Pediatric Pain Management in the Emergency Department

Points and Pearls Excerpt

• Untreated or undertreated pain in pediatric patients can lead to anxiety, greater pain response to later stimuli, post-traumatic stress, and persistent medical fear.
• Pain should be assessed upon presentation and during the visit. Changes in pain scores can help determine the effectiveness of interventions.
• The gold standard and most desirable method for pain assessment, when obtainable, is based upon self-report of pain by the patient. Self-reporting pain assessment scales exist for children as young as 3 years of age; behavioral pain scales exist for younger or nonverbal children.
• Nonpharmacological pain management (eg, distraction techniques and behavioral interventions) can reduce anxiety and procedural pain and increase parental satisfaction.

Most Important References

• Friedland LR, Pancioli AM, Duncan KM. Pediatric emergency department analgesic practice. Pediatr Emerg Care. 1997;13(2):103-106. (Retrospective review; 1994 subjects)
• * Birnie KA, Noel M, Chambers CT, et al. Psychological interventions for needle-related procedural pain and distress in children and adolescents. Cochrane Database Syst Rev. 2018;10:CD005179. (Systematic review; 59 studies)
• Ferguson C, Loryman B, Body R. Best evidence topic report: topical anaesthetic versus lidocaine infiltration to allow closure of skin wounds in children. Emerg Med J. 2005;22(7):507-509. (Systematic review)
• Kraemer F, Rose J. Pharmacologic management of acute pediatric pain. Anesthesiol Clin. 2009;27(2):241-268. (Review)
• * Borland M, Jacobs I, King B, et al. A randomized controlled trial comparing intranasal fentanyl to intravenous morphine for managing acute pain in children in the emergency department. Ann Emerg Med. 2007;49(3):335-340. (Randomized controlled trial; 67 subjects)
• * Green R, Buloch B, Kabani A, et al. Early analgesia for children with acute abdominal pain. Pediatrics. 2005;116(4):978-983. (Randomized controlled trial; 108 subjects)