Pediatric Pain: Assessment and treatment
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Pediatric Pain:Assessment and treatment
Cheryl Stohler RN BSNWolfson Children’s Hospital
Children’s Ambulatory Center2013
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The absolute value of the pain-intensity score is not as important as the changes in scores in each individual child.
Trending is most important to assess progress of pain control
Scoring shows effectiveness of pain interventions
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Wong Baker Faces Pain Rating Scale
Research suggest that FACES is the preferred method for identifying pain in children ages 3-18.
Advantages: Quick and simple to useMinimal instructions requiredTranslated into >10 languagesPreferred by children and nursesAvailable free of chargeCan be used in conjunction with VAS
Disadvantages: Confuses affect (smiles/tears) with pain intensity Ratings are higher than on scales with a neutral “no-pain” face Limited psychometric testing of translations
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VAS = visual analogue scale
Rating scale of 0 for no pain and 10 severe painBest used with school age children with concept of numbers
Advantages: Simple and quick to scoreAvoids imprecise descriptive termsProvides measuring pointsCan be used in conjunction with faces scale
Disadvantages: Require cognitive and linguistic developmentNeed of concentration and coordination(difficult for sedated or neurological disorders)
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FLACC Behavioral Pain Assessment ScaleF = FaceL = LegsA = ActivityC= CryC= Consolability
Advantages: Uses for infants and non-verbal childrenObservational expressionUse for children below age 2 months-7years oldCalculation of pain score in EMR
Disadvantages: Observational expressionIn older children may contain expressive behavior –not pain
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Types of painAcute – surgical, procedures,
accidents/injuries
Continuous/Chronic – JA, neurological/neuropathy pains, cancers, osteo’s’
Disease associated (periodic) - sickle cell, CF, MS, asthmas
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Types of pain controlPharmalogical vs. non-pharmalogical
• Topical/local
• Oral
• IV
• IM
• “Around the clock” dosing
• “As needed” dosing
• Patient – controlled analgesia
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Documentation in EMR
Assessment - what scale was used? What medication would be most appropriate to use?
Treatment – what was done
Re-assessment – was it effective?
Education – was the parent educated on the medication?
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LOOK MOM – NO PAIN!!
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References
Chiaretti, A., Pierri, F., Valentini, P., Russo, I., Gargiullo, L. & Riccardi, R. (2013). Current practice and recent advances in
pediatric pain management. European Review for Medical and Pharmacoloical Sciences 17(1), 112-126
Messerer, B., Gutmann, A., Weinber, A. & Sandner-Kiesling, A.
(2010) Implementation of a standardized pain management in a pediatric surgery unit. Pediatric Surgery Int. 26, 879-889. doi: 10.1007/s00383-010-2642-1
Tomlinson, D., Baeyer, C., Stinson, J. & Sung, L. (2010) A systematic review of faces scales for the self-report of pain intensity in children. Pediatrics 126(5)