Assessment of Pain Syndrome in Children. Current State of the Problem
The question of pain assessing in children of different age groups is important, because successful management of pain requires consideration of many factors. In particular, the majority of children under 5 years are not able to verbally describe the pain feeling. In addition, the behavioral reactions of children may be affected by different factors, such as previous negative experience of pain, the absence of parents, and other cognitive disorders. Physiological parameters often used for the objectification of pain may be incorrectly interpreted, if a child has concomitant serious diseases: sepsis, respiratory failure, hypovolemia, etc. So it is an important issue for practitioners to choose correctly the methods for assessment of pain in children of different ages and in different clinical situations, as well as to interpret the data properly. We have analyzed a number of European and American guidelines on the pain in children to select the most effective tools for assessment of pain in children with attempts to systematize approaches to assessing pain in children. According to the guidelines for the definition and assessment of acute pain in children by Royal College of Nursing and British Pain Society (2009), the following factors should be assessed to select appropriate instruments: age of the child, pain in the clinical context, the presence of cognitive impairment in the child or circumstances that limit the behavioral response of the child, to determine, who will assess pain (doctors, nurses, parents) and where, and their qualifications. It is important to notice that significant part of pediatric intensive care unit patients are children with cognitive disorders and neurological deficits. The assessment of pain in these patients has its own characteristics/features, which we should know for the effective assessment and treatment of pain. For this group of patients, special scales were developed (NCPC-PV (Non-Communicating Children’s Pain Checklist Postoperative Version), revised FLACC (Face, Legs, Activity, Cry, Consolability), INRS (Individualized Numeric Rating Scale) and others). In our view, the main problem to solve this issue lies in the organizational plane, especially the implementation of existing scales in clinical practice and training of personnel.
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