Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2020 Jun;34(3):421-433.
doi: 10.1007/s00540-020-02767-x. Epub 2020 Mar 31.

A practical guide to acute pain management in children

Nan Gai  1 , Basem Naser  1 , Jacqueline Hanley  1 , Arie Peliowski  1 , Jason Hayes  1 , Kazuyoshi Aoyama  2   3
Affiliations
Review

A practical guide to acute pain management in children

Nan Gai et al. J Anesth. 2020 Jun.

Abstract

In the pediatric population, pain is frequently under-recognized and inadequately treated. Improved education and training of health care providers can positively impact the management of pain in children. The purpose of this review is to provide a practical clinical approach to the management of acute pain in the pediatric inpatient population. This will include an overview of commonly used pain management modalities and their potential pitfalls. For institutions that have a pediatric acute pain service or are considering initiating one, it is our hope to provide a useful tool to aid clinicians in the safe and effective treatment of pain in children.

Keywords: Acute pain service; Multimodal management; Opioid; Pain assessment; Pediatric acute pain.

PubMed Disclaimer

Conflict of interest statement

The authors declare that they have no competing interests related to this publication.

Figures

Fig. 1
Fig. 1
The World Health Organization (WHO) pain ladder modified for Acute Pain Management. aAdjuncts include non-opioid analgesics such as ketamine, lidocaine, and gabapentinoids
Fig. 2
Fig. 2
Summary of Patient Controlled Analgesia (PCA) wean with hybrid transition process. For patients using a PCA, there should be a daily assessment to determine if it is appropriate to consider weaning the PCA, especially if the patient is able to tolerate oral medications. The first step to weaning off a PCA includes starting a “hybrid” PCA set-up with the oral medication acting as a background opioid and the PCA being used for breakthrough. If this hybrid is adequately treating pain, further weaning can take place by stopping the PCA completely and using oral breakthrough doses instead
Fig. 3
Fig. 3
Summary of epidural transition to oral opioid process. Once it is determined the epidural can be discontinued and the patient can tolerate oral medications, the transition can be started. Typically, patients start their transition early in the morning to ensure that if troubleshooting needs to occur, it will be done during the daytime. The oral opioid is loaded with 3 doses given every 3 h. The epidural infusion is held once the second dose is given. If the patient’s pain is still well controlled, the epidural catheter is removed after the third dose. Continue regularly schedule oral opioid every 4 h until the next morning, when it can be assessed whether to convert the patient to oral opioid on an as-needed basis
See this image and copyright information in PMC

References

    1. World Health Organization . WHO guidelines for the pharmacological and radiotherapeutic management of cancer pain in adults and adolescents. Geneva: World Health Organization; 2018. - PubMed
    1. Vargas-Schaffer G. Is the WHO analgesic ladder still valid? Twenty-four years of experience. Can Fam Physician. 2010;56(6):514–517. - PMC - PubMed
    1. Taylor EM, Boyer K, Campbell FA. Pain in hospitalized children: a prospective cross-sectional survey of pain prevalence, intensity, assessment and management in a Canadian pediatric teaching hospital. Pain Res Manag. 2008;13(1):25–32. - PMC - PubMed
    1. Committee on Psychosocial Aspects of Child and Family Health The assessment and management of acute pain in infants, children, and adolescents. Pediatrics. 2001;108(3):793–797. - PubMed
    1. Breivik H, Borchgrevink PC, Allen SM, Rosseland LA, Romundstad L, Breivik Hals EK, Kvarstein G, Stubhaug A. Assessment of pain. Br J Anaesth. 2008;101(1):17–24. - PubMed