2.4 Management of Pain

At the end of this session you will be able to:

1. Critically reflect on your own pain management practice and ensure that it becomes more optimal

In addition you will be able to:

2. identify children’s rights in relation to pain relief

3. consider the relevance of different methods of non pharmacological pain relief to children you provide care for

Management of Children’s Pain

Within the general child population studies provide ongoing evidence of under-medication and suboptimal management of children’s pain (Tesler, Holzemer, & Savedra, 1998; Burg, 2002; Van Hulle, 2004). Research also suggests that nurses under-document their management of procedural pain (Emed et al., 2004).

Various studies have identified reasons why under-medication exists: these include nurses’ attitudes; inadequate knowledge (Hamers et al., 1998); level of experience (Hamers et al, 1997).  There is evidence that even when nurses have positive attitudes to pain management, they do not always feel that they can provide quality pain care (Salanterä, 1999).
 
Because of the problems associated with under-medication the following six rights have been developed to help guide health care professionals

There are six key rights to pain relief:

• Right drug

• Right dosage

• Right route

• Right time

• Right treatment for side effects

• Right approach to child and family

(For more information, see ‘Principles of Pharmacologic Pain Management in Infants and Children: The 6 Rights to Relief’)

Non pharmacological management of children’s pain

Non-pharmacological management methods of managing children’s pain are well documented in the literature with distraction being one of the key methods (Carlson et al., 2000).

Distraction includes a range of different approaches (Tanabe et al., 2002) including Snoezelen (Schofield 2000), playing, reading, watching television/videos, guided imagery, blowing bubbles (Joseph et al., 1999) and relaxation imagery and music therapy (Sahler et al., 2003) and more recently virtual reality (Steele et al., 2003).

Other interventions include acupuncture and hypnotherapy (Waterhouse et al., 2000; Liossi & Hatira P, 2003). Parents have been shown to be successful distraction coaches (Kleiber et al., 2001). Each of these different methods has different utility and clinical applicability depending on the child’s age/cognitive ability, setting, and circumstances.

Involving parents is a vital part of pain management. There are a number of different sources of material that you can guide parents to that will help them understand the various interventions that can be used.

(see Pain Pain Go Away: Helping Children with Pain & Medical Procedures and Pain: Helping your Child

Pharmacological management of children’s pain

There are now many different pharmacological options available for the treatment and management of pain in infants, children and young people. The type of medication used needs to be closely matched to the child’s individual experience of pain and take into consideration a range of other factors.

The pain ladder is almost universally recognised as a good starting point for considering analgesia.

In community, ibuprofen is the most readily available NSAID.

Paracetamol and ibuprofen play a significant role in pain management for mild to moderate pain.