Pediatric Pain Management Research Articles

Approaches to Pediatric Chest Pain: A Narrative Review

Chest pain in children and adolescents is a common reason for emergency department visits and referrals to pediatric cardiologists, often driven by parental concern about potential cardiac causes. However, the vast majority of pediatric chest pain cases are benign and non-cardiac in origin. This narrative review examines the etiology, evaluation, and management of pediatric chest pain, emphasizing the importance of a thorough clinical history and physical examination in distinguishing between benign and serious conditions. This review also explores the role of diagnostic tests such as electrocardiograms, chest radiography, and echocardiography, highlighting the need to balance the avoidance of unnecessary tests with the imperative to rule out life-threatening cardiac conditions. Despite the low prevalence of cardiac causes, the variability in diagnostic approaches underscores the need for standardized evaluation algorithms. These could streamline care, reduce unnecessary resource utilization, and minimize anxiety for both patients and their families. Future studies should focus on assessing the effectiveness of such algorithms in improving clinical outcomes and resource management. The findings underscore the importance of a careful, evidence-based approach to the management of pediatric chest pain.

Helping Educators Learn Pediatric Pain Assessment and Intervention Needs Program (HELP PAIN): Program Development with Community Partners

Background/Objectives: This paper details the development of the Helping Educators Learn Pediatric Pain Assessment and Intervention Needs (HELP PAIN) program. Methods: HELP PAIN is an 8 h live training program for school providers (e.g., school nurses and social workers) to use evidence-based nonpharmacologic pediatric pain management tools. The program’s scope reflected the reach of the participating intermediary community organizations, resulting in focused training in rural northwest Michigan due to the Health Department of Northwest Michigan’s service in that region and statewide reach due to the broad representation of members from the Michigan Association of School Nurses. Results: We describe the development of the HELP PAIN program, drawing on evidence-based nonpharmacologic (e.g., cognitive behavioral and mindfulness meditation) strategies for pediatric pain management. Conclusions: In partnership with the key community organizations and community partners, we developed, interactively refined, and delivered this training program.

54 Efficacy of a quality improvement project in paediatric procedural pain management during needle procedures

Abstract Background In paediatric hospital settings, needle procedures significantly contribute to children’s experiences of pain and distress. A structured approach integrating preparation, comfort positions, distraction, relaxation techniques, and topical anesthetics can enhance children’s ability to cope with procedural discomfort. We developed a quality improvement (QI) initiative aiming to alleviate procedural pain and distress through a staggered implementation approach over a 3-year period. Objectives This study aimed to evaluate the impact of the first 2 years of an institutional QI initiative on managing procedural pain and distress in children undergoing needle procedures. The primary objective was to evaluate the use of multimodal strategies to reduce needle-related procedural pain/distress following the QI initiative. The secondary objective was to compare pain scores for needle procedures before and after the QI initiative. Design/Methods This observational study was conducted in a tertiary care university-affiliated paediatric hospital with an ongoing hospital-wide QI initiative aiming to alleviate procedural pain and distress in children undergoing needle procedures. The QI initiative consisted of mandatory sector-by-sector training of healthcare providers (HCP) on procedural pain/distress strategies to increase the use of multimodal pain care. Pain scores were measured during needle procedures (i.e. Numerical Rating Scale (NRS), Faces Pain Scale-R (FPS-R) or the FLACC scales, according to patient age) pre and 3-6 months post implementation of the QI initiative. Scheduled audits were conducted using a standardized questionnaire by a deployment champion nurse during needle procedures to document pain scales and pain/distress strategies used by the HCP during needle procedures in each of the hospital services. Results Throughout the first two implementation years (June 2021-June 2023), 363 audits were conducted on needle procedures for 363 children (Median age 7 yo (0month-18yo□). At this stage, audits took place in 14 different hospital services. The most frequent procedures were IV-line insertions (34%), venous blood draws (27%), and capillary blood sampling (26%). Parental presence and the use of distraction techniques were frequently used (90% and 80% of procedures, respectively). Of the 363 audits, 221 were pre-implementation and 142 post-implementation. Post QI initiative, an increased number of procedures were realized using multimodal strategies (4 or more strategies) to reduce pain/distress (from 60% to 78%). Pain scores were recorded for 203/221 audits pre and 134/142 post with a reduction in severe pain scores (7 or more) from 25% pre to 5% post-implementation. Conclusion The institutional QI initiative demonstrated both an increase in the number of strategies used to prevent pain/distress and a reduction in severe pain scores associated with paediatric needle procedures. This project emphasizes the significance of employing a multifaceted approach to managing procedural pain/distress in children undergoing needle procedures.

