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Drukuj stronęAssessment and treatment of pain in pediatric patients.
Category
Pathophysiological
Etiologically
Based on duration
Based on location
Assessment of Pain in Pediatrics
Pain is often referred to as the "fifth vital sign" and it should
be assessed and recorded as often as other vital signs.
The appropriate intervention of pain is planned based
on the accurate valuation of pain. Organized and routine
pain assessment by using the standardized and validated
measures is accepted as a corner stone for effective pain
management in patients, unrelatedly to the age or other
conditions [21]. A study in Brazil suggests that consistent
accomplishment of assessments of pain using ordinary
scales, such as Face, Legs, Activity, Cry and Consolability
score and other bodily parameters are mandatory to
optimize pain management in pediatric intensive care
units [22]. As pain is a subjective experience, individual
self-reporting is the favorite method for assessing
pain. However, when valid self-report is not available
as in children who cannot communicate due to age or
developmental status, the observational and behavioral
assessment tools are acceptable substitutions [5,7,22].
The use of the pain management algorism on Stollery
children's hospital shows significant improvement for
assessment of pain in pediatrics. The pre and post analysis
indicated in a staff (n=17) given that a feedback of 41.2%
felt that the algorism improved their ability to assess and
manage pain in children equally, 35% felt that it increased
Curr Pediatr Res 2017 Volume 21 Issue 1
Table 1. The general classification of pain in pediatrics [3,4,8,15-20]
Sub-classification
This type of pain arises as the tissue injury activates specific pain receptors
named nociceptors, which are sensitive to noxious stimuli. These
receptors' can respond to different stimulus and chemical substances
Nociceptive pain
released from tissues in response to oxygen deprivation, tissue disruption
or inflammation. It can be somatic or visceral pain based on the site of
the activated receptors.
This type of pain arises when the abnormal processing of sensory input
Neuropathic pain
recognized by the peripheral or central nervous system.
It includes the pain due to chronic musculoskeletal pains, neuropathic
pains, visceral pain (like distension of hollow viscera and colic pain) and
Non-malignant
chronic pain in some specific anemia. Rehabilitation care is there main
treatment protocol.
This is the pain in potentially life-limiting diseases such as multiple
sclerosis cancer, HIV/AIDS, end stage organ failure, amyotrophic lateral
sclerosis, advanced chronic obstructive pulmonary disease, Parkinsonism
Malignant
and advanced congestive heart failure. These illnesses are indicating for
similar pain treatment that emphases more on symptom control than
function.
This is pain of recent onset and probable limited duration. It usually has
Acute
an identifiable temporal and causal relationship to injury or disease. Most
acute pain resolves as the body heals after injury.
It is the pain which lasts a long time mostly 6 months, which commonly
Chronic
persisting beyond the time of curing of an injury and may be without any
clearly identifiable cause.
When Pain is often classified by body site (e.g. on head, on the back
or neck) or it can be the anatomic function of the affected tissue (e.g.
vascular, rheumatic, myofascial, skeletal, and neurological). It does not
provide a background to resolve pain, but it can be useful for differential
diagnoses.
Description
their capacity to communicate a child's pain with other
health care team members, 52.9% felt that the algorism
should be further applied on other units across the hospital
[23]. Even though, the assessment of pain symptoms is
easy in adults, selection of appropriate pain assessment
tools should consider age, cognitive level and the presence
of eventual disability, type of pain and the situation in
which pain is occurring in children. Therefore, healthcare
professionals need to be aware of their limitations in
addition to trained in the use of pain assessment tools
[7,24,25].
The assessment in Canadian pediatric teaching hospitals
indicated out of 265 children, majority (63%) of them
found with a minimum of one documented pain assessment
tool, 30% of children had at least two assessment tools,
17% had 3-5 measurement tools and 16% had at least
six assessments in 24 h of admission. Most (63%) of
the children were find a different document of 666 pain
assessment tools, with a median of three assessments per
one child [14]. Parent, patient, as well as staff satisfaction
is positively associated with accurate assessment of pain in
addition to well improvement of pain management. Brief
and well validated tools are available for the assessment
of pain in non-specialist settings. Nevertheless, each tool
cannot be broadly suggested for assessment of pain in all
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