Medicine › Pediatrics, Perinatology and Child Health

Pediatric Pain Management Techniques

Works Count: 38524

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This cluster of papers focuses on the assessment and management of pain in pediatric populations, including neonates, infants, children, and adolescents. It covers topics such as the epidemiology of chronic pain, validation of pain measurement tools, use of virtual reality for pain reduction, psychological interventions for pain and distress, impact of parental factors on pediatric pain, and the long-term consequences of early life pain experiences.

Keywords

Pediatric Pain; Pain Measurement; Chronic Pain; Adolescents; Neonatal Pain; Pain Management; Virtual Reality Distraction; Psychological Interventions; Pain Assessment Tools; Family Impact

The FLACC: a behavioral scale for scoring postoperative pain in young children.

1997-05-01

Sandra Merkel , Terri Voepel‐Lewis , J R Shayevitz +1 more

To evaluate the reliability and validity of the FLACC Pain Assessment Tool which incorporates five categories of pain behaviors: facial expression; leg movement; activity; cry; and consolability.Eighty-nine children aged 2 … To evaluate the reliability and validity of the FLACC Pain Assessment Tool which incorporates five categories of pain behaviors: facial expression; leg movement; activity; cry; and consolability.Eighty-nine children aged 2 months to 7 years, (3.0 +/- 2.0 yrs.) who had undergone a variety of surgical procedures, were observed in the Post Anesthesia Care Unit (PACU). The study consisted of: 1) measuring interrater reliability; 2) testing validity by measuring changes in FLACC scores in response to administration of analgesics; and 3) comparing FLACC scores to other pain ratings.The FLACC tool was found to have high interrater reliability. Preliminary evidence of validity was provided by the significant decrease in FLACC scores related to administration of analgesics. Validity was also supported by the correlation with scores assigned by the Objective Pain Scale (OPS) and nurses' global ratings of pain.The FLACC provides a simple framework for quantifying pain behaviors in children who may not be able to verbalize the presence or severity of pain. Our preliminary data indicates the FLACC pain assessment tool is valid and reliable.

Pain in children: comparison of assessment scales.

1988-03-01

Wong Dl , Baker Cm

Psychological therapies for the management of chronic and recurrent pain in children and adolescents

2014-05-05

Christopher Eccleston , Tonya M. Palermo , Amanda C de C Williams +4 more

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The Severity of Chronic Pediatric Pain: An Epidemiological Study

2007-12-27

Anna Huguet , Jordi Miró

Pain in the Emergency Department: Results of the Pain and Emergency Medicine Initiative (PEMI) Multicenter Study

2007-02-16

Knox H. Todd , James Ducharme , Manon Choinière +4 more

Systematic review of observational (behavioral) measures of pain for children and adolescents aged 3 to 18 years

2006-09-26

Carl L. von Baeyer , Lara J. Spagrud

Observational (behavioral) scales of pain for children aged 3 to 18 years were systematically reviewed to identify those recommended as outcome measures in clinical trials. This review was commissioned by … Observational (behavioral) scales of pain for children aged 3 to 18 years were systematically reviewed to identify those recommended as outcome measures in clinical trials. This review was commissioned by the Pediatric Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials (www.immpact.org). In an extensive literature search, 20 observational pain scales were identified for review including behavior checklists, behavior rating scales, and global rating scales. These scales varied in their reliance on time sampling and inclusion of physiological items, facial and postural items, as well as their inclusion of multiple dimensions of assessment (e.g., pain and distress). Each measure was evaluated based on its reported psychometric properties and clinical utility. Scales were judged to be indicated for use in specific acute pain contexts rather than for general use. Two scales were recommended for assessing pain intensity associated with medical procedures and other brief painful events. Two scales were recommended for post-operative pain assessment, one for use in hospital and the other at home. Another scale was recommended for use in critical care. Finally, two scales were recommended for assessing pain-related distress or fear. No observational measures were recommended for assessing chronic or recurrent pain because the overt behavioral signs of chronic pain tend to habituate or dissipate as time passes, making them difficult to observe reliably. In conclusion, no single observational measure is broadly recommended for pain assessment across all contexts. Directions for further research and scale development are offered.

Preoperative Anxiety, Postoperative Pain, and Behavioral Recovery in Young Children Undergoing Surgery

2006-08-01

Zeev N. Kain , Linda C. Mayes , Alison A. Caldwell-Andrews +2 more

Findings from published studies suggest that the postoperative recovery process is more painful, slower, and more complicated in adult patients who had high levels of preoperative anxiety. To date, no … Findings from published studies suggest that the postoperative recovery process is more painful, slower, and more complicated in adult patients who had high levels of preoperative anxiety. To date, no similar investigation has ever been conducted in young children.We recruited 241 children aged 5 to 12 years scheduled to undergo elective outpatient tonsillectomy and adenoidectomy. Before surgery, we assessed child and parental situational anxiety and temperament. After surgery, all subjects were admitted to a research unit in which postoperative pain and analgesic consumption were assessed every 3 hours. After 24 hours in the hospital, children were discharged and followed up at home for the next 14 days. Pain management at home was standardized.Parental assessment of pain in their child showed that anxious children experienced significantly more pain both during the hospital stay and over the first 3 days at home. During home recovery, anxious children also consumed, on average, significantly more codeine and acetaminophen compared with the children who were not anxious. Anxious children also had a higher incidence of emergence delirium compared with the children who were not anxious (9.7% vs 1.5%) and had a higher incidence of postoperative anxiety and sleep problems.Preoperative anxiety in young children undergoing surgery is associated with a more painful postoperative recovery and a higher incidence of sleep and other problems.

A new analogue scale for assessing children's pain: an initial validation study

1996-03-01

Patricia McGrath , Cheryl E. Seifert , Kathy N. Speechley +3 more

A new instrument was designed to provide a practical clinical measure for assessing children's pain intensity and pain affect. The pocket size measure includes a Coloured Analogue Scale (CAS) to … A new instrument was designed to provide a practical clinical measure for assessing children's pain intensity and pain affect. The pocket size measure includes a Coloured Analogue Scale (CAS) to assess intensity and a facial affective scale to assess the aversive component of pain. Both scales have numerical ratings on the back, so that the person administering it can quickly note the numbers that represent a child's pain. This study was conducted to determine the validity of the new instrument by evaluating the psychophysical properties of the intensity scale and by evaluating the discriminant validity of the intensity and affective scales. Since visual analogue scales (VAS) are valid and reliable measures for assessing children's pain, children's ability to use the new analog scale was compared with their performance on a VAS. Children's ability to rate pain affect using an affective scale, in which the 9 faces on a Facial Affective Scale (FAS) are presented in an ordered sequence from least to most distressed, was compared to their performance on the original FAS, in which the same faces were presented in a random order. Using a parallel groups design, 104 children (5-16 years; 60 female, 44 male; 51 healthy and 53 with recurrent headaches) were randomized into two groups: CAS or VAS. Children used the assigned scale to complete a calibration task, in which they rated the sizes of 7 circles varying in area (491, 804, 1385, 2923, 3848, 5675 and 7854 mm2). The psychophysical function relating perceived circle size to actual physical size was determined for the CAS and VAS. Children's CAS and VAS responses on the calibration task yielded similar mathematical relationships: psi cas = 0.035I0.87, psi vas = 0.027I0.89, where psi = perceived magnitude and I = stimulus intensity. The R2 values were 0.921 and 0.922 for the CAS and VAS groups, respectively. Analyses of covariance revealed no significant differences in the characteristics of these relationships, i.e., R2, slope, or y intercept, by scale type. Children used the same scale to complete the Children's Pain Inventory (CPI), in which they rated the intensity and affect of 16 painful events (varying in nature and extent of tissue damage). Children's CAS and VAS responses on the CPI were similar. Analyses of covariance indicated that there were no differences in either intensity or affective ratings by scale type. However, the mean number of painful events experienced by children increased significantly with age (P = 0.0001). Intensity ratings decreased significantly with age (P = 0.002), but affective ratings did not vary with age. The new instrument has equivalent psychometric properties to a 165 mm VAS. However, the CAS was rated as easier to administer and score than the VAS, so it may be more practical for routine clinical use. Since the CAS has fulfilled the first two criteria for a pain measure (psychophysical properties and discriminant validity), it is ethical to proceed with the formal definitive test for construct validity, in which children from various clinical populations use the CAS scale to assess their own pain.

Reliability of the Visual Analog Scale for Measurement of Acute Pain

2001-12-01

Polly E. Bijur , Wendy G. Silver , E.John Gallagher

Abstract Objective: Reliable and valid measures of pain are needed to advance research initiatives on appropriate and effective use of analgesia in the emergency department (ED). The reliability of visual … Abstract Objective: Reliable and valid measures of pain are needed to advance research initiatives on appropriate and effective use of analgesia in the emergency department (ED). The reliability of visual analog scale (VAS) scores has not been demonstrated in the acute setting where pain fluctuation might be greater than for chronic pain. The objective of the study was to assess the reliability of the VAS for measurement of acute pain. Methods: This was a prospective convenience sample of adults with acute pain presenting to two EDs. Intraclass correlation coefficients (ICCs) with 95% confidence intervals (95% CIs) and a Bland‐Altman analysis were used to assess reliability of paired VAS measurements obtained 1 minute apart every 30 minutes over two hours. Results: The summary ICC for all paired VAS scores was 0.97 [95% CI = 0.96 to 0.98]. The Bland‐Altman analysis showed that 50% of the paired measurements were within 2 mm of one another, 90% were within 9 mm, and 95% were within 16 mm. The paired measurements were more reproducible at the extremes of pain intensity than at moderate levels of pain. Conclusions: Reliability of the VAS for acute pain measurement as assessed by the ICC appears to be high. Ninety percent of the pain ratings were reproducible within 9 mm. These data suggest that the VAS is sufficiently reliable to be used to assess acute pain.

An epidemiologic comparison of pain complaints

1988-02-01

Michael Von Korff , Samuel F. Dworkin , Linda Le Resche +1 more

A survey concerning common pain conditions and psychological distress was carried out among a probability sample of the adult enrollees of a large health maintenance organization in Seattle. The prevalence … A survey concerning common pain conditions and psychological distress was carried out among a probability sample of the adult enrollees of a large health maintenance organization in Seattle. The prevalence of pain in the prior six months was 41% for back pain; 26% for headache; 17% for abdominal pain; 12% for chest pain; and 12% for facial pain. Headache, abdominal and facial pain were less prevalent among older persons and more prevalent among females. We examined the temporal dimensions of these pain conditions, as well as intensity, treatment seeking, and activity limitation. The pain conditions were typically long standing, recurrent, of mild to moderate intensity, and usually did not limit activities. However, depending on the pain condition, 9-40% reported one or more days in the prior six months when they were unable to carry out their usual activities due to the pain problem. On average, persons with a pain condition had higher levels of anxiety, depression, and non-pain somatic symptoms as measured by the scales of the Symptom Checklist (SCL); poorer self-rating of health status; and more family stress compared to persons without a pain condition. Of these alternative measures of distress, the SCL somatization scale had the strongest independent association with pain. The increments in measures of anxiety, depression, and family stress with the presence of pain were greatest among persons with higher levels of non-pain somatic symptoms.

