caring for these patients. Use of age-appropriate pain assessment tools and understanding of the mechanisms of action and roles in therapy of various nonopioid and opioid therapies can help optimize treatment of pain in neonatal and pediatric patients.

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Pain management

Oxford Handbook of Cancer Nursing ◽

10.1093/med/9780198701101.003.0046 ◽

2019 ◽

pp. 549-568

Author(s):

John Curtin

Keyword(s):

Pain Management ◽

Pain Assessment ◽

Rating Scales ◽

Interdisciplinary Approach ◽

Opioid Analgesics ◽

Brief Pain Inventory ◽

Assessment Tools ◽

World Health ◽

Numerical Rating ◽

Strong Opioids

Pain is described as being whatever the experiencing person says it is, and their perception of pain is determined by their mood and morale and the meaning of the pain for them. Cancer pain is common, and prevalence is related to the stage of the illness: 59% in patients undergoing treatment, and 64% in those with advanced disease. Pain is multi-causal and multidimensional, and a holistic, interdisciplinary approach to assessment is necessary, encompassing physical, psychological, social, and spiritual aspects of pain (together are ‘total pain’). A narrative approach to pain assessment is helpful, keeping the focus on the patient and their experience. Pain assessment tools can also be used to identify where pain is and how much it hurts. These include: pain body map, visual analogue scales (VAS), verbal rating scales (VRS), numerical rating scales (NRS), and Brief Pain Inventory (BPI). Classifications of pain include acute and chronic pain, nociceptive pain caused by the stimulation of nerve endings, and neuropathic pain caused by nerve dysfunction or compression. Analgesic drugs may be given according to the World Health Organization's pain relief ladder: step 1, non-opioid analgesics such as paracetamol and non-steroidal anti-inflammatory drugs; step 2, mild opioids like codeine with or without non-opioid analgesics; and step 3, strong opioids like morphine with or without non-opioid analgesics. Non-pharmacological interventions for pain management include transcutaneous electrical nerve stimulation (TENS), massage, distraction, relaxation, breathing exercises, comfort measures, and presence of the nurse. Effective communication at all stages of management is essential.

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Mechanistic, translational, quantitative pain assessment tools in profiling of pain patients and for development of new analgesic compounds

Scandinavian Journal of Pain ◽

10.1016/j.sjpain.2013.07.026 ◽

2013 ◽

Vol 4 (4) ◽

pp. 226-230 ◽

Cited By ~ 9

Author(s):

Lars Arendt-Nielsen ◽

Michele Curatolo

Keyword(s):

Pain Management ◽

Drug Development ◽

Healthy Volunteers ◽

Success Rate ◽

Pain Assessment ◽

Development Process ◽

Experimental Pain ◽

Assessment Tools ◽

Pain Mechanisms ◽

Pain Patients

AbstractBackgroundMechanistic, translational, human experimental pain assessment technologies (pain bio markers) can be used for: (1) profiling the responsiveness of various pain mechanisms and pathways in healthy volunteers and pain patients, and (2) profiling the effect of new or existing analgesic drugs or pain management procedures. Translational models, which may link mechanisms in animals to humans, are important to understand pain mechanisms involved in pain patients and as tools for drug development. This is urgently needed as many drugs which are effective in animal models fail to be efficient in patients as neither the mechanisms involved in patients nor the drugs’ mechanistic actions are known.AimThe aim of the present topical review is to provide the basis for how to use mechanistic human experimental pain assessment tools (pain bio markers) in the development of new analgesics and to characterise and diagnose pain patients. The future aim will be to develop such approaches into individualised pain management regimes.MethodExperimental pain bio markers can tease out mechanistically which pain pathways and mechanisms are modulated in a given patient, and how a given compound modulates them. In addition, pain bio markers may be used to assess pain from different structures (skin, muscle and viscera) and provoke semi-pathophysiological conditions (e.g. hyperalgesia, allodynia and after-sensation) in healthy volunteers using surrogate pain models.ResultsWith this multi-modal, multi-tissue, multi-mechanism pain assessment regime approach, new opportunities have emerged for profiling pain patients and optimising drug development. In this context these technologies may help to validate targets (proof-of-concept), provide dose-response relationships, predicting which patient population/characteristics will respond to a given treatment (individualised pain management), and hence provide better understanding of the underlying cause for responders versus non-responders to a given treatment.ConclusionIn recent years, pain bio markers have been substantially developed to have now a role to play in early drug development, providing valuable mechanistic understanding of the drug action and used to characterise/profile pain patients. In drug development phase I safety volunteer studies, pain bio marker scan provide indication of efficacy and later if feasible be included in clinical phase II, III, and IV studies to substantiate mode-of-action.ImplicationsRefining and optimizing the drug development process ensures a higher success rate, i.e. not discarding drugs that may be efficient and not push non-efficient drugs too far in the costly development process. Mechanism-based pain bio markers can help to qualify the development programmes and at the same time help qualifying them by pain profiling (phenotyping) and recognising the right patients for specific trials. The success rate from preclinical data to clinical outcome may be further facilitated by using specific translational pain bio-markers. As human pain bio markers are getting more and more advanced it could be expected that FDA and EMA in the future will pay more attention to such mechanism-related measures in the approval phase as proof-of-action.

