Pain Management in Pediatrics

Describe the 5 different pain scales utilized for children and identify the defining characteristics of each scale.

The five common pain scales used for children include self-report scales, visual/numerical analog scales, face scales, pediatric pain questionnaires, and pain diaries. The first option, self-report scales, evaluates chronic and acute pain in kids of different ages. Whereas some self-report scales can measure one element of pain (such as pain intensity), others can be multi-dimensional and comprehensive, meaning that they can measure the impact of pain on the quality of life. Visual/numerical analog scales differ from self-reports because they are particularly used to assess pain levels for children aged three and above. Typically, these scales comprise 4 inches (10 cm) lines with labels “Worst hurt” and “No hurt” on the right and left, respectively. From 1-10, kids are asked to label their pain intensity (Staff, 2009).

The third tool, face scales, is also applied to kids aged three and above. Children are generally required to identify their pain intensity using 5-6 cartoon faces arranged, starting with an emotionally neutral picture on the left and progressing to more distressed ones on the right. The Pediatric Pain Questionnaire, sometimes shortened as PPQ, is mostly applied to children suffering from chronic pain (older ones). The questionnaires focus less on pain intensity and more on the effects of the pain on the child’s life, including their ability to form relationships, emotional states, and participation in activities (Staff, 2009). Lastly, pain diaries are used for children six and older. It is often regarded as the complete scale for recording pain among children because it identifies pain intensity (on a scale of 1 to 10) and seeks to determine the root of the problem (or what the kids were doing when the pain started).

What is complementary pain management and how is it used in the pediatric population?

Complementary pain management refers to alternative pain management approaches that extend beyond the traditional clinical and hospital settings or examination rooms. They include acupuncture, biofeedback, chiropractic, cognitive behavioral therapy, massage therapy, hypnosis, visualization and guided imagery, meditation and yoga, etc. Complementary pain management techniques are often applied outside the normal hospital or clinical environments to strengthen individuals’ emotional and physical preparedness and strength, especially children. For example, in the pediatric population, psychotherapists sometimes can employ cognitive behavioral therapy to identify how behaviors, feelings, and thoughts affect the pain levels in children. Psychotherapists then design better strategies to help children cope with their pain (Shallik, 2018).

Explain the difference between non-pharmacologic and pharmacologic strategies for managing pain in the pediatric patient. Describe examples of each strategy.

Pharmacologic strategies involve using drugs, particularly analgesics and painkillers, to alleviate pain, while non-pharmacologic refer to using alternative methods other than medications (Shallik, 2018). An example of a pharmacologic strategy is the use of paracetamol syrup (5 ml dose) to lower pain levels in a two-year-old child suffering from a severe headache and fever. On the other hand, a typical illustration of non-pharmacologic therapy is the use of ‘distraction tools’ to assist children in shifting their focus from pain onto other pleasure events, such as play, video games, music, bubbles, school, a telephone conversation, and so on.

Describe 5 different consequences to unmanaged pain in infants.

Unresolved or unmanaged pain in infants can pose a range of challenges, both in the short and the long term. For an infant, the short-term effects can range from delayed healing, weakened immune function, and increased heart rate and blood pressure. This is because infants release stress hormones such as adrenaline when in pain or distress, which subsequently can affect the heart rate, blood pressure, and other body functions. If the pain is left unmonitored or unchecked for a long period, it can result in chronic trauma and distress for children. This can impact brain development, the ability to develop relationships and overall life development. They might end up mentally disturbed in their youth, a factor that can increase their chances of dropping out of school, abusing drugs, and getting incarcerated.

How would you monitor for side effects from pharmacologic pain management? What is the most significant side effect and why?

As mentioned above, pharmacological pain management refers to the use of drug substances, such as paracetamol and ibuprofen, to control pain. The use of pharmacologic elements often can result in side effects and contraindications due to reactions of the drugs taken and previously prescribed medications, herbal substances, foods consumed, and sometimes the patient’s genetic makeup. The best way to monitor for side effects is to read the instructions attached to the side label of the drug. Unlikely symptoms such as allergic reactions must be noted a few minutes, hours, or days after the drug is ingested. According to Morelli and Chang (n.d.), the most common side effects among pediatrics are associated with the gastrointestinal system (for those ingested) and skin irritation (for those applied externally). This is perhaps because any drug taken can cause stomach upset or nausea. External drugs commonly cause irritation because they often function by interacting with the skin structure.

References

Morelli, J., & Chang, L. (n.d.). Drug side effects. Rx List, https://www.rxlist.com/types_of_side_effects_and_fda_regulations/drugs-condition.htm

Shallik, N. (2018). Pain management in special circumstances. BoD – Books on Demand.

Staff, S. (2009). Tools for measuring pain. About Kids Health, https://www.aboutkidshealth.ca/Article?contentid=2994&language=English

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