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Curr Pediatr Res 2017; 21 (1): 148-157

 ISSN 0971-9032

www.currentpediatrics.com

Curr Pediatr Res 2017 Volume 21 Issue 1

148

Introduction

According to the International Association for the Study of 

Pain (IASP) Pain is “an un-pleasant sensory and emotional 

experience associated with actual and potential tissue 

damage”. Pain has also been defined as “existing whenever 

they  say  it  does  rather  than  whatever  the  experiencing 

person says” [1-4]. It is one of the most dreading and 

devastating  symptom  commonly  propagated  in  peoples 

with advanced chronic conditions including cancer patents. 

Pediatric patients are the most under treated and present to 

hospital for pain compared to adults; because of the wrong 

belief that they neither suffer pain nor they remember 

painful experiences [5]. The quality of life experienced 

by the patient can greatly reduce, regardless of their basic 

diagnosis. Thus, if pain will be poorly managed, it can 

reflect the influence on family and careers causing different 

which may leads to increased rates of hospital admission 

[5,6]. Uncontrolled pain has also direct impact on health 

outcomes and more than a few effects on all areas of life. 

The emotional, cognitive, and behavioral components of 

pediatric patient are also important to assess pain and to 

simplify the management practices [7,8].

A  long-term  negative  effect  of  untreated  pain  on  pain 

sensitivity,  immune  functioning,  neurophysiology, 

attitudes,  and  health  care  behavior  are  supported  with 

numerous evidences. Health care professionals’ who care 

for children  are mainly responsible for abolishing or 

assuaging pain and suffering when possible [5,7,9]. The 

practice of pediatric pain treatment protocol has made 

great  progress  in  the  last  decade  with  the  development 

and validation of pain valuation tools specific to pediatric 

patients. Almost all the major children hospitals now 

have  dedicated  pain  services  to  provide  evaluation  and 

immediate treatment of pain in any child [10,11]. 

In pediatric age, it is more difficult to assess and treat pain 

effectively relatively to adults. The lack of ability to notice 

pain, immaturity of remembering painful experiences 

and  other  reasons  are  the  reflection  of  persistence  of 

myths related to the infant’s ability to perceive pain [12]. 

However, the treatment of pain in childhood is like the adult 

management practice which includes pharmacological and 

non-pharmacological  interventions.  On  the  other  hand, 

it critically depends on an in-depth understand of the 

developmental  and  environmental  factors  that  influence 

nociceptive processing, pain perception and the response 

to treatment during maturation from infancy to adolescence 

[13,14]. 
The practice of assessing pain and its management in 

pediatric patients can show a discrepancy based on the 

different countries and their respective health institutions. 

So,  this  review  focused  on  the  contemporary  practice 

and  new  advances  in  pediatric  pain  assessment  and  its 

management.

 

Classification of Pain

Many  classification  systems  are  used  to  describe  the 

different  types  of  pain.  The  most  common  classification 

schemes refer to pain as acute or chronic; malignant or 

nonmalignant; and nociceptive or neuropathic [15]. Most 

studies are agreed with the following classification of pain 

(Table 1).

Assessment and treatment of pain in pediatric patients.

Halefom Kahsay

Department of Pharmacy, Collage of Health Science, Adigrat University, Adigrat, Ethiopia.

Pediatric patients experience pain which is more difficult to assess and treat relatively to 

adults. Evidence demonstrates that controlling pain in the pediatrics age period is beneficial, 

improving  physiologic,  behavioral,  and  hormonal  outcomes.  Multiple  validated  scoring 

systems exist to assess pain in pediatrics; however, there is no standardized or universal 

approach for pain management. Healthcare facilities should establish pediatrics pain control 

program.  This  review  summaries  a  collection  of  pain  assessment  tools  and  management 

practices in different facilities. This systematic approach should decrease pediatric pain and 

poor outcomes as well as improve provider and parent satisfaction.

Abstract

Keywords

: Pain, Pain assessment, Pain management, Pediatric patients.

Accepted January 30, 2017

Summary of Contents for RAX215DC

Page 1: ...ess and treat pain effectively relatively to adults The lack of ability to notice pain immaturity of remembering painful experiences and other reasons are the reflection of persistence of myths related to the infant s ability to perceive pain 12 However the treatment of pain in childhood is like the adult management practice which includes pharmacological and non pharmacological interventions On t...

Page 2: ...nts in 24 h of admission Most 63 of the children were find a different document of 666 pain assessment tools with a median of three assessments per one child 14 Parent patient as well as staff satisfaction is positively associated with accurate assessment of pain in addition to well improvement of pain management Brief and well validated tools are available for the assessment of pain in non specia...

Page 3: ...ent intervals Constantly awake Table 2 Neonatal pain rating scale 27 29 children and across all settings Individual needs of the children lead to assess and re evaluate of pain consistently as a mandatory in every situation On top of that ethnicity language and cultural factors should be under consideration as they may influence pain assessments and its expression 5 12 26 Most formal and commonly ...

Page 4: ...diagnosis and management of the different type of pains encountered in pediatrics Management of Pain in Pediatrics The management of pain in pediatrics is still misunderstood Explicitly neonates and infants are not managed for pain effectively due to the misperception that they are not able to sense pain as adults 16 18 American academy of pediatrics suggested that the lack of pain assessment and ...

Page 5: ...n demonstrated that skin to skin contact principally Kangaroo care plays its own role in reducing and caring their children as the care giver and the baby have a direct physical contact 4 30 Pharmacological Management of Pain The current pharmacologic treatment protocol of pain for children is primarily extrapolated from adult intervention without any evidence of value in children 32 High quality ...

Page 6: ...al pain management 47 This show to decrease morphine consumption and improve the quality of analgesia without increasing the incidence of side effects These drugs are now a standard peri operative analgesic agent in many pediatric institutions Ibuprofen mainly used is available in oral suspension infant drops Figure 3 The WHO analgesic ladder 15 24 45 Drug Oral peak time Usual Pediatric dosage Usu...

Page 7: ...ildren with severe pain Pharmacokinetics disparity Table 5 exists for this drug between age groups Because the plasma concentrations of morphine in neonates and infants display a prolonged half lives 2 3fold difference even with administration of constant infusion 7 12 27 Codeine It is a prodrug which activated to morphine by the enzyme cytochrome CYP2D6 However the activity of this enzyme is high...

Page 8: ...th management to control the pain through non pharmacological and pharmacological interventions On top of that pediatric institutions are well positioned to support and implement policy initiatives to improve the identification and management of pediatric pain and to contribute new knowledge through research Recommendations An appropriate pain assessment measurements and techniques are needed to m...

Page 9: ...n in the emergency department space North Sydney W NSW Minister of Health 2016 22 Dantas L Dantas T Santana Filho V et al Pain assessment during blood collection from sedated and mechanically ventilated children Rev Bras Ter Intensiva 2016 28 49 54 23 Reid K Lukenchuk L Shannon et al Does a pain algorithm improve pain assessment and management Pain aligorism Stollery Childrens Hospital 2012 24 Won...

Page 10: ...armacological treatment of persisting pain in children with medical illnesses Geneva Switzerland 2014 46 Yung A Thung A Tobias JD Acetaminophen for analgesia following pyloromyotomy Does the route of administration make a difference J Pain Res 2016 9 123 127 47 Cardile S Martinelli M Barabino A et al Italian survey on non steroidal anti inflammatory drugs and gastrointestinal bleeding in children ...

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