Evaluation and management of pain in children
- Julie Hauer, MD
Julie Hauer, MD
- Assistant Professor
- Children's Hospital Boston
- Barbara L Jones, PhD, MSW
Barbara L Jones, PhD, MSW
- Assistant Professor of Social Work
- University of Texas at Austin
Assessment and management of pain are essential components of pediatric care. In children, especially young children, it can be challenging to identify the presence and severity of pain, and then to treat the pain. The use of assessment tools based upon cognitive ability is important to ensure that children of all ages receive adequate pain control.
Assessment of pain and an overview of pain management in children will be reviewed here. Assessment and pain management in the neonate are discussed separately. (See "Assessment of neonatal pain" and "Prevention and treatment of neonatal pain".)
The evaluation of pediatric pain includes determining the underlying type, source and location, and severity of pain.
Types of pain — Pain is defined as an unpleasant somatic or visceral sensation associated with actual, potential, or perceived tissue damage. It is classified into nociceptive and neuropathic pain based upon the underlying pathophysiology. Determining the type of pain helps in identifying the cause of pain, which may guide treatment choices. (See "Assessment of cancer pain", section on 'Inferred pathophysiology (types of cancer pain)'.)
●Nociceptive pain is caused by stimulation of intact nociceptors as a result of tissue injury and inflammation (figure 1). It is divided into somatic pain with receptors in skin, soft tissue, skeletal muscle, and bone; and visceral pain with receptors in internal organs, such as the kidney and gastrointestinal tract. Somatic pain is well localized and described as sharp, aching, squeezing, stabbing, or throbbing. Visceral pain is typically poorly localized, and is often described as dull, crampy, or achy.
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- Types of pain
- Source and location
- Assessment of pain severity and cognition
- - Self-reporting
- Pain-location tools
- - Observational tools
- - Nonverbal children with neurological impairment
- PRINCIPLES OF MANAGEMENT
- WHO analgesic ladder
- NONPHARMACOLOGIC THERAPY
- Procedural pain
- PHARMACOLOGIC THERAPY
- Nonopioid analgesics
- - Acetaminophen
- - NSAIDs
- - Choice of opioid
- - Specific agents
- - Initial dosing
- - Escalating pain
- - Patient-controlled analgesia
- - Opioid equivalence dosing
- - Adverse effects
- - Renal and hepatic impairment
- - Barriers to opioid use
- Adjuvant agents
- Neurologically impaired children
- SUMMARY AND RECOMMENDATIONS