Somatic symptom reporting in women and men

2001-04-01

Arthur J. Barsky , Heli M. Peekna , Jonathan F. Borus

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The development of a tool to assess neonatal pain

1991-04-01

J. R. Lawrence , Denise Alcock , Jason Kay +1 more

The development of nociceptive circuits

2005-07-01

Melinda Fitzgerald

Pain and Its Effects in the Human Neonate and Fetus

1987-11-19

K.J.S. Anand , Paul R. Hickey

THE evaluation of pain in the human fetus and neonate is difficult because pain is generally defined as a subjective phenomenon.1 Early studies of neurologic development concluded that neonatal responses … THE evaluation of pain in the human fetus and neonate is difficult because pain is generally defined as a subjective phenomenon.1 Early studies of neurologic development concluded that neonatal responses to painful stimuli were decorticate in nature and that perception or localization of pain was not present.2 Furthermore, because neonates may not have memories of painful experiences, they were not thought capable of interpreting pain in a manner similar to that of adults.3 4 5 On a theoretical basis, it was also argued that a high threshold of painful stimuli may be adaptive in protecting infants from pain during birth.6 These traditional . . .

Validation of the Wong‐Baker FACES Pain Rating Scale in Pediatric Emergency Department Patients

2009-12-09

Gregory Garra , Adam J. Singer , Breena R. Taira +4 more

Abstract Objectives: The Wong‐Baker FACES Pain Rating Scale (WBS), used in children to rate pain severity, has been validated outside the emergency department (ED), mostly for chronic pain. The authors … Abstract Objectives: The Wong‐Baker FACES Pain Rating Scale (WBS), used in children to rate pain severity, has been validated outside the emergency department (ED), mostly for chronic pain. The authors validated the WBS in children presenting to the ED with pain by identifying a corresponding mean value of the visual analog scale (VAS) for each face of the WBS and determined the relationship between the WBS and VAS. The hypothesis was that the pain severity ratings on the WBS would be highly correlated (Spearman’s rho > 0.80) with those on a VAS. Methods: This was a prospective, observational study of children ages 8–17 years with pain presenting to a suburban, academic pediatric ED. Children rated their pain severity on a six‐item ordinal faces scale (WBS) from none to worst and a 100‐mm VAS from least to most. Analysis of variance (ANOVA) was used to compare mean VAS scores across the six ordinal categories. Spearman’s correlation (ρ) was used to measure agreement between the continuous and ordinal scales. Results: A total of 120 patients were assessed: the median age was 13 years (interquartile range [IQR] = 10–15 years), 50% were female, 78% were white, and six patients (5%) used a language other than English at home. The most commonly specified locations of pain were extremity (37%), abdomen (19%), and back/neck (11%). The mean VAS increased uniformly across WBS categories in increments of about 17 mm. ANOVA demonstrated significant differences in mean VAS across face groups. Post hoc testing demonstrated that each mean VAS was significantly different from every other mean VAS. Agreement between the WBS and VAS was excellent (ρ = 0.90; 95% confidence interval [CI] = 0.86 to 0.93). There was no association between age, sex, or pain location with either pain score. Conclusions: The VAS was found to have an excellent correlation in older children with acute pain in the ED and had a uniformly increasing relationship with WBS. This finding has implications for research on pain management using the WBS as an assessment tool. ACADEMIC EMERGENCY MEDICINE 2010; 17:50–54 © 2009 by the Society for Academic Emergency Medicine

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Gender variations in clinical pain experience

1996-05-01

Anita Unruh

This review is a critical summary of research examining gender variations in clinical pain experience. Gender-comparative pain research was identified through Medline and Psychlit searches and references obtained from bibliographies … This review is a critical summary of research examining gender variations in clinical pain experience. Gender-comparative pain research was identified through Medline and Psychlit searches and references obtained from bibliographies of pertinent papers and books. Review of this research demonstrates that women are more likely than men to experience a variety of recurrent pains. In addition, many women have moderate or severe pains from menstruation, pregnancy and childbirth. In most studies, women report more severe levels of pain, more frequent pain and pain of longer duration than do men. Women may be at greater risk for pain-related disability than men but women also respond more aggressively to pain through health related activities. Women may be more vulnerable than men to unwarranted psychogenic attributions by health care providers for pain. Underlying biological mechanisms of pain and the contribution of psychological and social factors as they contribute to the meaning of pain for women and men warrant greater attention in pain research.

Long-term consequences of pain in human neonates

2006-04-27

Ruth E. Grunau , Liisa Holsti , Jeroen Peters

Virtual reality as an adjunctive pain control during burn wound care in adolescent patients

2000-03-01

Hunter G. Hoffman , Jason N. Doctor , David R. Patterson +2 more

For daily burn wound care procedures, opioid analgesics alone are often inadequate. Since most burn patients experience severe to excruciating pain during wound care, analgesics that can be used in … For daily burn wound care procedures, opioid analgesics alone are often inadequate. Since most burn patients experience severe to excruciating pain during wound care, analgesics that can be used in addition to opioids are needed. This case report provides the first evidence that entering an immersive virtual environment can serve as a powerful adjunctive, nonpharmacologic analgesic. Two patients received virtual reality (VR) to distract them from high levels of pain during wound care. The first was a 16-year-old male with a deep flash burn on his right leg requiring surgery and staple placement. On two occasions, the patient spent some of his wound care in VR, and some playing a video game. On a 100 mm scale, he provided sensory and affective pain ratings, anxiety and subjective estimates of time spent thinking about his pain during the procedure. For the first session of wound care, these scores decreased 80 mm, 80 mm, 58 mm, and 93 mm, respectively, during VR treatment compared with the video game control condition. For the second session involving staple removal, scores also decreased. The second patient was a 17-year-old male with 33.5% total body surface area deep flash burns on his face, neck, back, arms, hands and legs. He had difficulty tolerating wound care pain with traditional opioids alone and showed dramatic drops in pain ratings during VR compared to the video game (e.g. a 47 mm drop in pain intensity during wound care). We contend that VR is a uniquely attention-capturing medium capable of maximizing the amount of attention drawn away from the ‘real world’, allowing patients to tolerate painful procedures. These preliminary results suggest that immersive VR merits more attention as a potentially viable form of treatment for acute pain.

The child version of the pain catastrophizing scale (PCS-C): a preliminary validation

2003-07-07

Geert Crombez , Patricia Bijttebier , Christopher Eccleston +4 more

Catastrophizing about pain has emerged as a critical variable in how we understand adjustment to pain in both adults and children. In children, however, current methods of measuring catastrophizing about … Catastrophizing about pain has emerged as a critical variable in how we understand adjustment to pain in both adults and children. In children, however, current methods of measuring catastrophizing about pain rely on brief subscales of larger coping inventories. Therefore, we adapted the Pain Catastrophizing Scale (Sullivan et al., 1995) for use in children, and investigated its construct and predictive validity in two studies. Study 1 revealed that in a community sample (400 boys, 414 girls; age range between 8 years 9 months and 16 years 5 months) the Pain Catastrophizing Scale for Children (PCS-C) assesses the independent but strongly related dimensions of rumination, magnification and helplessness that are subsumed under the higher-order construct of pain catastrophizing. This three factor structure is invariant across age groups and gender. Study 2 revealed in a clinical sample of children with chronic or recurrent pain (23 girls, 20 boys; age range between 8 years 3 months and 16 years 6 months) that catastrophizing about pain had a unique contribution in predicting pain intensity beyond gender and age, and in predicting disability, beyond gender, age and pain intensity. The function of pain catastrophizing is discussed in terms of the facilitation of escape from pain, and of the communication of distress to significant others.

Visceral pain: a review of experimental studies

1990-05-01

Timothy J. Ness , G. F. Gebhart

This paper reviews clinical and basic science research reports and is directed toward an understanding of visceral pain, with emphasis on studies related to spinal processing. Four main types of … This paper reviews clinical and basic science research reports and is directed toward an understanding of visceral pain, with emphasis on studies related to spinal processing. Four main types of visceral stimuli have been employed in experimental studies of visceral nociception: (1) electrical, (2) mechanical, (3) ischemic, and (4) chemical. Studies of visceral pain are discussed in relation to the use and 'adequacy' of these stimuli and the responses produced (e.g., behavioral, pseudoaffective, neuronal, etc.). We propose a definition of an adequate noxious visceral stimulus and speculate on spinal mechanisms of visceral pain.

Premature Infant Pain Profile: Development and Initial Validation

1996-03-01

Bonnie Stevens , Céleste Johnston , Patricia Petryshen +1 more

Objective: Inadequate assessment of pain in premature infants is a persistent clinical problem. The objective of this research was to develop and validate a measure for assessing pain in premature … Objective: Inadequate assessment of pain in premature infants is a persistent clinical problem. The objective of this research was to develop and validate a measure for assessing pain in premature infants that could be used by both clinicians and researchers. Design: The Premature Infant Pain Profile (PIPP) was developed and validated using a prospective and retrospective design. Indicators of pain were identified from clinical experts and the literature. Indicators were retrospectively tested using four existing data sets. Patients and Settings: Infants of varying gestational ages undergoing different painful procedures from three different settings were utilized to develop and validate the measure. Methods and Results: The largest data set (n = 124) was used to develop the PIPP. The development process included determining the factor structure of the data, developing indicators and indicator scales and establishing internal consistency. The remaining three data sets were utilized to establish beginning construct validity. Conclusions: The PIPP is a newly developed pain assessment measure for premature infants with beginning content and construct validity. The practicality and feasibility for using the PIPP in clinical practice will be determined in prospective research in the clinical setting.

Can Adverse Neonatal Experiences Alter Brain Development and Subsequent Behavior?

2000-01-01

K.J.S. Anand , Frank M. Scalzo

Self-destructive behavior in current society promotes a search for psychobiological factors underlying this epidemic. Perinatal brain plasticity increases the vulnerability to early adverse experiences, thus leading to abnormal development and … Self-destructive behavior in current society promotes a search for psychobiological factors underlying this epidemic. Perinatal brain plasticity increases the vulnerability to early adverse experiences, thus leading to abnormal development and behavior. Although several epidemiological investigations have correlated perinatal and neonatal complications with abnormal adult behavior, our understanding of the underlying mechanisms remains rudimentary. Models of early experience, such as repetitive pain, sepsis, or maternal separation in rodents and other species have noted multiple alterations in the adult brain, correlated with specific behavioral phenotypes depending on the timing and nature of the insult. The mechanisms mediating such changes in the neonatal brain have remained largely unexplored. We propose that lack of N-methyl-D-aspartate (NMDA) receptor activity from maternal separation and sensory isolation leads to increased apoptosis in multiple areas of the immature brain. On the other hand, exposure to repetitive pain may cause excessive NMDA/excitatory amino acid activation resulting in excitotoxic damage to developing neurons. These changes promote two distinct behavioral phenotypes characterized by increased anxiety, altered pain sensitivity, stress disorders, hyperactivity/attention deficit disorder, leading to impaired social skills and patterns of self-destructive behavior. The clinical important of these mechanisms lies in the prevention of early insults, effective treatment of neonatal pain and stress, and perhaps the discovery of novel therapeutic approaches that limit neuronal excitotoxicity or apoptosis.