Navigating the nexus of personalized medicine and healthcare management: Advancing paediatric pain management modalities in sickle cell disease through thematic analysis for ages 1–12

ABSTRACT Sickle cell disease (SCD) affects millions of people and is a significant public health concern due to the severe pain crises it causes, often requiring emergency care and leading to hospitalization. Effective pain management strategies are crucial to improving the quality of life of children with SCD, particularly those aged 1 to 12 years, who are especially vulnerable. This study evaluates the effectiveness and suitability of various healthcare management strategies, with a specific focus on pain management modalities for this paediatric population. Through a thematic analysis of 36 articles from major healthcare databases, five key themes were identified: cognitive behavioral therapy (CBT) and complementary alternative medicine (CAM), digital and technological pain management methods, pain medications, individualized pain plans and enhancement strategies aimed at improving protocols. The findings highlight critical opportunities to advance pain management approaches and address current care gaps. The study underscores the importance of integrating parents and caregivers into the care process and addressing health inequalities that affect treatment outcomes. Evidence reveals that existing research on paediatric SCD pain management remains inadequate, and future studies are urgently needed to establish clear guidelines that improve treatment efficacy and translate into actionable evidence-based practices for this vulnerable population.

Pediatric Pain

ABSTRACT OBJECTIVE This article reviews pain disorders encountered in pediatric neurology practice and provides current information regarding the assessment and treatment of pediatric chronic pain. LATEST DEVELOPMENTS Data about pediatric pain management remain sparse, owing to a dearth of controlled trials and longitudinal studies in these patients. However, the field of pain management and understanding of central and peripheral pain processing has expanded to allow more effective treatment of a broad group of children and adolescents with pain associated with neurologic disease. Neuroimaging visualizes sensory and nonsensory systems, and genetic markers of sensitivity and disease may guide specific therapy. The concept of central sensitization in chronic pain disorders has supported the development of multidisciplinary paradigms for the comprehensive care of these patients. ESSENTIAL POINTS Pain involves sensory activation and central nervous system modulation in pediatric patients. Pediatric neurologists should be prepared to define, investigate, and treat pain disorders in this complex patient population. Appropriate interventions during childhood may attenuate or prevent chronic pain later in life. Current interventions include behavioral, physical, and pharmacologic approaches, as well as potential noninvasive tools for neuromodulation. Research is progressing in sensory measurement, neuroimaging, genetics, and neuroinflammation to guide future targeted therapies.

Strategies for Managing Pediatric Fracture Pain: Assessment, Pharmacological, and Non-Pharmacological Interventions.

Fractures are prevalent among the pediatric population, with approximately 1 in 3 children experiencing at least 1 fracture during childhood. Children are not just little adults; they have unique needs in pain management. With a lack of knowledge in pediatric pain management, medical staff primarily focus on the fractures, often overlooking and inadequately addressing pain. There is a scarcity of literature on acute fracture pain for children, while a wealth of literature summarizes chronic and tumor-related pain in children, which is not suitable for addressing pain caused by fractures. Therefore, a pain management literature review grounded in clinical experience is essential to provide guidance to doctors and parents on safely and effectively reducing the pain associated with children's fractures. We conducted a thorough review of existing literature and summarized treatment experiences into the 3 areas of pain assessment, non-pharmacological treatments, and pharmacological treatments. First, we evaluated and analyzed existing pain assessment methods, identifying the most suitable tools for different age groups. Second, we explored non-pharmacological treatments suitable for children with fractures to alleviate mild to moderate pain and reduce the need for analgesics. Lastly, we reviewed pharmacological treatments. For moderate pain, we recommend administering non-steroidal anti-inflammatory drugs. For severe pain, we suggest opioid medications, providing detailed information on usage and contraindications for different age groups. Therefore, this article aimed to review the evaluation and management of pain in children with bone fracture, and covers aspects of pediatric pain characteristics, pain assessment tools, pharmacological therapy, and non-pharmacologic therapy.

Enhancing Caudal Analgesia in Pediatrics: A Comparison of Ropivacaine With and Without Clonidine for Infra-Umbilical Surgeries.

