Assessment and treatment of pain in pediatric patients.
Curr Pediatr Res 2017 Volume 21 Issue 1
151
Assessment of pain in older children:
Sel
f-report:
The single most reliable indicator of
the existence and intensity of pain and any resultant
distress is the patient’s self -report. For older children,
the use of a self-reporting scale can be helpful to staff
and empowering to the patient [24]. A self-report of
pain from a patient with limited verbal and cognitive
skills may be a simple yes/no or other vocalizations
or gestures, such as hand grasp or eye blink. When
self-report is absent or limited, explain why self-
report cannot be used and further investigation and
observation are needed [4,28]. Myriad guidelines are
coming together in using different self-report methods
in assessing pain in older children such as the Visual
Analogue Scale
(VAS) (Figure 1) which is described
by a horizontal line with “no pain” at the beginning to
“worst possible pain” at the termination and patients
draw a line to show their severity of pain. It has several
benefits: it avoids imprecise descriptive terms, quick
and simple to score, and offers many determining
points. However, it can be difficult in post-operatively
or in children with neural and psychological disorder as
it needs a concentration and coordination [1,12,24,29].
Wong-Baker faces pain rating scale is the other self-
report tool mainly used to assess acute pain. Expressed
by six line-drawn faces range from no pain at one end to
worst pain at the other end and assigns by number with
word descriptors to each face to indicate the intensity
of pain [11,37].
However, many studies take a type of self-report, face
scale method for assessing pain in older children
.
Below
is the Faces scale, currently used by the children’s hospital
at West Mead:
These faces show how much something can hurt. From no
pain to very much pain pointing to the face by the patient
him/herself to show how much he/she hurt to simplify
pain assessment (Figure 2).
Generally, most institutions approved using the pain
assessment tools as their basic instrument for 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 fears of adverse effects of
analgesic medications including respiratory depression
and addiction are the main barriers to the treatment
of pain in children [9]. As the underlying disease is
expected to advance a continuous adjustment of pain
therapy is required. A study in Toronto hospitals shows
that out of the total 265 children, 58.9% received a
minimum of one documented intervention of pain
management. Out of 66 children with recognized pain
(mild, moderate or severe), 55 of them received an
intervention for their pain [14]. It extends beyond pain
relief, encompassing the patient’s quality of life and
ability to work productively and to enjoy recreation.
Pain management is a joint responsibility among
the members of the health care team. This includes
addressing pain status of each patient daily on inpatient
unit rounds or with each patient visit, consultation if
pain treatment is ineffective, and discharge planning for
continuing pain management needs [3,15,38].
Generally, on consideration of the above challenges
Managements of pain in pediatrics encompass the use of
pharmacological and non-pharmacological interventions
to control the patient’s identified pain.
Non-Pharmacological Interventions
Non-pharmacological measures should be favored as base
line for both adults and children intervention of pain. in
conjunction with pharmacological options to help lower
levels of anxiety, pain and distress, the psychological
comfort measures such as relaxation techniques and
distraction as well as physical interventions including
the use of massage repositioning or heat and/or cold
compresses are useful Strategies [3,4,15,19,24,39].
According to the guidelines for clinical practice of
the American pain society, pain education such as the
interventions and options for pain relief during the pre-
Figure 2.
Face scale assessment tool [27]
Figure 1.
Visual analogue scale [21,25]