Pain in children and adolescents: a common experience

2000-07-01

Christel W. Perquin , Alice A.J.M. Hazebroek-Kampschreur , Joke A. M. Hunfeld +4 more

Little is known about the epidemiology of pain in children. We studied the prevalence of pain in Dutch children aged from 0 to 18 years in the open population, and … Little is known about the epidemiology of pain in children. We studied the prevalence of pain in Dutch children aged from 0 to 18 years in the open population, and the relationship with age, gender and pain parameters. A random sample of 1300 children aged 0-3 years was taken from the register of population in Rotterdam, The Netherlands. In the Rotterdam area, 27 primary schools and 14 secondary schools were selected to obtain a representative sample of 5336 children aged 4-18 years. Depending on the age of the child, a questionnaire was either mailed to the parents (0-3 years) or distributed at school (4-18 years). Of 6636 children surveyed, 5424 (82%) responded; response rates ranged from 64 to 92%, depending on the subject age and who completed the questionnaire. Of the respondents, 54% had experienced pain within the previous 3 months. Overall, a quarter of the respondents reported chronic pain (recurrent or continuous pain for more than 3 months). The prevalence of chronic pain increased with age, and was significantly higher for girls (P<0.001). In girls, a marked increase occurred in reporting chronic pain between 12 and 14 years of age. The most common types of pain in children were limb pain, headache and abdominal pain. Half of the respondents who had experienced pain reported to have multiple pain, and one-third of the chronic pain sufferers experienced frequent and intense pain. These multiple pains and severe pains were more often reported by girls (P<0.001). The intensity of pain was higher in the case of chronic pain (P<0. 001) and multiple pains (P<0.001), and for chronic pain the intensity was higher for girls (P<0.001). These findings indicate that chronic pain is a common complaint in childhood and adolescence. In particular, the high prevalence of severe chronic pain and multiple pain in girls aged 12 years and over calls for follow-up investigations documenting the various bio-psycho-social factors related to this pain.

Preoperative Anxiety and Emergence Delirium and Postoperative Maladaptive Behaviors

2004-11-17

Zeev N. Kain , Alison A. Caldwell-Andrews , Inna Maranets +5 more

In Brief Based on previous studies, we hypothesized that the clinical phenomena of preoperative anxiety, emergence delirium, and postoperative maladaptive behavioral changes were closely related. We examined this issue using … In Brief Based on previous studies, we hypothesized that the clinical phenomena of preoperative anxiety, emergence delirium, and postoperative maladaptive behavioral changes were closely related. We examined this issue using data obtained by our laboratory over the past 6 years. Only children who underwent surgery and general anesthesia using sevoflurane/O2/N2O and who did not receive midazolam were recruited. Children's anxiety was assessed preoperatively with the modified Yale Preoperative Anxiety Scale (mYPAS), emergence delirium was assessed in the postanesthesia care unit, and behavioral changes were assessed with the Post Hospital Behavior Questionnaire (PHBQ) on postoperative days 1, 2, 3, 7, and 14. Regression analysis showed that the odds of having marked symptoms of emergence delirium increased by 10% for each increment of 10 points in the child's state anxiety score (mYPAS). The odds ratio of having new-onset postoperative maladaptive behavior changes was 1.43 for children with marked emergence status as compared with children with no symptoms of emergence delirium. A 10-point increase in state anxiety scores led to a 12.5% increase in the odds that the child would have a new-onset maladaptive behavioral change after the surgery. This finding is highly significant to practicing clinicians, who can now predict the development of adverse postoperative phenomena, such as emergence delirium and postoperative behavioral changes, based on levels of preoperative anxiety. IMPLICATIONS: A practicing clinician can now predict the development of adverse postoperative phenomena, such as emergence delirium and postoperative behavioral changes, based on levels of preoperative anxiety.

Systematic review of the psychometric properties, interpretability and feasibility of self-report pain intensity measures for use in clinical trials in children and adolescents

2006-06-14

Jennifer Stinson , T. Kavanagh , Janet Yamada +2 more

The aim of this study was to systematically review the psychometric properties, interpretability and feasibility of self-report pain intensity measures for children and adolescents for use in clinical trials evaluating … The aim of this study was to systematically review the psychometric properties, interpretability and feasibility of self-report pain intensity measures for children and adolescents for use in clinical trials evaluating pain treatments. Databases were searched for self-report measures of single-item ratings of pain intensity for children aged 3–18 years. A total of 34 single-item self-report measures were found. The measures’ psychometric properties, interpretability and feasibility, were evaluated independently by two investigators according to a set of psychometric criteria. Six single-item measures met the a priori criteria and were included in the final analysis. While these six scales were determined as psychometrically sound and show evidence of responsivity, they had varying degrees of interpretability and feasibility. No single scale was found to be optimal for use with all types of pain or across the developmental age span. Specific recommendations regarding the most psychometrically sound and feasible measures based on age/developmental level and type of pain are discussed. Future research is needed to strengthen the measurement of pain in clinical trials with children.

The faces pain scale for the self-assessment of the severity of pain experienced by children: Development, initial validation, and preliminary investigation for ratio scale properties

1990-05-01

D Bieri , Robert A. Reeve , David G. Champion +2 more

Altogether 553 children (195 first graders, mean age 6.8 years, and 358 third graders, mean age 8.7 years) participated in the development of a self-report measure to assess the intensity … Altogether 553 children (195 first graders, mean age 6.8 years, and 358 third graders, mean age 8.7 years) participated in the development of a self-report measure to assess the intensity of children's pain. The first step was the derivation, from children's drawings of facial expressions of pain, of 5 sets of 7 schematic faces depicting changes in severity of expressed pain from no pain to the most pain possible. With the set of faces that achieved the highest agreement in pain ordering, additional studies were conducted to determine whether the set had the properties of a scale. In one study, children rank-ordered the faces on 2 occasions, separated by 1 week. All 7 faces were correctly ranked by 64% (retest 1 week later, 61%) of grade 1 children and by 86% (retest 89%) of grade 3 children. In a second study, the faces were presented in all possible paired combinations. All 7 faces were correctly placed by 62% (retest 86%) of the younger and by 75% (retest 71%) of the older subjects. A third study asked children to place faces along a scale: a procedure allowing a check on the equality of intervals. The fourth study checked on whether pain was acting as an underlying construct for ordering the faces in memory. We asked whether children perceived the set as a scale by asking if memory for an ordered set of faces was more accurate than for a random set. The final study checked, with 6-year-old children, the test-retest reliability of ratings for recalled experiences of pain. Overall, the faces pain scale incorporates conventions used by children, has achieved strong agreement in the rank ordering of pain, has indications that the intervals are close to equal, and is treated by children as a scale. The test-retest data suggest that it may prove to be a reliable index over time of self-reported pain.

Pain Among Children and Adolescents: Restrictions in Daily Living and Triggering Factors

2005-02-01

Angela Roth-Isigkeit , Ute Thyen , Hartmut Stöven +2 more

Pain among children and adolescents has been identified as an important public health problem. Most studies evaluating recurrent or chronic pain conditions among children have been limited to descriptions of … Pain among children and adolescents has been identified as an important public health problem. Most studies evaluating recurrent or chronic pain conditions among children have been limited to descriptions of pain intensity and duration. The effects of pain states and their impact on daily living have rarely been studied. The objective of this study was to investigate the impact of perceived pain on the daily lives and activities of children and adolescents. In addition, we sought to delineate self-perceived triggers of pain among children and adolescents. In this study, we (1) document the 3-month prevalence of painful conditions among children and adolescents, (2) delineate their features (location, intensity, frequency, and duration), (3) describe their consequences (restrictions and health care utilization), and (4) elucidate factors that contribute to the occurrence of pain episodes among young subjects.The study was conducted in 1 elementary school and 2 secondary schools in the district of Ostholstein, Germany. Children and adolescents, as well as their parents/guardians, were contacted through their school administrators. The teachers distributed an information leaflet, explaining the conduct and aim of the study, to the parents a few days before the official enrollment of the youths in the study. Parents of children in grades 1 to 4 of elementary school were asked to complete the pain questionnaire for their children at home, whereas children from grade 5 upward completed the questionnaire on their own during class, under the supervision of their teachers. The response rate was 80.3%. As previously stated, chronic pain was defined as any prolonged pain that lasted a minimum of 3 months or any pain that recurred throughout a minimal period of 3 months. The children and adolescents were surveyed with the Luebeck Pain-Screening Questionnaire, which was specifically designed for an epidemiologic study of the characteristics and consequences of pain among children and adolescents. The questionnaire evaluates the prevalence of pain in the preceding 3 months. The body area, frequency, intensity, and duration of pain are addressed by the questionnaire. In addition, the questionnaire inquires about the private and public consequences of pain among young subjects. Specifically, the questionnaire aims to delineate the self-perceived factors for the development and maintenance of pain and the impact of these conditions on daily life.Of the 749 children and adolescents, 622 (83%) had experienced pain during the preceding 3 months. A total of 30.8% of the children and adolescents stated that the pain had been present for >6 months. Headache (60.5%), abdominal pain (43.3%), limb pain (33.6%), and back pain (30.2) were the most prevalent pain types among the respondents. Children and adolescents with pain reported that their pain caused the following sequelae: sleep problems (53.6%), inability to pursue hobbies (53.3%), eating problems (51.1%), school absence (48.8%), and inability to meet friends (46.7%). The prevalence of restrictions in daily living attributable to pain increased with age. A total of 50.9% of children and adolescents with pain sought professional help for their conditions, and 51.5% reported the use of pain medications. The prevalence of doctor visits and medication use increased with age. Weather conditions (33%), illness (30.7%), and physical exertion (21.9%) were the most frequent self-perceived triggers for pain noted by the respondents. A total of 30.4% of study participants registered headache as the most bothersome pain, whereas 12.3% cited abdominal pain, 10.7% pain in the extremities, 8.9% back pain, and 3.9% sore throat as being most bothersome. A total of 35.2% of children and adolescents reported pain episodes occurring > or =1 time per week or even more often. Health care utilization because of pain differed among children and adolescents according to the location of pain. Children and adolescents with back pain (56.7%), limb pain (55.0%), and abdominal pain (53.3%) visited a doctor more often than did those with headache (32.5%). In contrast, children and adolescents with headache (59.2%) reported taking medication because of pain more often than did those with back pain (16.4%), limb pain (22.5%), and abdominal pain (38.0%). The prevalence of self-reported medication use and doctor visits because of pain increased significantly with age (chi2 test). The prevalence of self-reported medication use was significantly higher among girls than among boys of the same age, except between the ages of 4 and 9 years (chi2 test). The prevalence of restrictions in daily activities varied among children and adolescents with different pain locations; 51.1% of children and adolescents with abdominal pain and 43.0% with headache but only 19.4% with back pain reported having been absent from school because of pain. The prevalence of restrictions attributable to pain was significantly higher among girls than among boys of the same age, except between the ages of 4 and 9 years (chi2 test). The self-reported triggers for pain varied between girls and boys. Girls stated more often than boys that their pain was triggered by weather conditions (39% vs 25%), illness (eg, common cold or injury) (35.9% vs 23.9%), anger/disputes (20.9% vs 11.9%), family conditions (12.1% vs 5.2%), and sadness (11.9% vs 3.4%). In contrast, boys stated more often than girls that their pain was triggered by physical exertion (28% vs 17.2%). We used a logistic regression model to predict the likelihood of a child paying a visit to the doctor and/or using pain medication. Health care utilization was predicted by increasing age, greater intensity of pain, and longer duration of pain but not by the frequency of pain. We used a logistic regression model to predict restrictions in daily activities. Only the intensity of pain was predictive of the degree of restrictions in daily life attributable to pain; the duration of pain and the frequency of pain episodes had no bearing on the degree to which the daily lives of the children were restricted because of pain.More than two thirds of the respondents reported restrictions in daily living activities attributable to pain. However, 30 to 40% of children and adolescents with pain reported moderate effects of their pain on school attendance, participation in hobbies, maintenance of social contacts, appetite, and sleep, as well as increased utilization of health services because of their pain. Restrictions in daily activities in general and health care utilization because of pain increased with age. Girls > or =10 years of age reported more restrictions in daily living and used more medications for their pain than did boys of the same age. We found gender-specific differences in self-perceived triggers for pain. Pain intensity was the most robust variable for predicting functional impairment in > or =1 areas of daily life. Increasing age of the child and increasing intensity and duration of pain had effects in predicting health care utilization (visiting a doctor and/or taking medication), whereas restrictions in daily activities were predicted only by the intensity of pain. Our results underscore the relevance of pediatric pain for public health policy. Additional studies are necessary and may enhance our knowledge about pediatric pain, to enable parents, teachers, and health care professionals to assist young people with pain management, allowing the young people to intervene positively in their conditions before they become recurrent or persistent.

