Abstract

Paediatric pain and its assessment and management are challenging for medical professionals, especially in an urgent care environment. Patients in a paediatric emergency room (PER) often undergo painful procedures which are an additional source of distress, anxiety, and pain. Paediatric procedural pain is often underestimated and neglected because of various myths, beliefs, and difficulties in its evaluation and treatment. However, it is very different from other origins of pain as it can be preventable. It is known that neonates and children can feel pain and that it has long-term effects that last through childhood into adulthood. There are a variety of pain assessment tools for children and they should be chosen according to the patient’s age, developmental stage, communication skills, and medical condition. Psychological factors such as PER environment, preprocedural preparation, and parental involvement should also be considered. There are proven methods to reduce a patient’s pain and anxiety during different procedures in PER. Distraction techniques such as music, videogames, virtual reality, or simple talk about movies, friends, or hobbies as well as cutaneous stimulation, vibration, cooling sprays, or devices are effective to alleviate procedural pain and anxiety. A choice of distraction technique should be individualized, selecting children who could benefit from nonpharmacological pain treatment methods or tools. Nonpharmacological pain management may reduce dosage of pain medication or exclude pharmacological pain management. Most nonpharmacological treatment methods are cheap, easily accessible, and safe to use on every child, so it should always be a first choice when planning a patient’s care. The aim of this review is to provide a summary of paediatric pain features, along with their physiology, assessment, management, and to highlight the importance and efficacy of nonpharmacological pain management in an urgent paediatric care setting.

Highlights

  • The International Association for the Study of Pain defines pain as “an unpleasant sensoric and emotional experience linked to confirmed or possible tissue injury” [1]

  • Painful procedures are usually unexpected, so it intensifies hospital-related stress and anxiety leading to unpleasant experiences and bad memories associated with medical settings that can adversely affect procedure outcomes [3]

  • Effective pain reduction during different procedures in the emergency room (ER) is associated with procedural preplanning, appropriate pain evaluation, parental training, and clear and honest information about the process and associated emotions

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Summary

Introduction

The International Association for the Study of Pain defines pain as “an unpleasant sensoric and emotional experience linked to confirmed or possible tissue injury” [1]. Painful procedures are usually unexpected, so it intensifies hospital-related stress and anxiety leading to unpleasant experiences and bad memories associated with medical settings that can adversely affect procedure outcomes [3] It may further influence future visits and intensify a patient’s fears. Various scales have been created to assist physicians in understanding pain in children of different ages It is crucial for medical staff working in PERs to timely recognize signs and symptoms of pain during the procedures and determine if they are pain related, keeping in mind other possible factors as fear, distress, or manipulation [7]. An additional barrier to optimal pain control can be increased concerns regarding pharmacological pain medication and application methods This results in lower doses of painkillers at home, primary care, ER, and hospital settings. Nonpharmacological measures are able to control procedural-related pain and anxiety and lower doses of required medication and in some cases even avoid pharmacological painkillers [12,13]

Neurobiology and Physiology of Pain—It Is a Different Feeling!
Pain Assessment Strategies
Pain Assessment Tools
Acute Procedural Pain and Anxiety: A Complex Issue
Preprocedural Preparation
Role of a Parent
Resources
Nonpharmacological Pain and Anticipatory Anxiety Treatment
Findings
Conclusions and Recommendations
Full Text
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