Chapter 32: Pain Management & Pediatric Palliative & End-of-Life Care

INTRODUCTION

Children experience pain to at least the same level as adults. Multiple studies have shown that neonates and infants perceive pain and have memory of these painful experiences. Frequently, children are under prescribed and underdosed for opioid and nonopioid analgesics due to excessive concerns of respiratory depression and/or poor understanding of the need for pain medications in children. Few data are available to guide the dosing of many pain medications, and the majority of pain medications available on the market today are unlabeled for use in pediatric patients.

PAIN ASSESSMENT

Standardizing pain measurements require the use of appropriate pain assessment tools. Typically, these tools are one of two types: observational/behavioral (measures a patient’s reaction to pain) or self-report (patients quantify and describe pain). Self-report scales are standard of care in the assessment of pain, unless a patient is preverbal, cognitively impaired, or sedated. At most institutions, pain scales are stratified by age (see Table 32–1) and are used throughout the institution from operating room to medical floor to clinic, creating a common language around a patient’s pain. Pain assessment by scales has become the “5th vital sign” in hospital settings and is documented at least as frequently as heart rate and blood pressure at many pediatric centers around the world. There are many pain scales available, all of which have advantages and disadvantages (eg, Figures 32–1 and 32–2, and Table 32–1). For example, research has shown younger and school-age children prefer facial expression pain scales as it may be more difficult for them to understand numeric order and quantify pain, whereas older children and adolescents prefer numeric ratings. It is less important what type of scale is used, but that they are used on a consistent and continuous basis.