Validity of four pain intensity rating scales

2011-08-19

Alexandra Ferreira-Valente , José Luís Pais Ribeiro , Mark P. Jensen

The Visual Analogue Scale (VAS), Numerical Rating Scale (NRS), Verbal Rating Scale (VRS), and the Faces Pain Scale-Revised (FPS-R) are among the most commonly used measures of pain intensity in … The Visual Analogue Scale (VAS), Numerical Rating Scale (NRS), Verbal Rating Scale (VRS), and the Faces Pain Scale-Revised (FPS-R) are among the most commonly used measures of pain intensity in clinical and research settings. Although evidence supports their validity as measures of pain intensity, few studies have compared them with respect to the critical validity criteria of responsivity, and no experiment has directly compared all 4 measures in the same study. The current study compared the relative validity of VAS, NRS, VRS, and FPS-R for detecting differences in painful stimulus intensity and differences between men and women in response to experimentally induced pain. One hundred twenty-seven subjects underwent four 20-second cold pressor trials with temperature order counterbalanced across 1°C, 3°C, 5°C, and 7°C and rated pain intensity using all 4 scales. Results showed statistically significant differences in pain intensity between temperatures for each scale, with lower temperatures resulting in higher pain intensity. The order of responsivity was as follows: NRS, VAS, VRS, and FPS-R. However, there were relatively small differences in the responsivity between scales. A statistically significant sex main effect was also found for the NRS, VRS, and FPS-R. The findings are consistent with previous studies supporting the validity of each scale. The most support emerged for the NRS as being both (1) most responsive and (2) able to detect sex differences in pain intensity. The results also provide support for the validity of the scales for use in Portuguese samples.

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The post-anesthesia recovery score revisited

1995-02-01

J. Antonio Aldrete

The Assessment and Management of Acute Pain in Infants, Children, and Adolescents

2001-09-01

Acute pain is one of the most common adverse stimuli experienced by children, occurring as a result of injury, illness, and necessary medical procedures. It is associated with increased anxiety, … Acute pain is one of the most common adverse stimuli experienced by children, occurring as a result of injury, illness, and necessary medical procedures. It is associated with increased anxiety, avoidance, somatic symptoms, and increased parent distress. Despite the magnitude of effects that acute pain can have on a child, it is often inadequately assessed and treated. Numerous myths, insufficient knowledge among caregivers, and inadequate application of knowledge contribute to the lack of effective management. The pediatric acute pain experience involves the interaction of physiologic, psychologic, behavioral, developmental, and situational factors. Pain is an inherently subjective multifactorial experience and should be assessed and treated as such. Pediatricians are responsible for eliminating or assuaging pain and suffering in children when possible. To accomplish this, pediatricians need to expand their knowledge, use appropriate assessment tools and techniques, anticipate painful experiences and intervene accordingly, use a multimodal approach to pain management, use a multidisciplinary approach when possible, involve families, and advocate for the use of effective pain management in children.

Epidemiology and Treatment of Painful Procedures in Neonates in Intensive Care Units

2008-07-01

Ricardo Carbajal

Effective strategies to improve pain management in neonates require a clear understanding of the epidemiology and management of procedural pain.To report epidemiological data on neonatal pain collected from a geographically … Effective strategies to improve pain management in neonates require a clear understanding of the epidemiology and management of procedural pain.To report epidemiological data on neonatal pain collected from a geographically defined region, based on direct bedside observation of neonates.Between September 2005 and January 2006, data on all painful and stressful procedures and corresponding analgesic therapy from the first 14 days of admission were prospectively collected within a 6-week period from 430 neonates admitted to tertiary care centers in the Paris region of France (11.3 millions inhabitants) for the Epidemiology of Procedural Pain in Neonates (EPIPPAIN) study.Number of procedures considered painful or stressful by health personnel and corresponding analgesic therapy.The mean (SD) gestational age and intensive care unit stay were 33.0 (4.6) weeks and 8.4 (4.6) calendar days, respectively. Neonates experienced 60,969 first-attempt procedures, with 42,413 (69.6%) painful and 18,556 (30.4%) stressful procedures; 11,546 supplemental attempts were performed during procedures including 10,366 (89.8%) for painful and 1180 (10.2%) for stressful procedures. Each neonate experienced a median of 115 (range, 4-613) procedures during the study period and 16 (range, 0-62) procedures per day of hospitalization. Of these, each neonate experienced a median of 75 (range, 3-364) painful procedures during the study period and 10 (range, 0-51) painful procedures per day of hospitalization. Of the 42,413 painful procedures, 2.1% were performed with pharmacological-only therapy; 18.2% with nonpharmacological-only interventions, 20.8% with pharmacological, nonpharmacological, or both types of therapy; and 79.2% without specific analgesia, and 34.2% were performed while the neonate was receiving concurrent analgesic or anesthetic infusions for other reasons. Prematurity, category of procedure, parental presence, surgery, daytime, and day of procedure after the first day of admission were associated with greater use of specific preprocedural analgesia, whereas mechanical ventilation, noninvasive ventilation and administration of nonspecific concurrent analgesia were associated with lower use of specific preprocedural analgesia.During neonatal intensive care in the Paris region, large numbers of painful and stressful procedures were performed, the majority of which were not accompanied by analgesia.

Trends in Opioid Prescribing by Race/Ethnicity for Patients Seeking Care in US Emergency Departments

2008-01-01

Mark J. Pletcher , Stefan G. Kertesz , Michael A. Kohn +1 more

jor public health problem in the United States 1 and a particular problem in emergency departments. 2Patients usually present to the emergency department when other medical help is not accessible … jor public health problem in the United States 1 and a particular problem in emergency departments. 2Patients usually present to the emergency department when other medical help is not accessible or when symptoms, often including pain, are most severe.Emergency department visits therefore represent high-risk encounters in which assessment and treatment of pain should receive careful attention. 2acial and ethnic minority groups appear to be at particularly high risk of receiving inadequate treatment for pain in the emergency department.][8][9][10] Previous studies of the National Hospital Ambulatory Medical Care Survey (NHAMCS), a survey of US emergency department visits, have found national racial/ethnic differences in opioid prescribing for back pain and migraine (1997-1999) 6 and in provision of sedation for children with long-bone fractures (1992-1998). 11 In the 1990s, national attention focused on increasing awareness of the problem of inadequately treated pain. 1 Major campaigns undertaken by the Joint Commission on Accreditation of Healthcare Organizations ( JCAHO) 12 and the Veterans Health Administration 13 introduced standards for consistent monitoring and treatment of pain that have become important quality in-See also p 89 and Patient Page.

Consensus Statement for the Prevention and Management of Pain in the Newborn

2001-02-01

K.J.S. Anand

To develop evidence-based guidelines for preventing or treating neonatal pain and its adverse consequences. Compared with older children and adults, neonates are more sensitive to pain and vulnerable to its … To develop evidence-based guidelines for preventing or treating neonatal pain and its adverse consequences. Compared with older children and adults, neonates are more sensitive to pain and vulnerable to its long-term effects. Despite the clinical importance of neonatal pain, current medical practices continue to expose infants to repetitive, acute, or prolonged pain.Experts representing several different countries, professional disciplines, and practice settings used systematic reviews, data synthesis, and open discussion to develop a consensus on clinical practices that were supported by published evidence or were commonly used, the latter based on extrapolation of evidence from older age groups. A practical format was used to describe the analgesic management for specific invasive procedures and for ongoing pain in neonates.Recognition of the sources of pain and routine assessments of neonatal pain should dictate the avoidance of recurrent painful stimuli and the use of specific environmental, behavioral, and pharmacological interventions. Individualized care plans and analgesic protocols for specific clinical situations, patients, and health care settings can be developed from these guidelines. By clearly outlining areas where evidence is not available, these guidelines may also stimulate further research. To use the recommended therapeutic approaches, clinicians must be familiar with their adverse effects and the potential for drug interactions.Management of pain must be considered an important component of the health care provided to all neonates, regardless of their gestational age or severity of illness.

