Current concepts in the diagnosis and management of acute pain in children

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Abstract

BACKGROUND: In children, injuries are the focus of attention both for the increasing incidence and necessity of pain management, and pain can be indicate the severity of injuries or serious complications that worsens the treatment results. Despite the obvious problem, information available in the literature regarding the theoretical and practical aspects of acute pain in children is often contradictory and needs to be systematized.

AIM: To present current information about the epidemiology, physiology, diagnosis, and treatment of acute pain in children to pediatric orthopedic and trauma specialists.

MATERIALS AND METHODS: Selective analysis and narrative review of relevant studies analyzing the epidemiology, diagnosis, and management of acute pain in children were performed.

RESULTS: Although various pain assessment tools are available, the clinical assessment of acute pain in children remains challenging. The use of these tools depends on the child’s age, cognitive and communication skills, and pain location. The term oligoanalgesia has been used to describe inadequate pain relief in the emergency department. Oligoanalgesia in children has negative physiological and psychological effects, sometimes with long-term consequences, and may negatively affect their future pain experiences. Parents often underestimate their child’s pain level and have serious misunderstandings about how children express pain. The World Health Organization has developed recommendations for pain management in children. Ibuprofen and paracetamol are recommended as analgesics for mild-to-moderate pain in children aged >3 months. This choice considered extensive data on the effectiveness and safety.

CONCLUSIONS: Personalized management strategies utilizing biopsychosocial approach will ensure that children are treated comprehensively according to their unique pain status.

About the authors

Vladimir M. Kenis

H. Turner National Medical Research Center for Children’s Orthopedics and Trauma Surgery

Author for correspondence.
Email: kenis@mail.ru
ORCID iD: 0000-0002-7651-8485
SPIN-code: 5597-8832

