Pediatric Pain:Assessment and treatment

Cheryl Stohler RN BSNWolfson Children’s Hospital

Children’s Ambulatory Center2013

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

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

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)

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

Types of painAcute – surgical, procedures,

accidents/injuries

Continuous/Chronic – JA, neurological/neuropathy pains, cancers, osteo’s’

Disease associated (periodic) - sickle cell, CF, MS, asthmas

Types of pain controlPharmalogical vs. non-pharmalogical

• Topical/local

• Oral

• IV

• IM

• “Around the clock” dosing

• “As needed” dosing

• Patient – controlled analgesia

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?

LOOK MOM – NO PAIN!!

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)