Pediatric Pain Management
Abstract 2005 MHE Conference
Ashish Sinha
Department of Anesthesiology & Critical School of Medicine
University of Pennsylvania, Philadelphia PA 19104-4283
Pain in the pediatric patients is frequently under treated due to a variety of factors. From under recognition of the pain itself to
myths that children do not feel as much pain as adults, because of immature peripheral and central nervous systems. Part of
the problem is the mistaken belief that pain is less harmful than the side effects of analgesic therapy. Lack of awareness of
treatment options and ignorance of analgesic pharmacology in children compound this problem.
Pain assessment in children has been mandated by JCAHO and frequently referred to as the 5th vital sign. The need for
accurate pain assessment is essential for accurate pain management.\
Sometimes this is an approximation because of limited verbal communication in the younger children population. Multiple
reasons contribute to the denial of pain by children. Useful tools for pediatric pain assessment, depending on the age of the
child, include CRIES, FLACC, Wong Baker faces scale and VAS (Visual Analog Scale) scores.
Treatment of chronic pain is handled differently than that of acute pain in children. Pain treatment in the setting of chronic pain
in children is multimodal as in adults and has components of depression that should be addressed appropriately. The concept
of the WHO pain ladder being applied to children is consistent with appropriate and responsible pain management.
Pain that arises in the musculoskeletal system has issues with reluctant limb usage with its attendant problems, of dystrophy
and atrophy. An expert in physical therapy should be involved in the handling of these issues.
Abstract 2005 MHE Conference
Ashish Sinha
Department of Anesthesiology & Critical School of Medicine
University of Pennsylvania, Philadelphia PA 19104-4283
Pain in the pediatric patients is frequently under treated due to a variety of factors. From under recognition of the pain itself to
myths that children do not feel as much pain as adults, because of immature peripheral and central nervous systems. Part of
the problem is the mistaken belief that pain is less harmful than the side effects of analgesic therapy. Lack of awareness of
treatment options and ignorance of analgesic pharmacology in children compound this problem.
Pain assessment in children has been mandated by JCAHO and frequently referred to as the 5th vital sign. The need for
accurate pain assessment is essential for accurate pain management.\
Sometimes this is an approximation because of limited verbal communication in the younger children population. Multiple
reasons contribute to the denial of pain by children. Useful tools for pediatric pain assessment, depending on the age of the
child, include CRIES, FLACC, Wong Baker faces scale and VAS (Visual Analog Scale) scores.
Treatment of chronic pain is handled differently than that of acute pain in children. Pain treatment in the setting of chronic pain
in children is multimodal as in adults and has components of depression that should be addressed appropriately. The concept
of the WHO pain ladder being applied to children is consistent with appropriate and responsible pain management.
Pain that arises in the musculoskeletal system has issues with reluctant limb usage with its attendant problems, of dystrophy
and atrophy. An expert in physical therapy should be involved in the handling of these issues.
| Dr. Ashish Sinha |
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