1. Pediatric Pain: Assessment and treatment Cheryl Stohler RN BSN Wolfson Children’s Hospital Children’s Ambulatory Center 2013

2.  The absolute value of the pain-intensity score is not as important as the changes in scores in each individual child.  Trending is most important to assess progress of pain control  Scoring shows effectiveness of pain interventions

4. Wong Baker Faces Pain Rating Scale Research suggest that FACES is the preferred method for identifying pain in children ages 3-18. Advantages: Quick and simple to use Minimal instructions required Translated into >10 languages Preferred by children and nurses Available free of charge Can be used in conjunction with VAS Disadvantages: Confuses affect (smiles/tears) with pain intensity Ratings are higher than on scales with a neutral “no-pain” face Limited psychometric testing of translations

5. VAS = visual analogue scale Rating scale of 0 for no pain and 10 severe pain Best used with school age children with concept of numbers Advantages: Simple and quick to score Avoids imprecise descriptive terms Provides measuring points Can be used in conjunction with faces scale Disadvantages: Require cognitive and linguistic development Need of concentration and coordination (difficult for sedated or neurological disorders)

7. FLACC Behavioral Pain Assessment Scale F = Face L = Legs A = Activity C= Cry C= Consolability Advantages: Uses for infants and non-verbal children Observational expression Use for children below age 2 months-7years old Calculation of pain score in EMR Disadvantages: Observational expression In older children may contain expressive behavior –not pain

8. Types of pain Acute – surgical, procedures, accidents/injuries Continuous/Chronic – JA, neurological/neuropathy pains, cancers, osteo’s’ Disease associated (periodic) - sickle cell, CF, MS, asthmas

9. Types of pain control Pharmalogical vs. non-pharmalogical Topical/local Oral IV IM “Around the clock” dosing “As needed” dosing Patient – controlled analgesia

10. Documentation in EMR  Assessment - what scale was used? What medication would be most appropriate to use?  Treatment – what was done  Re-assessment – was it effective?  Education – was the parent educated on the medication?

13. LOOK MOM – NO PAIN!!

14. References Chiaretti, A., Pierri, F., Valentini, P., Russo, I., Gargiullo, L. & Riccardi, R. (2013). Current practice and recent advances in pediatric pain management. European Review for Medical and Pharmacoloical Sciences 17(1), 112-126 Messerer, B., Gutmann, A., Weinber, A. & Sandner-Kiesling, A. (2010) Implementation of a standardized pain management in a pediatric surgery unit. Pediatric Surgery Int. 26, 879-889. doi: 10.1007/s00383-010-2642-1 Tomlinson, D., Baeyer, C., Stinson, J. & Sung, L. (2010) A systematic review of faces scales for the self-report of pain intensity in children. Pediatrics 126(5)