Introduction Regional anesthesia, particularly caudal blocks, is increasingly used in pediatric surgeries for effective post-operative pain management. However, the duration of analgesia with agents such as ropivacaine alone can be limited. This study investigates the effects of adding clonidine to ropivacaine in caudal blocks for pediatric patients undergoing infra-umbilical surgeries, with the purpose of enhancing the duration and quality of analgesia. Methods We conducted a randomized, double-blind study including 50 children aged one to eight years, divided equally into two groups: group R received 0.2% ropivacaine and group RC received 0.2% ropivacaine with 2 mcg/kg clonidine. Intraoperative and post-operative monitoring included heart rate, blood pressure, and respiratory parameters. Analgesia duration, sedation scores, and the need for rescue analgesia were assessed. Results Group RC exhibited significantly longer analgesia duration (18.4 ± 2.31 hours) compared to group R (10.56 ± 2.27 hours, P < 0.0001). Fewer patients in group RC required a second dose of rescue analgesia (4% vs. 32%, P = 0.023), with no significant differences in sedation scores or adverse effects between the groups. Conclusion Adding clonidine to ropivacaine in caudal blocks significantly prolongs analgesia and reduces the need for additional post-operative pain management in pediatric surgeries without increasing the risk of side effects. This study supports the use of clonidine as an effective adjuvant in pediatric pain management.

Acceptability and Usability of Smileyscope Virtual Reality for Paediatric Pain Management During Burn Procedures: Perspectives of Patients, Carers and Clinicians.

To explore clinician, child and parent acceptability and usability of the Smileyscope VR device in the context of addressing the unique pain and distress needs of young burn patients. A survey comprising closed and open-ended questions. Descriptive statistics analysed participant characteristics, pain and analgesia. Qualitative content was collected from April 2022-August 2022 and analysed to identify barriers and enablers. Categories were then mapped onto the Capabilities, Opportunities and Motivation-Behaviour Wheel (COM-B) framework. Smileyscope was found to be effective for reducing pain and anxiety during dressing changes by both patients (n = 39) and parents (n = 37). Clinicians (n = 35) reported high self-efficacy and willingness to reuse the device. However, concerns arose regarding the device's fit and the need for age-appropriate programmes. Smileyscope demonstrated promise in reducing procedural pain and distress. The device is well accepted by all participants implying ease of implementation. Feedback suggests further program development and fitting optimisation is required. Improved procedural pain has proven to decrease wound healing times, decreasing possible need for further scar management and long-term consequences after sustaining a burn injury. Smileyscope use in rural hospitals presents valuable opportunities for optimising early paediatric burn pain. Increased burn pain can delay wound healing and have long term physical and psychological impact on patients. Smileyscope was well received within this cohort; however, improvements in device design and programmes were suggested. This study shows the potential for use of Smileyscope as a non-pharmacological approach to improving paediatric burn pain and distress. While our study included patients, parents and clinicians as research participants, there was no patient or public contribution in the design or conduct of the study, analysis or interpretation of the data.

Knowledge and Attitudes of Nursing Students Regarding Children's Pain.

Although the occurrence of pain among hospitalized children is inevitable, the way to assess and detect the intensity of pain is still challenging to pediatric professionals and may lead to increased morbidity and mortality rates if left untreated. The knowledge base of nurses regarding both pharmacological and non-pharmacological pain management among children plays a significant role in managing and making a management plan. The purpose of this study was to assess nursing students' knowledge and attitudes toward pediatric painmanagement. This study used a cross-sectional design to investigate the knowledge and attitudes regarding pain and its management among undergraduate nursing students at a university. A convenience sample of students from all levels was obtained. The pediatric nurses knowledge and attitudes survey (PNKAS) regarding pain was used. Data were analyzed by IBM SPSS Statistics for Windows, Version 22 (Released 2013; IBM Corp., Armonk, New York, USA). In this study, 86.3% of participants (n = 69) scored within the satisfactory range on the PNKAS, suggesting adequate knowledge and attitudes about pediatric pain management. The results showed there was no significant relationship between age and a total score p-value of 0.740, as well as between academic levels and the same p-value of 0.397. This study highlights the importance of undergraduate nursing education in pediatric pain management. The findings suggest that students may benefit from additional training in pain assessment and pharmacological interventions.

Implementation of Virtual Reality Pain Alleviation Therapeutic into Routine Pediatric Clinical Care: Experiences and Perspectives of Stakeholders.

