CHAPTER 39 - Pain Management in Children
PAIN AND CHILDREN
• Many children are undereducated
because go common misperceptions
about pain in children
• Non pharmacologic intervention should
be employed
• Combinations of pharmacologic and
non-pharmacologic interventions are
often most effective
• Anesthetic cream should be used if
possible
• Medications routes preferred are oral
and intravenous
• Conscious sedation should be used for
painful and frightening procedures
PHYSIOLOGY OF PAIN
Acute Pain - sharp pain; cause extreme
distress anxiety; short of duration
Chronic pain - prolonged period can lead
to depression and decrease pt
Cutaneous Pain - superficial structures
include: skin, repeat injury, non healing skin
ulcers
Somatic Pain - form deep body structures
occurs when pain receptors in tissue are
activated; Two Forms: Superficial and
Deep
Visceral Pain - involves sensation that arise
from internal organs such as the intestines
Referred Pain - pain that is perceived at a
site distant from its origin
9 Danger Signs of Pain
Pain Threshold - the point which the child
first senses pain
Pain Tolerance - the maximum level of
pain a person is able to tolerate
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Gate Control Theory of Pain
- envision gating mechanism in the
substantia gelatinous of the dorsal horn
of the spinal cord that when activated
can halt an impulse at the level of the
cord
can be stimulated:
• Cutaneous stimulation - the peripheral
nerves next to an injury site are
stimulated
• Distraction - allows the cells of the brain
stem that register an impulse as pain to
be preoccupied with other stimuli so a
pain impulse cannot register
• Anxiety Reduction - any attempt to
reduce a child’s anxiety as much as
possible such as teaching the school
age child what to expect with a
procedure, so there are no surprises
can help reduce the anxiety of pain
• Nerve Blocks - way to help reduce
pain and discomfort after surgery.
NURSING PROCESS
Assessment: Type and Degree of Pain
according to Infant, School Age, Toddler
• Poker Chip Tool - a child will be asked to
pick the number of poker chips to shows
the level of his pain. one chip represents
a small amount of pain. Max of 4
• Pain Experience Tool - a tool consisting
eight questions for children and eight
questions for the parents (for school age)
• CRIES Neonatal Postoperative Pain Scale
• Comfort Behavioral Scale - a pain scale
and distress assessment instrument:
Alertness, Calmness, Respiratory response
or crying, Body movements, Facial
tension, Muscle tone; ranges from 6-30
• FLACC Pain assessment tool
• The Face, Leg, Activity, Cry, Com
solubility scale - measurement used to
assess pain for children between 2 most
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CHAPTER 39 - Pain Management in Children
to 7 years or individuals who cannot
communicates; range 0-10
• Wong-Baker FACES Pain Rating Scale
• Oucher Pain Rating Scale - a poster
developed for children to help them
communicate how much pain or hurt
they feel
• Numeric and Visual Analog Scales
• Adolescent Pediatric Pain Tool
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• Logs and Diaries - typically allow
descriptions of duration intensity type
and context of physical activity.
Nursing Diagnosis
Pain related to an invasive procedure
Fear related to anticipation of a painful
procedure
Disturbed sleep pattern related to chronic
pain
PAIN MANAGEMENT
Pain Management dependent on age,
degree
NON PHARMACOLOGICAL
Distraction - a method (behavior
modification) that helps a child focus
attention on a preferred activity in order to
think less about another, less desirable (but
necessary) activity; helps children be less
anxious and more relaxed.
Substitution of meaning or imagery - is a
powerful technique where children use
their imagination to have a sensory
experience (imagining scenes, smells,
texture, actions) that help them to relax
and be distracted from some less pleasant
activity (like having medical procedure)
Thought stopping - Hypnosis is very
effective at alleviating the pain of children
undergoing treatments.
Aromatherapy and Essential Oils - have
been determined to be both safe and
effective for use with children over age;
lavender, peppermint, orange and ginger.
Of these, lavender is the one Battista
suggest trying first. Many children like the
smell and it is generally effective in
calming children.
Herbal Therapies - the study of botany
and the use of medicinal plants. Plants
have been the basis for medical
treatments through much of human history
and each traditional medicine is still widely
used.
Others
- Magnet therapy
- Music Therapy
- Yoga and Meditation
- Acupuncture and acupressure
- Crystal or gemstone
- Biofeedback
- Therapeutic touch and massage
- Tr a n s c u t a n e o u s e l e c t r i c a l n e r v e
stimulation
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CHAPTER 39 - Pain Management in Children
- Heat or cold application
PHARMACOLOGICAL PAIN RELIEF
Topical Anesthetic Cream - medicines that
numb and reduce the sensation of pain in
the area to which they are applied
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abdomen and lower body for 12 to 24
hours or longer if needed; epidural needle
does not enter the cerebrospinal fluid, so
spinal headaches are extremely rare.

Oral Analgesia - ACETAMINOPHEN,

IBUPROFEN, NAPROXEN, DICLOFENAC,
AND KETOROLAC are non-opioid
analgesics that are available for the
treatment of pain. When used alone, they
are adequate to treat mild pain although
they need to be combined with other
agents for moderate to severe pain.

Intramuscular injection - used to deliver

medications deep into the musicles. this
allows medication to be absorbed into the
bloodstream quickly.

Intravenous Administration - delivers fluids

directly into a vein. can be used both for
injections, using a syringe at higher
pressures; as well as for infusions, typically
using only the pressure supply by gravity.

Patient-Controlled Analgesia - any method

allowing a person in pain to administer
their own pain relief. Programmable by the
prescriber; if it is programmed and
functioning as intended, the machine is
unlikely to deliver an overdose of
medication.

Conscious Sedation - refers to the state of

depressed consciousness usually obtained
through analgesia therapy; allows a child
to be both pain free and sedated for the
procedure.

Intranasal administration - absorbs well

from the nasal mucous membrane; very
short in duration it may require repeat
administration.

Local anesthetic injection - stop pain

transmission by blocking nerve conduction
of the impulse at the site of pain. e.g.
bone marrow aspiration, peritoneal dialysis
or suturing a laceration.

Epidural Analgesia - an injection of

analgesic agent into the epidural space
just outside the spinal canal, can be used
to provide analgesia to the lower chest,
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