Effects of morphine analgesia in ventilated preterm neonates: primary outcomes from the NEOPAIN randomised trial

2004-05-01

K.J.S. Anand , Richard Hall , Nirmala S. Desai +7 more

Systematic Review and Meta-Analysis of Psychological Therapies for Children With Chronic Pain

2014-03-06

Emma Fisher , Lauren C. Heathcote , Tonya M. Palermo +3 more

Objectives This systematic review and meta-analysis examined the effects of psychological therapies for management of chronic pain in children. Methods Randomized controlled trials of psychological interventions treating children (<18 years) … Objectives This systematic review and meta-analysis examined the effects of psychological therapies for management of chronic pain in children. Methods Randomized controlled trials of psychological interventions treating children (<18 years) with chronic pain conditions including headache, abdominal, musculoskeletal, or neuropathic pain were searched for. Pain symptoms, disability, depression, anxiety, and sleep outcomes were extracted. Risk of bias was assessed and quality of the evidence was rated using GRADE. Results 35 included studies revealed that across all chronic pain conditions, psychological interventions reduced pain symptoms and disability posttreatment. Individual pain conditions were analyzed separately. Sleep outcomes were not reported in any trials. Optimal dose of treatment was explored. For headache pain, higher treatment dose led to greater reductions in pain. No effect of dosage was found for other chronic pain conditions. Conclusions Evidence for psychological therapies treating chronic pain is promising. Recommendations for clinical practice and research are presented.

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The Visual Analog Scale in the Immediate Postoperative Period

1998-01-01

Lauren J. DeLoach , Michael S. Higgins , Amy B. Caplan +1 more

The visual analog scale (VAS) has been used to assess the efficacy of pain management regimens in patients with acute postoperative pain, but its usefulness has not been confirmed in … The visual analog scale (VAS) has been used to assess the efficacy of pain management regimens in patients with acute postoperative pain, but its usefulness has not been confirmed in postoperative pain studies. We studied 60 subjects in the immediate postoperative period. The specific data collected were: VAS scores versus an 11-point numeric pain scale; repeatability in VAS scores over a short time interval; and change in VAS scores from one assessment period to the next versus a verbal report of change in pain. The correlation coefficients for VAS scores with the 11-point pain scale were 0.94, 0.91, and 0.95. The repeatability coefficients were 17.6, 23.0, and 13.5 mm. Of the 56 patients who completed all three assessments, only 16 (29%) had repeatability within 5 mm on all three. Some of the changes in VAS scores between assessments were in the direction opposite the verbally reported changes in pain (31%); however, most (92%) were within 20 mm. There was no correlation between the level of sedation, previous pain experience, anxiety, or anticipated pain with consistency in VAS scores. We conclude that any single VAS score in the immediate postoperative period should be considered to have an imprecision of +/- 20 mm.The visual analog scale was developed for assessing chronic pain but is often used in studies of postoperative pain. This study finds that the visual analog scale correlates well with a verbal 11-point scale but that any individual determination has an imprecision of +/- 20 mm.

Effect of neonatal circumcision on pain response during subsequent routine vaccination

1997-03-01

Anna Taddio , Joel Katz , A Lane Ilersich +1 more

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Assessing Distress in Pediatric Intensive Care Environments: The COMFORT Scale

1992-01-01

Bruce Ambuel , Kim W. Hamlett , Celeste M. Marx +1 more

Managing psychological distress is a central treatment goal in Pediatric Intensive Care Units (PICUs), with medical and psychological implications. However, there is no objective measure for assessing efficacy of pharmacologic … Managing psychological distress is a central treatment goal in Pediatric Intensive Care Units (PICUs), with medical and psychological implications. However, there is no objective measure for assessing efficacy of pharmacologic and psychological interventions used to reduce distress. Development of the COMFORT scale is described, a nonintrusive measure for assessing distress in PICU patients. Eight dimensions were selected based upon a literature review and survey of PICU nurses. Interrater agreement and internal consistency were high. Criterion validity, assessed by comparison with concurrent global ratings of PICU nurses, was also high. Principal components analysis revealed 2 correlated factors, behavioral and physiologic, accounting for 84% of variance. An ecological-developmental model is presented for further study of children's distress and coping in the PICU.

The Faces Pain Scale – Revised: toward a common metric in pediatric pain measurement

2001-08-01

Carrie L. Hicks , Carl L. von Baeyer , Pamela A. Spafford +2 more

The Faces Pain Scale (FPS; Bieri et al., Pain 41 (1990) 139) is a self-report measure used to assess the intensity of children's pain. Three studies were carried out to … The Faces Pain Scale (FPS; Bieri et al., Pain 41 (1990) 139) is a self-report measure used to assess the intensity of children's pain. Three studies were carried out to revise the original scale and validate the adapted version. In the first phase, the FPS was revised from its original seven faces to six, while maintaining its desirable psychometric properties, in order to make it compatible in scoring with other self-rating and observational scales which use a common metric (0–5 or 0–10). Using a computer-animated version of the FPS developed by Champion and colleagues (Sydney Animated Facial Expressions Scale), psychophysical methods were applied to identify four faces representing equal intervals between the scale values representing least pain and most pain. In the second phase, children used the new six-face Faces Pain Scale – Revised (FPS-R) to rate the intensity of pain from ear piercing. Its validity is supported by a strong positive correlation (r=0.93, N=76) with a visual analogue scale (VAS) measure in children aged 5–12 years. In the third phase, a clinical sample of pediatric inpatients aged 4–12 years used the FPS-R and a VAS or the colored analogue scale (CAS) to rate pain during hospitalization for surgical and non-surgical painful conditions. The validity of the FPS-R was further supported by strong positive correlations with the VAS (r=0.92, N=45) and the CAS (r=0.84, N=45) in this clinical sample. Most children in all age groups including the youngest were able to use the FPS-R in a manner that was consistent with the other measures. There were no significant differences between the means on the FPS-R and either of the analogue scales. The FPS-R is shown to be appropriate for use in assessment of the intensity of children's acute pain from age 4 or 5 onward. It has the advantage of being suitable for use with the most widely used metric for scoring (0–10), and conforms closely to a linear interval scale.

The epidemiology of chronic pain in children and adolescents revisited: A systematic review

2011-11-11

Sará King , Christine T. Chambers , Anna Huguet +4 more

Chronic and recurrent pain not associated with a disease is very common in childhood and adolescence, but studies of pain prevalence have yielded inconsistent findings. This systematic review examined studies … Chronic and recurrent pain not associated with a disease is very common in childhood and adolescence, but studies of pain prevalence have yielded inconsistent findings. This systematic review examined studies of chronic and recurrent pain prevalence to provide updated aggregated prevalence rates. The review also examined correlates of chronic and recurrent pain such as age, sex, and psychosocial functioning. Studies of pain prevalence rates in children and adolescents published in English or French between 1991 and 2009 were identified using EMBASE, Medline, CINAHL, and PsycINFO databases. Of 185 published papers yielded by the search, 58 met inclusion criteria and were reviewed, and 41 were included in the review. Two independent reviewers screened papers for inclusion, extracted data, and assessed the quality of studies. Prevalence rates ranged substantially, and were as follows: headache: 8-83%; abdominal pain: 4-53%; back pain: 14-24%; musculoskeletal pain: 4-40%; multiple pains: 4-49%; other pains: 5-88%. Pain prevalence rates were generally higher in girls and increased with age for most pain types. Lower socioeconomic status was associated with higher pain prevalence especially for headache. Most studies did not meet quality criteria.

Do We Still Hurt Newborn Babies?

2003-11-01

Sinno H. P. Simons , Monique van Dijk , K.J.S. Anand +3 more

<h3>Background</h3> Despite an increasing awareness regarding pain management in neonates and the availability of published guidelines for the treatment of procedural pain, preterm neonates experience pain leading to short- and … <h3>Background</h3> Despite an increasing awareness regarding pain management in neonates and the availability of published guidelines for the treatment of procedural pain, preterm neonates experience pain leading to short- and long-term detrimental effects. <h3>Objective</h3> To assess the frequency of use of analgesics in invasive procedures in neonates and the associated pain burden in this population. <h3>Methods</h3> For 151 neonates, we prospectively recorded all painful procedures, including the number of attempts required, and analgesic therapy used during the first 14 days of neonatal intensive care unit admission. These data were linked to estimates of the pain of each procedure, obtained from the opinions of experienced clinicians. <h3>Results</h3> On average, each neonate was subjected to a mean ± SD of 14 ± 4 procedures per day. The highest exposure to painful procedures occurred during the first day of admission, and most procedures (63.6%) consisted of suctioning. Many procedures (26 of 31 listed on a questionnaire) were estimated to be painful (pain scores >4 on a 10-point scale). Preemptive analgesic therapy was provided to fewer than 35% of neonates per study day, while 39.7% of the neonates did not receive any analgesic therapy in the neonatal intensive care unit. <h3>Conclusions</h3> Clinicians estimated that most neonatal intensive care unit procedures are painful, but only a third of the neonates received appropriate analgesic therapy. Despite the accumulating evidence that neonatal procedural pain is harmful, analgesic treatment for painful procedures is limited. Systematic approaches are required to reduce the occurrence of pain and to improve the analgesic treatment of repetitive pain in neonates.

The effectiveness of virtual reality distraction for pain reduction: A systematic review

2010-07-14

Kevin M. Malloy , Leonard S. Milling

Core Outcome Domains and Measures for Pediatric Acute and Chronic/Recurrent Pain Clinical Trials: PedIMMPACT Recommendations