MD, PhD, Dr. Sci. (Med.), Professor

Russian Federation, 64-68 Parkovaya str., Pushkin, Saint Petersburg, 196603

References

  1. Sterchen TH. Management of pain in the Emergency Department. ISRN Emergency Medicine. 2013;2013. doi: 10.1155/2013/583132
  2. Krauss BS, Calligaris L, Green SM, et al. Current concepts in management of pain in children in the emergency department. Lancet. 2016;387(10013):83–92. doi: 10.1016/S0140-6736(14)61686-X
  3. Selbst SM, Clark M. Analgesic use in the emergency department. Ann Emerg Med. 1990;19(9):1010–1013. doi: 10.1016/s0196-0644(05)82565-x
  4. Karreman E, Krause CS, Smith S. Children receive less analgesia in general ERs than adults: a retrospective study. JEMTAC. 2016;2016(1):1–5. doi: 10.5339/jemtac.2016.1
  5. Drendel AL, Brousseau DC, Gorelick MH. Pain assessment for pediatric patients in the emergency department. Pediatrics. 2006;117(5):1511–1518. doi: 10.1542/peds.2005-2046
  6. Albertyn R, Rode H, Millar AJ, et al. Challenges associated with paediatric pain management in Sub Saharan Africa. Int J Surg. 2009;7(2):91–93. doi: 10.1016/j.ijsu.2009.01.005
  7. Eccleston C, Fisher E, Howard RF, et al. Delivering transformative action in paediatric pain: a Lancet Child & Adolescent Health Commission. Lancet Child Adolesc Health. 2021;5(1):47–87. doi: 10.1016/S2352-4642(20)30277-7
  8. American Academy of Pediatrics. Committee on Psychosocial Aspects of Child and Family Health; Task Force on Pain in Infants, Children, and Adolescents. The assessment and management of acute pain in infants, children, and adolescents. Pediatrics. 2001;108(3):793–797. doi: 10.1542/peds.108.3.793
  9. Beltramini A, Milojevic K, Pateron D. Pain Assessment in newborns, infants, and children. Pediatr Ann. 2017;46(10):e387–e395. doi: 10.3928/19382359-20170921-03
  10. Walker SM. Pain in children: recent advances and ongoing challenges. Br J Anaesth. 2008;101(1):101–110. doi: 10.1093/bja/aen097
  11. Lohman D, Schleifer R, Amon JJ. Access to pain treatment as a human right. BMC Med. 2010;8:8. doi: 10.1186/1741-7015-8-8
  12. Craig KD, Grunau RV, Anand KJ, et al, editors. Neonatal pain perception and behavioral measurement. In: Pain research and clinical management. New York: Elsevier, 1993. P. 67–99.
  13. Herr K, Coyne PJ, Ely E, et al. Pain Assessment in the patient unable to self-report: clinical practice recommendations in support of the ASPMN 2019 position statement. Pain Manag Nurs. 2019;20(5):404–417. doi: 10.1016/j.pmn.2019.07.005
  14. Izsak E, Moore JL, Stringfellow K, et al. Prehospital pain assessment in pediatric trauma. Prehosp Emerg Care. 2008;12(2);182–186. doi: 10.1080/10903120801907471
  15. Herd DW, Babl FE, Gilhotra Y, et al; PREDICT group. Pain management practices in paediatric emergency departments in Australia and New Zealand: a clinical and organizational audit by National Health and Medical Research Council’s National Institute of Clinical Studies and Paediatric Research in Emergency Departments International Collaborative. Emerg Med Australas. 2009;21(3). doi: 10.1111/j.1742-6723.2009.01184.x
  16. Friedrichsdorf SJ, Postier A, Eull D, et al. Pain outcomes in a US children’s hospital: a prospective cross-sectional survey. Hosp Pediatr. 2015;5(1):18–26. doi: 10.1542/hpeds.2014-0084
  17. Wilson JE, Pendleton JM. Oligoanalgesia in the emergency department. Am J Emerg Med. 1989;7(6):620–623. doi: 10.1016/0735-6757(89)90286-6
  18. Wintgens A, Boileau B, Robaey P. Posttraumatic stress symptoms and medical procedures in children. Can J Psychiatry. 1997;42(6):611–616. doi: 10.1177/070674379704200607
  19. Taddio A, Katz J. The effects of early pain experience in neonates on pain responses in infancy and childhood. Paediatr Drugs. 2005;7(4);245–257. doi: 10.2165/00148581-200507040-00004
  20. Browne LR, Studnek JR, Shah MI, et al. Prehospital Opioid administration in the emergency care of injured children. Prehosp Emerg Care. 2016;20(1):59–65. doi: 10.3109/10903127.2015.1056897
  21. Singer AJ, Gulla J, Thode HC Jr. Parents and practitioners are poor judges of young children’s pain severity. Acad Emerg Med. 2002;9(6):609–612. doi: 10.1197/aemj.9.6.609
  22. Manocha S, Taneja N. Assessment of paediatric pain: a critical review. J Basic Clin Physiol Pharmacol. 2016;27(4):323–331. doi: 10.1515/jbcpp-2015-0041
  23. Wong C, Lau E, Palozzi L, et al. Pain management in children: part 1 – pain assessment tools and a brief review of nonpharmacological and pharmacological treatment options. Can Pharm J (Ott). 2012;145(5):222–225. doi: 10.3821/145.5.cpj222
  24. Peacock S, Patel S. Cultural influences on pain. Rev Pain. 2008;1(2):6–9. doi: 10.1177/204946370800100203
  25. Vetter TR, Bridgewater CL, Ascherman LI, et al. Patient versus parental perceptions about pain and disability in children and adolescents with a variety of chronic pain conditions. Pain Res Manag. 2014;19(1):7–14. doi: 10.1155/2014/736053
  26. Foltin GL, Dayan P, Tunik M, et al. Priorities for pediatric prehospital research. Pediatr Emerg Care. 2010;26(10). doi: 10.1097/PEC.0b013e3181fc4088
  27. Conrad C, Soni P, Coorg V, et al. Prehospital analgesic administration by parents for pain relief in children. Pediatr Emerg Care. 2019;35(5). doi: 10.1097/PEC.0000000000001622
  28. Twycross AM, Williams AM, Bolland RE, et al. Parental attitudes to children’s pain and analgesic drugs in the United Kingdom. J Child Health Care. 2015;19(3):402–411. doi: 10.1177/1367493513517305
