Pediatric Procedural Pain Management: A Review of the Literature

Abstract

Abstract:Research in the last two decades has revealed the complex nature of pain and has thereby improved the understanding, treatment, and management of pediatric pain by health care practitioners. However, a significant gap between knowledge and practice still exists. Pediatric pain remains under-managed. Several themes emerged in this literature review as factors influencing adequate pain management. These include: outdated beliefs about pain management; inconsistent use of evidence-based interventions; difficulties assessing children's pain; and the role of the values and beliefs of caregivers and practitioners. The literature indicates a high risk of deleterious consequences of undermanaged pediatric pain, linking early health care experiences to later health-seeking behaviours. Implications for practice are considerable. Recommendations include: an individualized "3-P" approach combining pharmacologic, physical and psychological strategies; collaborative approaches eliciting expertise from caregivers and health care professionals across multiple disciplines; and utilizing interventions before, during, and after procedures.

The Feasibility of Using the BrightHearts Biofeedback‐Assisted Relaxation Application for the Management of Pediatric Procedural Pain: A Pilot Study

“…Recent studies have reported that management of procedural pain in children is often suboptimal . Inadequate management of pain during a procedure can lead to the formation of an association between pain and the procedure, which can lead to the development of fear and anxiety related to the procedure and an aversion to medical care . Enhanced anxiety related to a procedure can in turn exacerbate the perception of pain from a procedure .…”

“…Long‐term pain sensitivity may also develop. The psychological distress and related behaviors resulting from poorly managed pain can also impede the administration of the procedure …”

“…[3][4][5] Inadequate management of pain during a procedure can lead to the formation of an association between pain and the procedure, which can lead to the development of fear and anxiety related to the procedure and an aversion to medical care. [6][7][8][9] Enhanced anxiety related to a procedure can in turn exacerbate the perception of pain from a procedure. 6,9 Long-term pain sensitivity may also develop.…”

“…[6][7][8][9] Enhanced anxiety related to a procedure can in turn exacerbate the perception of pain from a procedure. 6,9 Long-term pain sensitivity may also develop. The psychological distress and related behaviors resulting from poorly managed pain can also impede the administration of the procedure.…”

Pediatric Procedural Pain: How Far Have We Come? An Ethnographic Account

“…An area which has gained more attention by clinicians and researchers is that of procedural pain. As a category of acute pain, children have identified diagnostic and monitoring procedures as the most feared and painful of events (Cummings, Reid, Finley, McGrath, & Ritchie, 1996; Kortesluoma & Nikkonen, 2004; Liossi, 2002; Petovello, 2012). The most common source of procedural pain has been documented to be needle pain (Blount, Piira, & Cohen, 2003; Cohen, 2002; Ortiz, Lopez-Zarco, & Arreola-Bautista, 2012; Rogers & Ostrow, 2004; Uman, Chambers, McGrath, & Kisley, 2006).…”