Virtual reality (VR) needs to be implemented in clinical settings to improve pediatric patient care during painful medical procedures. Engaging doctors and nurses to lead the adoption of new clinical techniques can facilitate the transition from research to routine practice. Integrating VR into routine clinical practice could reduce patient pain and anxiety, making medical procedures smoother and more efficient. This feasibility pilot quality improvement (QI) project provides evidence for broader expansion and implementation of VR into different clinical areas. Medical providers (doctors and nurses) implemented VR during brief pediatric medical procedures and completed a demographics and feasibility survey. Qualitative feedback from semi-structured interviews indicated VR's ease of use and effectiveness in reducing anxiety and easing medical procedures. Patients (n = 30) played the VR game during either their medically necessary pin-pulling or needlestick procedures within three clinical environments. Children ranged from 5-16 years and were 50% male. The majority of patients reported enjoyment (mean 8.2 out of 10) with VR during the procedure, and only one minor technical issue was reported. Qualitative semi-structured interview data showed the benefits of using VR, including its ease of use, decreased observed anxiety, and patients having an easier time getting through the medical procedures. Feedback from medical providers regarding the dissemination of VR into pediatric clinical environments showed promising results. Standardized guidelines are needed to further implement VR pain alleviation into standard care in real-world clinical settings. This pilot study suggests that VR could be a valuable tool in pediatric pain management, warranting further research and broader clinical implementation.

Breaking Barriers in Paediatric Pain Management: Combined Cryotherapy and Vibration Therapy Vs. Audio-visual Aids for Alleviating Discomfort during Inferior Alveolar Nerve Block Administration in Children - a Randomized Controlled Study

Breaking Barriers in Paediatric Pain Management: Combined Cryotherapy and Vibration Therapy Vs. Audio-visual Aids for Alleviating Discomfort during Inferior Alveolar Nerve Block Administration in Children - a Randomized Controlled Study

Experiences of Teaching and Learning Pediatric Pain Management in Ghana

BackgroundThe literature has revealed gaps in knowledge and attitudes regarding pediatric pain management among Ghanaian nurses and nursing students that can be attributed to inadequate education in the area. Consequently, nursing tutors teaching pain management might not have the appropriate knowledge to transfer to their students. PurposeTo explore nursing tutors’ experiences of teaching pediatric pain management as well as their students’ learning experiences before and after the tutors’ training workshop. DesignA descriptive qualitative design was employed for the conduct of the study. MethodsData were collected via focus groups from 32 tutors and 24 students before and after an educational workshop. Data analysis drew on Braun and Clarke's thematic analysis. FindingsPre-workshop themes revealed knowledge deficits regarding pediatric pain management in both tutors and students due to learning having occurred in bits and pieces. Furthermore, lack of accessibility to books and pain scales perpetuated this bits-and-pieces approach to learning. Post-workshop findings revealed gains in tutors’ knowledge and skills. Consequently, students gained new insights into pediatric pain management. ConclusionTutors and student nurses had a knowledge deficit regarding pediatric pain management. The educational workshop and the provision of learning materials resulted in enhanced knowledge and attitudes that subsequently improved tutors’ ability to effectively teach the topic to their students, with a clear implication for improvements in clinical practice. Clinical ImplicationEducating nursing tutors about pediatric pain is imperative to enable students and thus future nurses to be equipped with the necessary evidence-based knowledge of how to manage pediatric pain.

Navigating through 65years of insights: lessons learned on functional abdominal pain in children.

In 1958, Apley and Naish authored a groundbreaking paper in Archives of Disease in Childhood, elucidating the epidemiology and risk factors of recurrent abdominal pain in children-a subject that had confounded clinicians of their time. Surprisingly, even after 65years, there are several unanswered questions regarding the etiology, pathophysiology, and management of pediatric abdominal pain. Contrary to the prevailing notion that children naturally outgrow functional abdominal pain, compelling evidence suggests it's possible these children develop a number of clinically significant psychological issues that could profoundly impact their quality of life and, consequently, future health and educational outcomes. In this light, we aimed to comprehensively review the current literature to update the knowledge of practicing clinicians on functional abdominal pain, summarizing the evidence from the last 65years.Conclusion: The enduring unanswered questions surrounding childhood abdominal pain continue to challenge clinicians, resulting in unnecessary investigations, thereby contributing to substantial healthcare expenditures. It is also evident that children with long-standing symptoms would progress to adulthood with the potential to develop irritable bowel syndrome and many psychological disturbances. Several key interventions using pharmacological agents, such as amitriptyline, showed that someof these drugs are no more effective than the placebo in clinical trials. Several research during the recent past suggest that psychological interventions such as gut-directed hypnotherapy alleviate symptoms and ensure better prognosis in the long run. Therefore, clinicians and researchers must join hands to explore the pathophysiological mechanisms underpinning functional abdominal pain and novel therapeutic strategies to ensure the well-being of these children. What is Known: • Functional abdominal pain disorders are common among children, with a worldwide prevalence of 13.5% of children suffering from at least one of these disorders • These disorders contribute to a significant reduction in the quality of life of affected children and their families and lead to an array of psychological problems What is New: • The biological basis of functional abdominal pain is becoming more explicit, including complex interactions between altered microbiome, deranged motility, and psychological dysfunction with gut-brain interactions • Novel approaches giving minimal emphasis on pharmacological interventions and exploring psychological interventions are showing promising results.

