1. Pediatric Pain Management

2. Pain
Definition: Physiological response transmitted through the nervous system that notifies your body that something is wrong
Acute
Chronic
Gate control theory: pain is a complex phenomenon that includes both physiological and psychological input
*emotional factors (e.g., anxiety) can increase pain perception in children

3. Distress
Definition: an increase in the amount of pain “experienced” by the patient often caused by psychological factors
The emotional experience of pain
Variables that influence distress
Age
Prior experience
Parent anxiety/response
Coping skills
Approach (try to deal) vs. avoidance (hide, run, pull away)

4. Biobehavioral Model Intervening Variables Biological Predisposition
Family Environment
Cognitive Appraisal
Coping Strategies
Perceived Social Support

5. Categories of Pediatric Pain
Associated with chronic illness
Sickle cell, arthritis
Associated with physical injury/trauma
Burns, broken bones
Not associated with illness or injury
Headache
Associated with medical/dental procedures
Injections, surgeries

6. Common Referral Issues
If the treating team believes the procedure to be highly painful or distressing
If the treating team has concerns about the child ability to cope with the procedure
If the child has experienced more than expected pain and distress during previous procedures

7. Pain Assessment Self Report Other report Visual Analog Scale
Faces Pain Scale
*pain is personal and subjective
Other report
Parent
Staff
*advantage of comparisons

9. Pain Assessment Behavioral Observation Physiological
Child-Adult Medical Procedure Interaction Scale (CAMPIS)
Adult vocalizations: Praise, Commands, Criticism
Child vocalizations: Cry, Information Seeking
Behavioral Approach-Avoidance and Distress Scale (BAADS)
Physiological
Heart rate
Blood pressure
Breathing rate

10. Pain Assessment Reading: Blount et al (2006)
Child distress most often preceded by adults’ reassuring comments, apologies, empathy, criticism of child
Child distress inversely correlated with adults’ coaching of the children to cope and child coping behaviors (I..e, distraction, breathing, making coping statements)
Pg 35

11. Cognitive Behavioral Management of Chronic Pain
Framework: Gate control theory and biobehavioral model
1. Pain Perception Regulation
Progressive Muscle Relaxation
Deep Breathing
Guided Imagery
incompatible

12. Cognitive Behavioral Management of Chronic Pain
2. Pain Behavior Modification
Encourage adaptive behaviors – HOW?
Pain behaviors: crying, resting
Coping
Relaxation
Distraction
Discourage maladaptive behaviors – HOW?
Pain behaviors: secondary gain
Helplessness

13. Cognitive Behavioral Management of Chronic Pain
3.Intervening variables
Family environment and Social Support
Establish support systems
Encourage parent to empower child
Coping skills
Filmed modeling
Coaching
Incentives
Cognitive appraisals
Blame: “I deserve this.”
Anticipated pain: “This is going to hurt REALLY bad – I can’t do it!”
CBT has been found to be more cost-effective than medications
Although medications do also help

14. Conclusions Children can accurately report their pain
Pharmacological and psychological treatments often are both necessary
Cognitive-behavioral therapy can increase children’s coping and decrease their distress
Adequate pain control is a measure of the quality of treatment