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Pain Assessment in a Geriatric Psychiatry Program

Pain Research and Management ◽

10.1155/2007/975282 ◽

2007 ◽

Vol 12 (4) ◽

pp. 273-280 ◽

Cited By ~ 4

Author(s):

Paul Stolee ◽

Loretta M Hillier ◽

Jacquelin Esbaugh ◽

Nancy Bol ◽

Laurie McKellar ◽

...

Keyword(s):

Health Care ◽

Pain Management ◽

Pain Assessment ◽

Health Care Professionals ◽

Management Practice ◽

Group Discussion ◽

Geriatric Psychiatry ◽

Assessment Tools ◽

Pain Symptoms ◽

Consistent Approach

BACKGROUND: The assessment of pain in older persons with psychiatric illness is particularly challenging for health care professionals. There are few well-tested pain assessment tools for this population.OBJECTIVES: A study was conducted to explore pain assessment and management issues in geriatric psychiatry.METHODS: Seventy-four staff members of a geriatric psychiatry service at Regional Mental Health Care London, St Joseph’s Health Care London, London, Ontario completed a survey to assess current pain assessment and management practice for geriatric psychiatry patients, and to identify indicators used to assess pain in this population. The results of the survey were later shared with members of the program’s pain management team in a focus group discussion to explore opportunities on how to transfer these findings into clinical practice.RESULTS: The majority of survey respondents (91.8%) agreed that pain assessment and management could be improved for patients; only 14.9% reported that there was a consistent approach to pain management. Misconceptions and attitudes about pain, lack of easily administered pain tools, inconsistent monitoring of pain, and lack of documentation of pain symptoms and indicators were identified as significant barriers to optimal pain management for their patients. A number of behaviours indicative of pain were identified but emphasis was placed on recognition of changes from usual behaviour.CONCLUSIONS: The findings of the present study highlight the need for a comprehensive, practical and consistent approach to pain assessment and management, and provide insight into the critical components, including behavioural indicators, that could be incorporated into a pain protocol to be used with this population.

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Adherence of Pain Assessment to the German National Standard for Pain Management in 12 Nursing Homes

Pain Research and Management ◽

10.1155/2014/785765 ◽

2014 ◽

Vol 19 (3) ◽

pp. 133-140 ◽

Cited By ~ 2

Author(s):

Jürgen Osterbrink ◽

Zsuzsa Bauer ◽

Barbara Mitterlehner ◽

Irmela Gnass ◽

Patrick Kutschar

Keyword(s):

Nursing Home ◽

Cognitive Impairment ◽

Pain Management ◽

Nursing Homes ◽

Pain Assessment ◽

Survey Methodology ◽

Nursing Home Residents ◽

Assessment Tools ◽

National Standard ◽

Severe Cognitive Impairment

BACKGROUND: Pain is very common among nursing home residents. The assessment of pain is a prerequisite for effective multiprofessional pain management. Within the framework of the German health services research project, ‘Action Alliance Pain-Free City Muenster’, the authors investigated pain assessment adherence according to the German national Expert Standard for Pain Management in Nursing, which is a general standard applicable to all chronic/acute pain-affected persons and highly recommended for practice.OBJECTIVES: To evaluate the state of pain assessment and to identify need for improvement in 12 nursing homes in a German city.METHODS: In the present study, the authors used an ex-post-facto design (survey methodology). Available written policies for routine pain assessment in residents ≥65 years of age were reviewed and a standardized online survey completed by 151 of 349 nurses in 12 nursing home facilities was conducted between September 2010 and April 2011.RESULTS: Most of the included nursing homes provided written policies for pain assessment, and the majority of nurses reported that they assess and regularly reassess pain. However, observational tools for residents with severe cognitive impairment and written reassessment schedules were lacking in many facilities or were inconsistent.CONCLUSIONS: Essentially, pain assessment appeared to be feasible in the majority of the German nursing homes studied. However, the absence or inconsistency of reassessment schedules indicate that pain management guidelines should include a detailed and explicit reassessment schedule for the heterogenic needs of nursing home residents. For residents with severe cognitive impairment, assessment tools are needed that are simple to use and clearly indicate the presence or absence of pain.

