Pain Control

Pain management is often an important component of care. It is difficult to assess pain because it is subjective and there are no objective measures of pain. Children are more difficult to manage because their response to pain is so varied and they have problems verbalizing exactly what they are feeling.

There are various means of assessment of pain in children which vary especially with the age of the child. Children can often indicate the severity and location of pain if the questions are appropriate. It is important to reduce the stress and emotional component so that the specific problem of pain can be separated. Pain often induces fear in the child. It must be remembered that some children will deny pain if they are likely to receive an injection for treatment and may deny it to a stranger but admit it to the parent.

By 3 or 4 years of age, children may be able to accurately point to the site pain or to indicate the position on a drawing and this age can use a pain scale to indicate severity. The commonest pain scales for young children involve facial expressions. It is important that the clinician not make a judgment about the amount of pain that a child might have based on behavior alone. Older children may be able to rate pain on score of 1 to 10 and then changes in the pain will usally relate to changes in the number that they assign to the pain.

It is important to be aware of symptoms of pain in the child who is non-verbal. This includes the child who is very young or neourologically impaired. In this situation, abnormal movements or behaviors, such as agitation or restlessness, may indicate pain. Crying or verbalization may suggest pain. Physiologic changes may be uselful signs, including increased heart rate, blood pressure, or respirations. There may be sweating or pupillary changes. All of these indicators may be present when there is pain and absent when the pain is gone or controlled.

Fear of addiction is realistic if there is going to be chronic use of opiate medications. For acute or short-term usage, addiction is unlikely in children.