Pain and acute stress reaction in pediatric physical injury

Abstract

Children who experience physical injury requiring hospitalization have been shown to develop Acute Stress Disorder (ASD) and later Posttraumatic Stress Disorder (PTSD). When a trauma requires medical intervention, the physical integrity of the child is threatened along with the child’s psychological integrity. The injury, resulting medical procedures and associated pain symptoms can each be a traumatic experience. Recent studies argue that chronic pain and PTSD can be a mutually maintaining condition and that effective pharmacological interventions for pain may actually decrease the incidence of ASD/PTSD symptoms. The current study is investigating children (8–18) and their caregivers following a traumatic event requiring hospitalization. The study is an ongoing prospective multi-rater quasi-experimental design to assess the immediate, 1-month and 3-month impact of physical injury on the development of ASD and later PTSD. Instrumentation includes the Acute Stress Checklist-Kids, the UCLA PTSD Checklist and child/parental self-report questionnaires (i.e., CBCL, Pain Inventory, PedsQL, KIDCOPE, PCL-C). Two case reports are discussed comparing acute stress symptoms, acute pain, and physiological measures from initial paramedic intervention to the emergency department. Both children reported acute stress symptoms, significant pain levels, and increased physiological levels (heart rate and mean arterial blood pressure (MAP)). The data revealed that the child who received early and dose/weight specific analgesia (.06mg/kg) had fewer acute stress symptoms, faster pain relief, and decreased heart rate responsivity. Whereas, the child who received a sub-therapeutic dose of pain medication (.03mg/kg) continued to have an elevated heart rate and met criteria for ASD. While acute pain following an acute physical injury has not been an identified as a symptom or a trigger of ASD/PTSD, this data begins to suggest that untreated acute pain may exacerbate a child’s risk of developing ASD and that the assessment and treatment of pain symptoms require closer investigation. Children who experience physical injury requiring hospitalization have been shown to develop Acute Stress Disorder (ASD) and later Posttraumatic Stress Disorder (PTSD). When a trauma requires medical intervention, the physical integrity of the child is threatened along with the child’s psychological integrity. The injury, resulting medical procedures and associated pain symptoms can each be a traumatic experience. Recent studies argue that chronic pain and PTSD can be a mutually maintaining condition and that effective pharmacological interventions for pain may actually decrease the incidence of ASD/PTSD symptoms. The current study is investigating children (8–18) and their caregivers following a traumatic event requiring hospitalization. The study is an ongoing prospective multi-rater quasi-experimental design to assess the immediate, 1-month and 3-month impact of physical injury on the development of ASD and later PTSD. Instrumentation includes the Acute Stress Checklist-Kids, the UCLA PTSD Checklist and child/parental self-report questionnaires (i.e., CBCL, Pain Inventory, PedsQL, KIDCOPE, PCL-C). Two case reports are discussed comparing acute stress symptoms, acute pain, and physiological measures from initial paramedic intervention to the emergency department. Both children reported acute stress symptoms, significant pain levels, and increased physiological levels (heart rate and mean arterial blood pressure (MAP)). The data revealed that the child who received early and dose/weight specific analgesia (.06mg/kg) had fewer acute stress symptoms, faster pain relief, and decreased heart rate responsivity. Whereas, the child who received a sub-therapeutic dose of pain medication (.03mg/kg) continued to have an elevated heart rate and met criteria for ASD. While acute pain following an acute physical injury has not been an identified as a symptom or a trigger of ASD/PTSD, this data begins to suggest that untreated acute pain may exacerbate a child’s risk of developing ASD and that the assessment and treatment of pain symptoms require closer investigation.