2008-06-18

Patrick J. McGrath , Gary A. Walco , Dennis C. Turk +7 more

Sucrose for analgesia in newborn infants undergoing painful procedures

2004-07-19

Bonnie Stevens , Janet Yamada , Arne Ohlsson

Background Management of pain for neonates is less than optimal. The administration of sucrose with and without non‐nutritive sucking (pacifiers) has been the most frequently studied non‐pharmacological intervention for relief … Background Management of pain for neonates is less than optimal. The administration of sucrose with and without non‐nutritive sucking (pacifiers) has been the most frequently studied non‐pharmacological intervention for relief of procedural pain in neonates. Objectives To determine the efficacy, effect of dose, and safety of sucrose for relieving procedural pain as assessed by validated individual pain indicators and composite pain scores. Search methods Standard methods as per the Neonatal Collaborative Review Group. A MEDLINE search was carried out for relevant randomized controlled trials (RCTs) published from January 1966 ‐ March 2004, EMBASE from 1980 ‐ 2004 and search of the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library, Issue 1, 2004). Key words and (MeSH) terms included infant/newborn, pain, analgesia and sucrose. Language restrictions were not imposed. Bibliographies, personal files, the most recent relevant neonatal and pain journals and recent major pediatric pain conference proceedings were searched manually. Unpublished studies, or studies reported only as abstracts, were not included. Additional information from published studies was obtained. Selection criteria RCTs in which term and/or preterm neonates (postnatal age maximum of 28 days after reaching 40 weeks corrected gestational age) received sucrose via oral syringe, NG‐tube, dropper or pacifier for procedural pain from heel lance or venepuncture. In the control group, water, pacifier or positioning/containing were used. Studies in which the painful stimulus was circumcision were excluded. Data collection and analysis Trial quality was assessed according to the methods of the Neonatal Collaborative Review Group. Quality measures included blinding of randomization, blinding of intervention, completeness of follow up and blinding of outcome measurement. Data were abstracted and independently checked for accuracy by the three investigators. Statistical Analysis The statistical package (RevMan 4.2) of the Cochrane Collaboration was used. For meta‐analysis, a weighted mean difference (WMD) with 95% confidence intervals (CI) using the fixed effects model was reported for continuous outcome measures. Main results Forty‐four studies were identified for possible inclusion in this review. Seven studies reported only as abstracts, and sixteen additional studies were excluded, leaving 21 studies (1,616 infants) included in this review. Sucrose in a wide variety of dosages was generally found to decrease physiologic (heart rate) and behavioural (the mean percent time crying, total cry duration, duration of first cry, and facial action) pain indicators and composite pain scores in neonates undergoing heel stick or venepuncture. When pain scores (Premature Infant Pain Profiles) were pooled across 3 studies (Gibbins 2001; Johnston 1999a; Stevens 1999), they were significantly reduced in infants who were given sucrose (dose range 0.012 g to 0.12 g) compared to the control group, [WMD ‐1.64 (95% CI ‐2.47,‐ 0.81); p = 0.0001] at 30 seconds and [WMD ‐2.05, (95% CI ‐3.08, ‐1.02); p = 0.00010] at 60 seconds after heel lance. When results for change in heart rate were pooled for two studies (Haouari 1995, Isik 2000), there were no significant differences between changes in heart rate for infants given sucrose (dose range 0.5 g to 0.6 g) compared to the control group, [WMD 0.90 (95% CI ‐5.81, 7.61); p = 0.8] at one minute and [WMD ‐6.20 (95% CI ‐15.27, 2.88); p = 0.18] at three minutes after heel lance. Authors' conclusions Sucrose is safe and effective for reducing procedural pain from single painful events (heel lance, venepuncture). There was inconsistency in the dose of sucrose that was effective (dose range of 0.012 g to 0.12 g), and therefore an optimal dose to be used in preterm and/or term infants could not be identified. The use of repeated administrations of sucrose in neonates needs to be investigated as does the use of sucrose in combination with other behavioural (e.g., facilitated tucking, kangaroo care) and pharmacologic (e.g., morphine, fentanyl) interventions. Use of sucrose in neonates who are of very low birth weight, unstable and/or ventilated also needs to be addressed.

Updating the definition of pain

2016-05-18

Amanda C de C Williams , Kenneth D. Craig

aResearch Department of Clinical, Educational and Health Psychology, University College London, London, United Kingdom bDepartment of Psychology, University of British Columbia, Vancouver, BC, Canada *Corresponding author. Address: Research Department of … aResearch Department of Clinical, Educational and Health Psychology, University College London, London, United Kingdom bDepartment of Psychology, University of British Columbia, Vancouver, BC, Canada *Corresponding author. Address: Research Department of Clinical, Educational and Health Psychology, University College London, Gower St, London WC1E 6BT, United Kingdom. Tel.: 00442076791608; fax: 00442079161989. E-mail address: [email protected] (A. C.d.C. Williams). Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article.

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A systematic review of the pain scales in adults: Which to use?

2018-01-06

Özgür Karcıoğlu , Hakan Topaçoğlu , Özgür Dikme +1 more

Psychological interventions for needle-related procedural pain and distress in children and adolescents

2018-10-04

Kathryn A. Birnie , Melanie Noel , Christine T. Chambers +2 more

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Noradrenergic and peptidergic innervation of lymphoid tissue

1985-08-01

Felten Dl , SY Felten , SL Carlson +2 more

Sympathetic noradrenergic nerve fibers innervate both the vasculature and parenchymal fields of lymphocytes and associated cells in several lymphoid organs, including the thymus, spleen, lymph nodes, gut-associated lymphoid tissue (GALT), … Sympathetic noradrenergic nerve fibers innervate both the vasculature and parenchymal fields of lymphocytes and associated cells in several lymphoid organs, including the thymus, spleen, lymph nodes, gut-associated lymphoid tissue (GALT), and bone marrow, in a variety of mammalian species. This innervation is both regional and specific, and generally is directed into zones of T lymphocytes and plasma cells rather than into nodular regions or B lymphocyte regions. In the thymus, noradrenergic fibers enter with nerve bundles and plexuses around blood vessels, travel into the cortex from subcapsular plexuses and with the vasculature, and branch into the parenchyma of the thymic cortex. The vasculature and parenchymal regions of both the outer and deep cortex are innervated by these fibers. In the spleen, noradrenergic fibers enter with the vasculature, travel along the trabeculae and along the branching vasculature, and are distributed mainly in the white pulp along the central artery and associated periarterial lymphatic sheath. Fibers branch from a dense plexus around the central artery and travel into the parenchyma, where they end among fields of lymphocytes and other cell types. In lymph nodes, noradrenergic fibers enter at the hilus, travel along the vasculature and in a subcapsular plexus, and branch into the parenchyma in paracortical and cortical regions, where they end among lymphocytes. In the GALT, represented in these studies by rabbit appendix, sacculus rotundus, and Peyer's patches, noradrenergic fibers enter at the serosal surface, travel longitudinally with the muscularis interna, turn radially into internodular plexuses, plunge directly through the thymus-dependent zones, and ramify profusely among lymphocytes, enterochromaffin cells, and plasma cells in the interdomal regions. In the bone marrow, noradrenergic fibers enter with blood vessels, distribute deeply into the marrow on those vessels, and branch sparsely into the substance of the marrow. Immunocytochemical observations revealed the presence of neuro-peptide-like immunoreactivity in the thymus and spleen. Vasoactive intestinal peptide (VIP)-like immunoreactivity is found in varicose profiles in the thymus within the cortex. In the spleen, immunoreactive profiles showing neuropeptide Y-like, Met-enkephalin-like, cholecystokinin-8 (CCK)-like, and neurotensin-like immunoreactivity are present along the central artery of the white pulp and its smaller branches, with only sparse fibers of most of these peptides entering the parenchyma. CCK-like profiles are present in abundance in the white pulp among parenchymal elements.(ABSTRACT TRUNCATED AT 400 WORDS)

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Cannabis Use Is Associated With Increased Postoperative Pain and Opioid Use After Mohs Micrographic Surgery: A Retrospective Cohort Analysis

2025-06-25

Tarun Sontam , Seo Won Cho , Mojahed Shalabi +1 more | Dermatologic Surgery

Navigating Growing Pains in Pediatric Emergency Care: New Perspectives and Emerging Challenges

2025-06-24

Muhammad Nouman Tariq , Md. Raihan Chowdhury , Syed Shayan Gilani +7 more | The American Journal of Medical Sciences and Pharmaceutical Research

Growing pains are a prevalent condition in children, often leading to discomfort and anxiety for both patients and their families. These pains typically manifest as bilateral limb discomfort that occurs … Growing pains are a prevalent condition in children, often leading to discomfort and anxiety for both patients and their families. These pains typically manifest as bilateral limb discomfort that occurs primarily in the evenings or at night, affecting approximately 10-20% of the pediatric population. Despite their benign nature, growing pains pose significant challenges in pediatric emergency care due to their episodic nature and lack of specific diagnostic markers. Recent research has shifted the understanding of growing pains from a simplistic view of mere skeletal growth to a multifactorial condition influenced by genetic predisposition, vitamin D deficiency, hypermobility syndrome, and psychosocial factors. This evolving perspective introduces new diagnostic uncertainties as healthcare providers must differentiate growing pains from serious underlying conditions, such as infections, malignancies, and autoimmune disorders. Communication with parents plays a critical role, as they often seek immediate reassurance amid concerns about their child's health. The integration of mental health evaluations and tailored pain management strategies, including non-pharmacological approaches, is essential for effective treatment. Additionally, establishing structured follow-up care can aid in monitoring symptom progression and improving long-term outcomes. In conclusion, addressing growing pains requires a holistic approach that encompasses both physical and psychological aspects of care. By enhancing the understanding of this condition and improving communication and management strategies, pediatric emergency care can better support children experiencing growing pains and their families

Effects of respiratory physiotherapeutic interventions on pulmonary mechanics, vital parameters and pain in newborns: A systematic review

2025-06-24

Adriele de Morais Nunes , Adelaide Fernandes , Amanda Cristina Freitas da Silva +3 more | Canadian Journal of Respiratory Therapy

To evaluate the effects of conventional and non-conventional respiratory physiotherapy on pulmonary mechanics, vital parameters, and pain in newborns admitted to a neonatal intensive care unit. Databases including PubMed, LILACS, … To evaluate the effects of conventional and non-conventional respiratory physiotherapy on pulmonary mechanics, vital parameters, and pain in newborns admitted to a neonatal intensive care unit. Databases including PubMed, LILACS, SciELO, Science Direct, Cochrane Library, and Web of Science were searched. Randomized clinical trials comparing conventional and non-conventional respiratory physiotherapy in newborns (1 hour to 28 days) in neonatal intensive care units were included. Two reviewers independently screened titles and abstracts and assessed bias using the PEDro scale. Data were presented as mean, standard deviation, median, and quartiles. Meta-analysis was not feasible due to incomplete post-intervention data. Out of 5,653 articles found, four were included. Two studies reported major increases in peripheral oxygen saturation after both respiratory physiotherapy techniques, a third showed decreased respiratory rate, and a fourth showed increased heart rate. Neither conventional nor non-conventional respiratory physiotherapy was suggested to cause pain in participants. No study evaluated lung mechanics parameters. The methodological quality of the included studies was predominantly moderate. Only one study exhibited low methodological quality. Both conventional and non-conventional respiratory physiotherapy techniques showed no adverse effects on vital signs or pain in NICU newborns. Further clinical trials are encouraged to assess lung function more comprehensively. Future studies should include short- and long-term evaluations of lung mechanics, respiratory distress, and pain.