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Neuroscience Nurses' Perceptions of the Barriers to Identifying and Treating Pain in Acutely Brain-Injured Adult Patients

10.28971/532015ik137 ◽

2015 ◽

Author(s):

Kimberly Iannotti

Keyword(s):

Pain Management ◽

Adult Patient ◽

Critically Ill ◽

Pain Assessment ◽

Life Support ◽

Neurological Status ◽

Assessment Tools ◽

Neurological Patient ◽

Altered Level ◽

Brain Injured

<p>Pain management for the critically ill adult can be daunting. Numerous factors contribute to this challenging process including altered level of consciousness (LOC), inability to speak, life support measures, family input, level of sedation, paralyzing agents, restraints, cognitive impairment, and numerous other factors. The current practice related to pain management in the neurologically critically ill adult patient population is limited by inadequate pain scales, altered neurological status, and atypical pain-associated behaviors. Additionally, nurses are challenged by unclear practice guidelines. The critical care nurse is required to assess and manage pain, as well as implement specific interventions based on the patient’s exhibiting characteristics or behaviors. The purpose of this study was to explore the neuroscience nurses’ perception of the barriers to identifying and treating pain in the acutely brain-injured adult patient. Participants were registered nurses working on a Neurocritical Care Unit. The methodology included two short answer questions and 15 Likert format questions rating the frequency of specific barriers. Nurses reported declining neurological status and subjective assessment tools as the most frequently seen barriers to pain assessment and management. Development of pain assessment measures in the brain-injured acutely ill adult patient continues to be important. The need for nurse-driven research to explore alternate measures to identify pain in the neurological patient is indicated. Implications for advanced practice are discussed.</p>

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CRIES: A Neonatal Postoperative Pain Measurement Score

50 Studies Every Anesthesiologist Should Know ◽

10.1093/med/9780190237691.003.0049 ◽

2018 ◽

pp. 263-267

Keyword(s):

Pain Management ◽

Postoperative Pain ◽

Pain Assessment ◽

Reliable Method ◽

Assessment Tool ◽

Assessment Tools ◽

Neonatal Pain ◽

Reliable Assessment ◽

Assessment And Treatment ◽

Neonatal Population

This case focuses on neonatal pain management by asking the question: Is the CRIES score a valid and reliable method for assessing neonatal postoperative pain? Regular pain assessment and treatment in the neonatal population are important postoperatively. The CRIES scale was designed to measure pain in the neonatal population, and this study demonstrated CRIES to be a valid and reliable assessment tool for identifying postsurgical pain in neonates. Multiple pain assessment tools, including CRIES, are available for use in neonatal patients and in patient populations who are otherwise unable to verbalize discomfort.

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Pain Management and Conscious Sedation for the Pediatric Patient

Journal of Pharmacy Practice ◽

10.1177/089719009600900106 ◽

1996 ◽

Vol 9 (1) ◽

pp. 57-74 ◽

Cited By ~ 1

Author(s):

Cathy Y. Poon

Keyword(s):

Pain Management ◽

Health Care Providers ◽

Pain Assessment ◽

Clinical Condition ◽

Conscious Sedation ◽

Assessment Tools ◽

Care Providers ◽

Patient Response ◽

Pharmacological Agents ◽

Accepted Practice

Pain management in children was previously ignored primarily because of myths and misconceptions about childhood pain. Undertreatment of pain was once a common and accepted practice. However, in recent years, with increased knowledge and understanding coupled with improved pain assessment tools, health care providers are more conscious about providing adequate and safe analgesia to children. Because of the differences in patient response to various pharmacological agents, it is important to understand the pharmacokinetic and pharmacodynamic differences of the various agents. Choices of pain management should be individualized, and adjustments should be made based on the patient's clinical condition. Conscious sedation before diagnostic and therapeutic procedures should be approached with caution. Deaths and complications related to conscious sedation therapy have prompted the development of guidelines for safer and more effective pharmacological interventions. The recently published guidelines include recommendations for skilled personnel, continuous monitoring, appropriate use of drugs, and ability to manage unforeseen complications. Selection of the most appropriate sedatives should take into consideration the type of procedure, the patient's clinical condition, and the desired level and duration of consciousness. Similar to pain management, individualization is crucial. This article will discuss the principles of pain management and conscious sedation in children. Facts and scientific findings will be presented to discredit the myths and misconceptions often associated with pediatric pain. Various pain assessment tools will be summarized. The newly published sedation guidelines set forth by the American Academy of Pediatrics Committee on Drugs will be briefly discussed. Furthermore, commonly used agents will be reviewed. Copyright © 1996 by W.B. Saunders Company

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