Over the years, significant advances have been made in the understanding and practice of pediatric pain management. Previous myths such as the inability of infants to experience pain or the inessential need to treat perioperative nociception or postoperative pain have been debunked by the evidence of mature nociceptive pathways by 30 weeks of gestation (Lowery et al. 2007) and the unquestionable benefits of treating noxious stimuli with analgesics (Anand et al. 1987, Anand and Hickey 1992).
Despite these important advances, pediatric pain management remains undertreated and challenging for the practitioner. In a study looking at the treatment of painful procedures in neonates in the intensive care unit, out of 42,413 painful procedures 79.2% were treated without specific analgesia (Carbajal et al. 2008). Furthermore compared to the pain assessment for adult and older pediatric patients, assessment of pain in nonverbal pediatric patients or patients with chronic diseases such as sickle cell is often more difficult for the practitioner. For the nonverbal infant, crying may not be due to pain but simple factors such as hunger or the stress of being in a strange hospital environment. For the sickle cell patient in acute crisis, the biophysical profile may not reflect typical changes seen in acute pain. Yet given the ever changing landscape of pediatric pain management with regard to newer assessment scales or pharmacological and non-pharmacological approaches, one basic principle remains clear. Communication among patient, parents, surgical, pediatric, and pain teams regarding assessment, treatment, potential treatment side effects, and treatment alternative is both an imperative and the foundation for a successful and sound pediatric pain management strategy.
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