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Assessment and treatment of pain in pediatric patients.

Table 7. Opioids commonly used in pediatric pain management [12,50,51]

Drugs

Morphine

Codeine

Oxycodone

Methadone

Fentanyl

Indication Based on Pain Intensity

• Stage 1 – Non-opioid +/- adjuvant agent for mild

pain

• Stage 2 – Opioid +/- non-opioid +/- adjuvant agent.

For moderate to severe pain or pain uncontrolled

after Step 1.

Common Analgesic Adjuvant

When a drug has a primary indication other than pain

but is analgesic in some conditions it can be describe

as adjuvant analgesic. Such adjuvants mainly used

for the treatment of non-malignant pain in combined

with primary analgesics to improve the outcome and to

maintain the balance between relief and side effect [12].

Moreover, adjuvants can provide independent analgesic

activity and treat concurrent symptoms that exacerbate

pain for specific types of pain. The most commonly used

adjuvants such as anti-depressants (amitriptyline), topical

and local anesthetics and anticonvulsants (e.g. gabapentin

and pregabaline) for neuropathic pain, steroids in edema

induced pains, bisphosphonates and radiation therapy for

metastases bone pain, neuroleptics for pain associated

with anxiety, restlessness or nausea) [7,27,52].

Conclusion

In summary, numerous clinical practice guidelines and

policy statements have been published in the last 10 years

about pediatric pain. These publications are valuable

resources for physical therapists and other health care

providers who serve infants, children, and adolescents

who have, or are at risk for, pain resulting from diverse

etiologies. Improved management is contingent on valid

and reliable measurement of pain. Fortunately, there

are many excellent pediatric pain measures. Selection

of appropriate measures requires an understanding of

pain, measurement, and child development. Because,

measurement of pain in infants, young children, and

Curr Pediatr Res 2017 Volume 21 Issue 1

Usual Recommended Starting Dose

Oral

0.3 mg/kg every 3–4 h

0.5–1 mg every 3–4 h

0.1–0.2 mg/kg every 3–4 h

0.2 mg/kg every 4–8 h

5–15 mcg/kg Oralet

Parenteral

0.1 mg/kg every 3–4 h

Not recommended

0.1 mg/kg every 4–8 h

1 mcg/kg every 1–2 h

children with disabilities who are unable to self-

report is particularly challenging and merits increased

attention. These assessment tools have a basic benefit to

the health care providers who are involved in pediatric

health management to control the pain through non-

pharmacological and pharmacological interventions. On

top of that, pediatric institutions are well positioned to

support and implement policy initiatives to improve the

identification and management of pediatric pain and to

contribute new knowledge through research.

Recommendations

An appropriate pain assessment measurements and

techniques are needed to manage pain in pediatric

patients and should be applied in every pediatric health

care institution. Firstly, high possible standard of pain

care for all patients should be provided through a

multi modal (non-pharmacological, pharmacological

and adjuvants) approach. Secondly, pediatric centers

collaboration will be necessary to share the standard

treatment protocol. Finally, even though the incidence

of pain in children is like that of adults, clinicians should

have considered the distinctiveness of children. The

Cooperation of the caregivers and families are essential

for successful pain assessment and its intervention in

pediatric patients.

References

1. O'Rourke D. The measurement of pain in infants,

children and adolescents: from policy to practice.

Physical Therapy 2004; 84: 560-570.

2. Harris J, Ramelet AS, Dijk Mv, et al. Clinical

recommendations for pain, sedation, withdrawal and

delirium assessment in critically ill infants and children.

Intensive Care Med 2016; 42: 972-986.

3. Hospital TJH. Interdisciplinary clinical practice manual.

Pain, Assesment and management 2001.

Comments

Used as a standard of

comparison for all opioid

drugs

Codeine is a pro-drug and

not all patients convert

it to an active form to

achieve analgesia

Use as first line therapy

for severe pain

0.1mg/kg commonly used

for acute pain 0.2-0.4 mg/

kg commonly used for

chronic pain

The Oralet is not widely

used because of nausea

and vomiting side effects

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