Health Watch

Pediatric pain: (An interview with Lori Kozlowski)

Your recent research suggests that many hospitalized children still experience serious pain. What kind of pain did your research refer to, i.e. what were the causes of the children’s pain?

The pain experienced by the infants, children and adolescents in our study was the result of a broad range of medical and surgical conditions. Almost 70% of the children had pain related to a “major” or “minor” surgical procedure, such as a posterior spinal fusion or tonsillectomy.

Most of the remaining children had pain related to an underlying condition, such as sickle cell disease or cancer. However, a few reported procedural or “nuisance” pain related to diagnostic tests, intravenous catheters, etc.

Do some children experience disproportionally worse pain than others?

Some children did describe moderate or severe pain despite aggressive interventions. These children included those undergoing major surgical procedures, cancer patients receiving chemotherapy who experienced mouth or throat pain from mucositis, children with sickle cell vaso-occlusive crisis, and children with burn pain.

How does the age of the child affect their experience of pain?

We found that older children reported higher pain scores than younger children. However, we don’t know for sure if they actually experienced more severe pain because older children self-assess their pain while in young children pain is “measured” using objective behavioral assessment tools which tend to underestimate pain.

How many hospitalized children does serious pain continue to affect?

In our Children’s Center, 40% if hospitalized children reported moderate or severe pain at some time during their hospitalization. These results are consistent with recent studies in both adults and children.

Why, other than making them very uncomfortable, is pain such a bad thing for children?

Pain can have many negative effects. Studies have shown that untreated or undertreated pain can lead to delayed wound healing, infection, anxiety, prolonged hospitalization, exaggerated response to pain and increased sensitivity to pain for life, and even death.

How could pediatric pain be lessened?

Several strategies for decreasing pediatric pain include:

1.         Treating pain pre-emptively and being alert for continuing pain

2.         Treating pain at regular intervals (“around the clock”) if it is persistent rather than on an “as needed” basis with appropriate doses of pain medicine

3.         Carefully considering potential differences in children as to their pain experience, including age, gender and race

What are the restrictions when treating pediatric pain? Presumably there is a need for lower dosages of pain-relief medication than those given to adults?

Medications used to treat pain in children are typically based on the weight and age of the child. Neonates, infants and children can receive pain medications safely with proper age and weight-related adjustments in dosing.

Do these restrictions require any particularly specialist medical personnel?

Children expected to experience severe or chronic pain may benefit from the involvement of a pediatric pain specialist. However, it is important that general pediatricians and pediatric surgeons should also be trained in the treatment of pain in children.This training should include understanding how to assess pain, the different types of pain medications available to treat pain (anti-inflammatory medications, opioids, medications to treat nerve-mediated pain), and the impact of different ages, weights, and chronic medical conditions on pain management.

Does this restrict which hospitals could realistically lower pediatric pain levels?

Regulatory agencies mandate that all hospitals establish policies and procedures that support appropriate ordering of pain medications. While children expected to experience severe pain, or those with special medical or surgical needs, may require specialty treatment at tertiary care hospitals, more frequently it is the general pediatrician or pediatric surgeon who is responsible for caring for infants, children and adolescents experiencing mild or moderate pain.

Thus, training these physicians in the assessment and treatment of pain in children will help lower pediatric pain levels. There are a multitude of resources available to help these practitioners so that pain can be managed in any setting (i.e. World Health Organization guidelines).

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