Development and validation of the Pediatrics Functional Living Index—Emesis scale

2025-06-24

Lili Han , Jun Deng , Yuyun Yang +7 more | Frontiers in Oncology

Background and objective Assessing the impact of chemotherapy-induced nausea and vomiting (CINV) on the quality of life (QoL) of cancer patients is critical. However, there is a dearth of specialized … Background and objective Assessing the impact of chemotherapy-induced nausea and vomiting (CINV) on the quality of life (QoL) of cancer patients is critical. However, there is a dearth of specialized assessment tools designed specifically for pediatric cancer patients. The aim of this study was to develop and validate the Pediatrics Functional Living Index-Emesis (PFLIE) as a patient-reported outcome measure (PROM) to assess the impact of CINV on QoL in pediatric patients. This study was approved by the Institutional Review Board of Sun Yat-sen University Cancer Center (Approval No. B2021-113-01) and was conducted in accordance with the Declaration of Helsinki. Materials and methods The reliability, content validity, structural validity, and concurrent validity of the PFLIE were assessed through two rounds of Delphi expert consultation and a questionnaire survey of 90 pediatric cancer patients receiving chemotherapy at a tertiary care hospital cancer center in China. Results The PFLIE consists of two domains: nausea (10 items) and vomiting (10 items). The content validity index (CVI) for both the nausea and vomiting domains was 0.933. The Cronbach’s alpha coefficients for the total scale, nausea domain, and vomiting domain were 0.964, 0.928, and 0.943, respectively. Item-domain correlations were stronger for the PFLIE (r = 0.678-0.882) across domains compared to across-domain correlations (r = 0.493-0.780), suggesting that the PFLIE has acceptable construct validity. In addition, the PFLIE demonstrated acceptable concurrent validity. Conclusions The validity and reliability of the Chinese version of the PFLIE are reliable and valid. The tool can help healthcare providers effectively identify and manage CINV symptoms, thereby improving the QoL of pediatric cancer patients. In low- and middle-income countries (LMICs) with limited resources, PFLIE can be used to improve the management of CINV and to ensure that pediatric cancer patients receive adequate care despite inadequate healthcare infrastructures. The tool can be used to improve the management of CINV and to ensure that pediatric cancer patients receive adequate care despite inadequate healthcare infrastructures.

A study evaluating whether immobilisation or no immobilisation affects pain scores in toddlers fractures

2025-06-23

Katie Ridsdale , N. Nicolaou , Muniba Aslam | http://isrctn.com/

Rapid local anesthesia in children enhanced by STAR particles: a first-in-humans, randomized clinical trial

2025-06-23

Andrew R. Tadros , Mark R. Prausnitz , Eric I. Felner | Drug Delivery and Translational Research

Pharmacological interventions for the prevention of pain during endotracheal suctioning in ventilated neonates

2025-06-20

Sofie Pirlotte , Katrien Beeckman , Michelle Fiander +3 more | Cochrane library

PHARMACOLOGICAL CORRECTION OF PAIN IN THE INTRA- AND POSTOPERATIVE PERIODS IN PEDIATRIC PRACTICE

2025-06-20

Ekaterina E. Yakovleva , Э.Р. Бычков , Петр Д. Шабанов +2 more | Reviews on Clinical Pharmacology and Drug Therapy

Facilitating the healing process and the minimizing or eliminating pain are the main goals of the perioperative period. Newborns, including premature infants, also feel pain and have a stress response, … Facilitating the healing process and the minimizing or eliminating pain are the main goals of the perioperative period. Newborns, including premature infants, also feel pain and have a stress response, which was first described by Anand K.J. et al. in 1987 [16]. During similar surgical interventions, the stress response activated by afferent impulses of neurons from the site of injury in newborns is greater in magnitude but shorter in duration than in adults [28]. Stress initiates a series of metabolic changes leading to the catabolism of proteins, fats and carbohydrates. In premature infants it can lead to metabolic acidosis, increased concentrations of catecholamines, growth hormone, glucagon, corticosteroids, hypoglycemia/hyperglycemia, electrolyte imbalance [19; 37]. In 1992, Anand and Hickey showed that pain relief during cardiac surgery using opioids is associated with improved surgical outcomes [17]. Severe chronic pain in a newborn with insufficient and ineffective anesthesia leads to the severe disorders up to the development of increasing hypoxia, hypercapnia, acidosis, hyperglycemia, liver and kidney dysfunction, respiratory disorders, intraventricular hemorrhage, ischemia and periventricular leukomalacia, leads to an increased risk of sepsis, DIC syndrome, increases neonatal mortality [36; 45]. At present, the possibilities of traditional methods of analgesia remain limited. In this regard, the main directions of improving the quality of pain relief in pediatrics are the systematization and implementation in clinical practice of available evidence-based medicine data on the feasibility of using various combinations of non-opioid analgesics, supplemented with opioids if necessary, as well as the development of new effective and safe medicines with analgesic activity.

Caring Science in the Neonatal Intensive Care Unit: Transforming Neonatal Pain Management

2025-06-20

Helen McCord , Lisa Goldberg , Jean Watson +1 more | Nursing Science Quarterly

Neonatal nurses provide highly specialized care to critically ill preterm infants who endure frequent painful procedures. Despite evidence of effective strategies to manage pain, pain continues to be undertreated. Caring … Neonatal nurses provide highly specialized care to critically ill preterm infants who endure frequent painful procedures. Despite evidence of effective strategies to manage pain, pain continues to be undertreated. Caring science offers a mature disciplinary foundation as a guide to professional practice. The aim of this paper is to utilize a caring science framework to help guide nurses to offer authentic neonatal care through the creation of a caring relationship and environment for promoting optimal pain assessment and management practices in preterm infants.

Comparing Kangaroo Mother Care and Expressed Breast Milk as Non-pharmacological Strategies for Reducing Procedural Pain in Neonates: A Randomized Controlled Trial

2025-06-20

Santosh K Lodhi , Suman Rana , Surendra Kumar +6 more | Cureus

Mandala coloring reduces anxiety and pain in circumcised children: A randomized controlled trial

2025-06-19

Gamze Akay , Elif Simay Koç , Hatice Oğuzhan | Journal of Pediatric Nursing

The Intersection of Psychology and Gynecology: A Comprehensive Review of Pain Management Strategies in Women's Health

2025-06-19

Archana Kori , Ajay Singh , Yash Satish Caroicar +2 more | Cureus

Addressing Pain During Outpatient Gynecologic Procedures: A Call to Action

2025-06-18

Rebecca H. Allen | Obstetrics and Gynecology

The effect of virtual reality on skin prick test-related pain and fear in children: a randomized controlled trial

2025-06-18

Cihangir Sahin , Şule Çinakli , Simge Atar Beşe +4 more | European Journal of Pediatrics

Abstract Skin prick tests are a common method for diagnosing allergies in pediatric allergy clinics. Unfortunately, these tests can be distressing for children, causing pain and fear that can make … Abstract Skin prick tests are a common method for diagnosing allergies in pediatric allergy clinics. Unfortunately, these tests can be distressing for children, causing pain and fear that can make them challenging to conduct. Virtual reality (VR) can be used to distract children during medical procedures. This study examines the effect of VR on skin prick test-related pain and fear in children. This parallel-group, single-blind, prospective, randomized controlled trial enrolled 233 children evaluated at the Pediatric Allergy Clinic and scheduled to undergo skin prick testing between March and June 2024. Among these children, 75 children aged 4–10 years who met the inclusion criteria were divided into two groups as VR group ( n = 25) and control group ( n = 25) by block randomization using gender and age group variables. The VR group wore VR goggles during the skin prick test, while the control group underwent the standard procedure. Pain and fear levels were assessed using the Wong-Baker FACES® Pain Scale and the Child Fear Scale. Children in the VR group exhibited a significant reduction in pain and fear levels associated with the skin prick test experience compared to the control group, as evaluated by children, parents, and researchers ( p < 0.05). No side effects related to VR were reported. Conclusion : Virtual reality can be an effective tool in pediatric allergy clinics to reduce pain and fear during skin prick testing. By enhancing the child’s comfort, VR may also improve adherence to allergy follow-up and treatment, ultimately contributing to better clinical outcomes. What is Known: • Children often experience significant pain and fear during invasive procedures such as skin prick tests, and distraction methods have been shown to reduce pain and anxiety. What is New: • This study is the first randomized controlled trial to demonstrate that virtual reality (VR) significantly reduces pain and fear during skin prick tests in children. • This study supports the integration of new technologies such as VR as a standard practice for managing pain and fear during skin prick tests in pediatric allergy clinics. Trial registration : The clinical trial registration number is NCT06421779. Study start date: March 22, 2024. Study completion date: July 22, 2024. ( https://clinicaltrials.gov/study/NCT06421779 ). Graphical Abstract

Parental assessment and management of children’s postoperative pain: observational cohort study

2025-06-18

Mitiku Desalegn , Yisehak Wolde , Yidnekachew Dedachew +2 more | Annals of Medicine and Surgery

Differential maturation of the brain networks required for the sensory, emotional, and cognitive aspects of pain in human newborns

2025-06-18

Laura Jones , Dafnis Batallé , Judith Meek +4 more | Pain

Abstract Pain is multidimensional, including sensory-discriminative, affective-motivational, and cognitive-evaluative components. Although the concept of pain is learned through life, it is not known when and how the brain networks that … Abstract Pain is multidimensional, including sensory-discriminative, affective-motivational, and cognitive-evaluative components. Although the concept of pain is learned through life, it is not known when and how the brain networks that are required to encode these different dimensions of pain develop. Using the 2 largest available databases of brain magnetic resonance images—the developing Human Connectome Project and the Human Connectome Project—we have mapped the development of the pain connectome—the neural network required for pain perception—in infants from 26 to 42 weeks of postmenstrual age (PMA, n = 372), compared with adults (n = 98). Partial correlation analysis of resting BOLD signal between pairwise combinations of 12 pain-related brain regions showed that overall functional connectivity is significantly weaker before 32 weeks PMA compared with adults. However, over the following weeks, significantly different developmental trajectories emerge across pain connectome subnetworks. The first subnetwork to reach adult levels in strength and proportion of connections is the sensory-discriminative subnetwork (34-36 weeks PMA), followed by the affective-motivational subnetwork (36-38 weeks PMA), while the cognitive-evaluative subnetwork has still not reached adult levels at term. This study reveals a previously unknown pattern of early development of the infrastructure necessary to encode different components of pain experience. Newborn neural pathways required for mature pain processing in the brain are incomplete in newborns compared with adults, particularly regarding the emotional and evaluative aspects of pain. The rapid age-related changes suggest that pain processing, and consequently pain experience, changes rapidly over this developmental period and unlikely to be the same as in adults, even at term.

Physiological Correlates of Pain in Children during the Skin Diagnostic Testing and Prevention of Childhood Procedural Pain and Distress

2025-06-17

V. F. Pyatin , Е. А. Бородулина , Olga Sergeevna Kozlova +1 more | IntechOpen eBooks

The chapter is devoted to procedural pain for children as the most frequent cause of anxiety and distress in children and their parents. The chapter will provide an overview of … The chapter is devoted to procedural pain for children as the most frequent cause of anxiety and distress in children and their parents. The chapter will provide an overview of the topic and present the results of our own studies of children’s psychosomatic reactions to pain during the Mantoux test and skin prick test under standard clinical conditions. The chapter will present objective data on the progressive reduction of negative emotional reactions in children from 75% in the Mantoux test to their complete absence in the skin prick test, based on the study of physiological correlates of pain during skin diagnostic testing. In the chapter, we show а ways of preventing childhood procedural pain and distress by measuring physiological correlates of pain and anxiety in children during the diagnostic skin testing.