A Narrative Review of Pain in Pediatric Oncology: The Opioid Option.

Opioid therapy is the mainstay for managing pain in pediatric oncology. This narrative review describes the current literature regarding opioids for pediatric cancer pain. The review explores the multifaceted landscape of opioid utilization in this population, including the role of opioids in certain clinical circumstances, modalities of opioid delivery, unique opioids, outpatient and at-home pain management strategies, and other key concepts such as breakthrough pain. This review highlights the importance of individualized dosing and multimodal approaches to enhance efficacy and minimize adverse effects. Drawing from a wide range of evidence, this review offers insights to optimize pediatric oncology pain management.

Optimizing pediatric periprocedural pain management part II-Adjunct therapies to support the use of infiltrative anesthetics.

Pediatric procedure-related pain management is often incompletely understood, inadequately addressed, and critical in influencing a child's lifelong relationship with the larger healthcare community. We present a comprehensive review of infiltrative anesthetics, including a comparison of their mechanisms of action and relative safety and efficacy data to help guide clinical selection. We also describe the multimodal utilization of adjunct therapies-in series and in parallel-to support the optimization of pediatric periprocedural pain management, enhance the patient experience, and provide alternatives to sedation medication and general anesthesia.

Hypnotherapy, Relaxation, and Music Therapy in Pediatric Cancer Pain Management: A Clinical Trial Comparison

Introduction Pain is a prevalent issue across various medical conditions, and numerous methods have been employed to manage it. In developed countries, cancer ranks as the second leading cause of mortality after cardiovascular diseases. This study aims to compare the effectiveness of hypnotherapy, relaxation therapy, and Music Therapy (MT) with control groups in alleviating pain in children with cancer. Methods The research involved a single-blind clinical trial with a study population comprising children diagnosed with an abdominal mass and acute lymphoblastic leukemia. Fifty-eight patients were selected through blocked randomization. Data were collected through a demographic checklist and the Visual Analog Scale (VAS) to measure pain intensity. Data analysis was carried out using repeated measures ANOVA in SPSS version 22 to compare mean pain intensity among the study groups. Results A total of 58 patients, with an average age of 9.28±4.02 years, participated in the study. Significant differences were observed between the hypnotherapy group and the other study groups (F=14.51; P≤0.001), as well as between the MT group and the other study groups (F=12.81; P≤0.001). Moreover, significant differences were found in terms of time between the relaxation therapy group and the other study groups (F=8.46; P≤0.001) and between the control group and the other groups (F=5.506; P≤0.001). Conclusion Based on the findings, relaxation therapy, hypnotherapy, and Music Therapy (MT) have shown significant effectiveness in alleviating pain in cancer patients during their treatment. Trial Registration Clinical Trial Trial registration Clinical trial. gov Identifier: IRCTID website (code: IRCT20120905010744N2; http://irct.ir).

Optimizing pediatric periprocedural pain management part I-Evolving ethics and topical anesthetics.

Pediatric procedure-related pain management is often incompletely understood, inadequately addressed, and critical in influencing a child's lifelong relationship with the larger health care community. We highlight the evolution of ethics and expectations around optimizing periprocedural pain management as a fundamental human right. We investigate the state-of-the-art of topical anesthetics, reviewing their mechanisms of action and providing comparisons of their relative safety and efficacy data to help guide clinical selection. In total, this two-part review offers a combination of conventional approaches and innovative techniques that should be used multimodally-in series and in parallel-to help optimize pain management and provide alternatives to sedation medication and general anesthesia.

Multisite prospective study of perioperative pain management practices for anterior cruciate ligament reconstruction in adolescents: Society for Pediatric Anesthesia Improvement Network (SPAIN) Project Report

IntroductionAlthough 200 000 adolescents undergo anterior cruciate ligament reconstruction (ACLR) surgery annually, no benchmarks for pediatric post-ACLR pain management exist. We created a multicenter, prospective, observational registry to describe pain...

Pediatric Pain Management: Acute and Persistent Pain Using an Interdisciplinary and Integrative Approach

Pediatric Pain Management: Acute and Persistent Pain Using an Interdisciplinary and Integrative Approach

Optimization of Pediatric Pain Management Through the Development of a Pediatric Pain Resource Nurse (PRN) Program

Optimization of Pediatric Pain Management Through the Development of a Pediatric Pain Resource Nurse (PRN) Program