  29. Chambers CT, Reid GJ, Craig KD, et al. Agreement between child and parent reports of pain. Clin J Pain. 1998;14(4):336–342. doi: 10.1097/00002508-199812000-00011
  30. Spedding RL, Harley D, Dunn FJ, et al. Who gives pain relief to children? J Accid Emerg Med. 1999;16(4). doi: 10.1136/emj.16.4.261
  31. Maimon MS, Marques L, Goldman RD. Parental administration of analgesic medication in children after a limb injury. Pediatr Emerg Care. 2007;23(4):223–226. doi: 10.1097/PEC.0b013e31803f5adc
  32. Williams DM, Rindal KE, Cushman JT, et al. Barriers to and enablers for prehospital analgesia for pediatric patients. Prehosp Emerg Care. 2012;16(4):519–526. doi: 10.3109/10903127.2012.695436
  33. Murphy A, Barrett M, Cronin J, et al. A qualitative study of the barriers to prehospital management of acute pain in children. Emerg Med J. 2014;31(6):493–498. doi: 10.1136/emermed-2012-202166
  34. Murphy A, McCoy S, O’Reilly K, et al. A Prevalence and management study of acute pain in children attending emergency departments by ambulance. Prehosp Emerg Care. 2016;20(1):52–58. doi: 10.3109/10903127.2015.1037478
  35. Krechel SW, Bildner J. CRIES: a new neonatal postoperative pain measurement score. Initial testing of validity and reliability. Paediatr Anaesth. 1995;5(1):53–61. doi: 10.1111/j.1460-9592.1995.tb00242.x
  36. Ge X, Tao JR, Wang J, et al. Bayesian estimation on diagnostic performance of face, legs, activity, cry, and consolability and neonatal infant pain scale for infant pain assessment in the absence of a gold standard. Paediatr Anaesth. 2015;25(8):834–839. doi: 10.1111/pan.12664
  37. Savedra M, Gibbons P, Tesler M, et al. How do children describe pain? A tentative assessment. Pain. 1982;14(2):95–104. doi: 10.1016/0304-3959(82)90091-4
  38. Fortuna RJ, Robbins BW, Caiola E, et al. Prescribing of controlled medications to adolescents and young adults in the United States. Pediatrics. 2010;126(6):1108–1116. doi: 10.1542/peds.2010-0791
  39. Hewes HA, Dai M, Mann NC, et al. Prehospital pain management: disparity by age and race. Prehosp Emerg Care. 2018;22(2):189–197. doi: 10.1080/10903127.2017.1367444
  40. Srouji R, Ratnapalan S, Schneeweiss S. Pain in children: assessment and nonpharmacological management. Int J Pediatr. 2010;2010. doi: 10.1155/2010/474838
  41. Leahy S, Kennedy RM, Hesselgrave J, et al. On the front lines: lessons learned in implementing multidisciplinary peripheral venous access pain-management programs in pediatric hospitals. Pediatrics. 2008;122(Suppl 3):S161–S170. doi: 10.1542/peds.2008-1055i
  42. Craig KD, Lilley CM, Gilbert CA. Social barriers to optimal pain management in infants and children. Clin J Pain. 1996;12(3):232–242. doi: 10.1097/00002508-199609000-00011
  43. Krauss BS, Krauss BA, Green SM. Videos in clinical medicine. Managing procedural anxiety in children. N Engl J Med. 2016;374(16):e19. doi: 10.1056/NEJMvcm1411127
  44. WHO guidelines on the pharmacological treatment of persisting pain in children with medical illnesses. Geneva: World Health Organization; 2012.
  45. rosminzdrav.ru [Internet]. State register of medicines. Available from: https://grls.rosminzdrav.ru.
  46. Lutz M. Metamizole (dipyrone) and the liver: a review of the literature. J Clin Pharmacol. 2019;59(11):1433–1442. doi: 10.1002/jcph.1512
  47. Saygitov R. Efficacy of ibuprofen in treatment of pain in children: systematic review of randomized controlled studies. Current Pediatrics. 2010;9(6):52–62. EDN: NELVCN
  48. Ali S, Manaloor R, Johnson DW, Rosychuk RJ, et al; Pediatric Emergency Research Canada. An observational cohort study comparing ibuprofen and oxycodone in children with fractures. PLoS One. 2021;16(9). doi: 10.1371/journal.pone.0257021
  49. Poonai N, Bhullar G, Lin K, et al. Oral administration of morphine versus ibuprofen to manage postfracture pain in children: a randomized trial. CMAJ. 2014;186(18):1358–1363. doi: 10.1503/cmaj.140907
  50. Jelinek GA. Ketorolac versus morphine for severe pain. Ketorolac is more effective, cheaper, and has fewer side effects. BMJ. 2000;321(7271):1236–1237. doi: 10.1136/bmj.321.7271.1236
  51. Chang AK, Bijur PE, Esses D, et al. Effect of a single dose of oral opioid and nonopioid analgesics on acute extremity pain in the emergency department: a randomized clinical trial. JAMA. 2017;318(17):1661–1667. doi: 10.1001/jama.2017.16190
  52. Bailey E, Worthington HV, van Wijk A, et al. Ibuprofen and/or paracetamol (acetaminophen) for pain relief after surgical removal of lower wisdom teeth. Cochrane Database Syst Rev. doi: 10.1002/14651858.CD004624.pub2
  53. Smith MD, Spiller HA, Casavant MJ, et al. Out-of-hospital medication errors among young children in the United States, 2002–2012. Pediatrics. 2014;134(5):867–876. doi: 10.1542/peds.2014-0309
  54. Geppe NA, Kolosova NG, Malakhov AB, et al. Fever management in children with acute respiratory tract infections. Doctor.Ru. 2021;20(10):6–11. EDN: JTZLTU doi: 10.31550/1727-2378-2021-20-10-6-11
  55. Danilov AB, Danilov AB. Physiological and psychological model and chronic pain. Modern therapy in psychiatry and neurology. 2013;(1):30–36. (in Russ.) EDN: PXUFGF

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2. Figure. Results of a randomized clinical trial of the effect of single-dose opioid and nonopioid analgesics given orally on acute limb pain in the emergency department [51]. Pain scores according to the numerical rating scale and their reduction after 1 and 2 h of followup

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