Relato de caso: abordagem intensiva de pancreatite traumática canina com suporte multimodal para controle efetivo de dor

2025-06-17

Lucas Fornari | DELOS Desarrollo Local Sostenible

A pancreatite é uma afecção inflamatória do pâncreas, comumente diagnosticada em cães e, com menor frequência, em gatos. Caracteriza-se pela ativação de enzimas pancreáticas dentro do próprio órgão, levando à … A pancreatite é uma afecção inflamatória do pâncreas, comumente diagnosticada em cães e, com menor frequência, em gatos. Caracteriza-se pela ativação de enzimas pancreáticas dentro do próprio órgão, levando à autodigestão tecidual, inflamação local e, potencialmente, a complicações sistêmicas. A etiologia é frequentemente multifatorial, envolvendo fatores dietéticos, predisposição genética, uso de fármacos, distúrbios metabólicos e, em alguns casos, trauma abdominal. Em cães, a forma aguda é mais prevalente, com sinais clínicos que incluem vômito, dor abdominal, letargia, anorexia e desidratação. Já nos gatos, os sinais costumam ser mais sutis e inespecíficos. O diagnóstico envolve a combinação de sinais clínicos, exames laboratoriais, achados ultrassonográficos e exclusão de diagnósticos diferenciais. A gravidade da doença pode variar de casos leves e autolimitantes a formas graves com falência de múltiplos órgãos. O tratamento é de suporte e deve ser individualizado, sendo fundamentais a fluidoterapia, controle da dor, suporte nutricional precoce, antieméticos e monitoramento intensivo. Este estudo visa descrever a abordagem intensiva e a estratégia terapêutica multimodal empregada no manejo de um cão acometido por pancreatite traumática aguda, com ênfase no controle analgésico eficaz e na implementação precoce do suporte nutricional enteral.

Ultrasound‐Guided Nerve Block for Pediatric Femur Fractures in the Emergency Department: A Prospective Multi‐Center Study

2025-06-17

Zachary W. Binder , Carrie Ng , Nicole Klekowski +7 more | Academic Emergency Medicine

ABSTRACT Background Managing pain associated with pediatric femur fractures is challenging. The ultrasound‐guided fascia iliaca compartment nerve block (FICNB) provides regional analgesia for femur fractures in adults, but data on … ABSTRACT Background Managing pain associated with pediatric femur fractures is challenging. The ultrasound‐guided fascia iliaca compartment nerve block (FICNB) provides regional analgesia for femur fractures in adults, but data on its effectiveness when provided by pediatric emergency medicine (PEM) physicians for children in the emergency department (ED) is limited. Methods This multi‐center, prospective, observational study enrolled children aged 4–17 years who presented to the ED with an isolated, acute femur fracture. Participants received either a FICNB performed by a PEM physician or systemic analgesia alone, determined by each site's routine practice. Participants self‐reported pain intensity using the Faces Pain Scale‐Revised (0–10 continuous) at baseline, 60 min, and 240 min post‐enrollment. The primary outcome was the mean difference in pain score reduction at 60 min compared to baseline between the two groups. Secondary outcomes included the mean difference in pain score at 240 min, opioid use, and adverse events. Results Across 12 sites 114 participants were enrolled, and 54 received the FICNB. The groups had similar baseline characteristics. The FICNB group had a larger reduction in pain score compared to the No‐FICNB group at 60 min (mean 3.8 vs. 0.8, difference between groups 3.0 [95% CI, 1.7 to 4.3]) and 240 min (mean 3.6 vs. 1.7, difference between groups 1.9 [95% CI, 0.5 to 3.2]). The FICNB group used 73% fewer oral morphine equivalents per hour (0.3 vs. 1.1, difference between groups 0.8 [95% CI, 0.4 to 1.1]). There were no significant adverse events in either group. Conclusions Children who received a FICNB appeared to have a greater reduction in pain intensity and required less opioid medication than those who did not. This is the largest prospective study evaluating the ultrasound‐guided FICNB performed on children in the ED, and its findings support the procedure's use for pediatric femur fracture pain management. Trial Registration Clinicaltrials.gov (NCT05947292, https://clinicaltrials.gov/study/NCT05947292 )

Effect of regional nerve block on tourniquet-related injury in pediatric patients undergoing lower limb surgery: a randomized controlled study

2025-06-17

Qin Xia , Chen Rui , Chao Lin +6 more | Annals of Medicine

The efficacy of regional nerve block for pain management has garnered considerable attention. However, few studies have explored their effectiveness in mitigating tourniquet-related injuries and promoting functional recovery in lower … The efficacy of regional nerve block for pain management has garnered considerable attention. However, few studies have explored their effectiveness in mitigating tourniquet-related injuries and promoting functional recovery in lower limb surgery patients. : Sixty-four pediatric patients aged 6-12 undergoing knee arthroscopic surgery under general anesthesia. All patients were randomized to receive either femoral nerve block combined with sciatic nerve block (the PNB group) or standard general anesthesia only (the control group). The primary endpoint was the incidence of tourniquet-induced hypertension. Secondary endpoints included the cumulative oral morphine equivalent consumption within 24 h post-surgery, the perioperative pain intensity, inflammation and oxidative stress levels (assessed via IL-6, IL-10, SOD, and MDA), plasma levels of circulating adipokines (FABP-4 and Apelin-13), time to first ambulation, and hospital stay duration. The PNB group showed a lower incidence of tourniquet-induced hypertension compared with the control group (33.33% vs 73.33%, relative risk [95% confidence interval] of 0.182 [0.06-0.55]; p = 0.004). Patients in the PNB group demonstrated a 39% reduction in oral morphine equivalent consumption at 24 h postoperatively (p < 0.001). In comparison to the control group, the PNB group also exhibited reduced postoperative pain intensity, inflammation, and oxidative stress levels, as well as lower blood glucose fluctuation. Additionally, patients in the PNB group had a significantly shorter time to first ambulation and a shorter hospital length of stay. The present study demonstrated that combining femoral nerve block and sciatic nerve block can alleviate tourniquet-related injuries, decrease opioid consumption, facilitate a quicker and less painful recovery period.

Methodological Observations on the Meta-analysis by Alsabri et al Regarding Ketorolac Use in Pediatric Acute Pain

2025-06-16

Javier Arredondo Montero | Pediatric Emergency Care

The Role of Stress in Venipuncture Pain in Adolescents: Secondary Analysis of a Prospective Observational Study

2025-06-14

Joel S. Brown , Zoe Ademuyiwa , Elizabeth Wu-Chen +1 more | Children

Background/Objectives: Venipuncture is a painful and distress-inducing procedure, especially in adolescents. However, the effect of stress on venipuncture pain remains unclear. This study investigated the relationships between stress (venipuncture-related and … Background/Objectives: Venipuncture is a painful and distress-inducing procedure, especially in adolescents. However, the effect of stress on venipuncture pain remains unclear. This study investigated the relationships between stress (venipuncture-related and general stress) and venipuncture pain intensity and unpleasantness, hypothesizing that higher stress levels would be associated with greater pain levels. Methods: Forty-two adolescents (five boys, mean age 12.2 ± 1.4) participated in the study, which included completing questionnaires and a blood draw. General stress was assessed using the Perceived Stress Scale. Before the blood draw, participants were asked to rate their venipuncture-related stress level using a Visual Analog Scale (VAS). Following venipuncture, participants rated their pain intensity and pain unpleasantness using the VAS. Nineteen participants returned for a similar study visit after 1 year. Regression models were used to assess the relationships between pain and stress. In addition, correlations were used to examine the relationships between baseline and 1-year follow-up stress and pain levels. Results: Only baseline venipuncture stress, but not general stress, was related to venipuncture pain intensity (estimate (SE) = 0.185 (0.046), t-ratio = 4.00, p < 0.001) and pain unpleasantness (estimate (SE) = 0.378 (0.116), t-ratio = 3.27, p = 0.002). Baseline stress levels were related to stress levels at 1-year follow-up. However, this was not found for pain levels. In addition, stress at baseline did not impact pain levels at 1-year follow-up. Conclusions: General stress may be different from venipuncture stress, with the latter having a greater influence on venipuncture pain. Developing interventions focused on reducing stress related to venipuncture in adolescents could assist in reducing pain and increase willingness to undergo needle procedures.

Mild chronic post-natal pain induces endocrine and metabolic alterations associated to enlargement in pituitary glands size in adult CD-1 male mice

2025-06-13

Teresa Dipol , Andrea Fortuna , Ornella Morsilli +7 more | Endocrine

Effect of Breast-feeding on Pain Intensity among Infants during Blood Sampling

2025-06-12

Sharbat Ramadan Riad , Eman Sayed Masoed , Marwan Ali +1 more | Deleted Journal

Subcutaneously Administered Anesthetics and Analgesics for Pain Management: An Integrative Review

2025-06-12

Bruno D’Paula Andrade , William Caracas Moreira , Roger Rodrigues da Silva +2 more | Journal of Pain & Palliative Care Pharmacotherapy

This article aims to summarize evidence regarding subcutaneously administered anesthetics and analgesics and their effects on pain management. Searches were conducted in September 2023 by a paired review in the … This article aims to summarize evidence regarding subcutaneously administered anesthetics and analgesics and their effects on pain management. Searches were conducted in September 2023 by a paired review in the MEDLINE database via the Virtual Health Library (BVS) and SCOPUS via Elsevier. Study selection was independently performed by two researchers according to inclusion criteria: primary studies, published in any language, and without temporal restriction. Duplicates, irrelevant studies, and those outside the research scope were excluded, with discrepancies resolved by a third reviewer. The final sample for the review comprised 45 articles, predominantly clinical trials with eligible patients, published between 1982 and 2022. Key drug classes identified in the evaluation of subcutaneous administration for pain management included amide and amino-amide anesthetics, opioids, and adjuvant agents (such as anti-inflammatory drugs, antihypertensives, and catecholamines). Primary advantages noted were reduced postoperative opioid use, effective analgesic control in postoperative settings, adjuvant efficacy in intraoperative settings and invasive exams, fewer cognitive side effects compared to other anesthesia types, decreased coughing, and shorter hospitalization and ambulation times. Disadvantages included subcutaneous bupivacaine's poor adjuvant performance when combined with general anesthesia, tissue necrosis associated with tumescent anesthesia technique, and ambiguity regarding postoperative respiratory function.

Postsurgical Pain, Psychosocial Functioning, and Cannabis Use Among Adolescents and Young Adults Undergoing Gender-Affirming Surgery

2025-06-12

Eleanor Battison , Emily A. Kenyon , Corrin Murphy +4 more | Transgender Health

Visceral Pain System/Neuro-Immune Interaction

2025-06-10

Laura K. Case | CRC Press eBooks