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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Apfelbaum J.L. Postoperative pain experience Results from a national survey suggest postoperative pain continues to be undermanaged /J.L Apfelbaum, C. Chen, S.S. Mehta, T.J. Gan //Anesth Analg. – 2003. - № 97. – P. 534-540. PMID: 12873949
Gan T. J. Incidence, patient satisfaction, and perceptions of postsurgical pain: Results from a US national survey / T.J. Gan, A.S. Habib, T.E. Miller [et al.]//. Curr Med Res Opin. -2014. - № 30. – P. 149-160. doi: 10.1185/03007995.2013.860019.
Guidelines on the Management of Postoperative Pain Management of Postoperative Pain: A Clinical Practice Guideline From the American Pain Society, the American Society of Regional Anesthesia and Pain Medicine, and the American Society of Anesthesiologists’ Committee on Regional Anesthesia, Executive Committee, and Administrative Council // J Pain. - 2016 Feb. – Vol.17, № 2. – P.131-157. doi: 10.1016/j.jpain.2015.12.008.
Kehlet H. Persistent postsurgical pain: Risk factors and prevention /H.Kehlet, T. Jensen, C. Woolf// Lancet. – 2006. - №367. – P.1618-1625. doi:10.1016/S0140-6736(06)68700-X
WHO guidelines on the pharmacological treatment of persisting pain in children with medical illnesses. p.37.Available from: http: // apps.who.int / medicinedocs / documents / s19116en / s19116en. pdf. (Accessed on July 07, 2013).
Good practice in postoperative and procedural pain management, 2nd edition // Paediatr Anaesth. – 2012. – Vol. 22 Suppl 1. – P.1-79. doi: 10.1111/j.1460-9592.2012.03838.x.
A study of the effectiveness of a pain management education booklet for parents of children having cardiac surgery/ M.M. Huth, M.E. Broome, K. A. Mussatto,S. V. Morgan, // Pain Manage. Nurs. – 2003. - №4. – P. 31–39. doi: http://dx.doi.org/10.1053/jpmn.2003.7
Cheng S. F. A review of factors predicting children’s pain experiences // S.FCheng, R.L. Foster, N.O. //Issues Compr Pediatr Nurs. – 2003. - № 26. – P. 203-216. Available from: http://dx.doi.org/10.1080/01460860390246678
Grond S. Clinical pharmacology of tramadol / S. Grond, A. Sablotzki // Clin Pharmacokinet. – 2004. -№43. – P. 879–923. PMID:15509185
The reliability and validity of the Face, Legs, Activity, Cry, Consolability observational tool as a measure of pain in children with cognitive impairment / T. Voepel-Lewis, S. Merkel, A.R. Tait [et al.]// Anesth Analg. – 2002. - № 95. – P. 1224-1229. doi: 10.1097/00000539-200211000-00020
Von Baeyer C. L. Systematic review of observational (behavioral) measures of pain in children and adolescents aged 3 to 18 years / C. L. Von Baeyer, L. Spagrud // Pain. – 2007. -№ 127. – P. 140-150. http://dx.doi.org/10.1016/j.pain.2006.08.014
Elia N. Does multimodal analgesia with acetaminophen, nonsteroidal anti-inflammatory drugs, or selective cyclooxygenase-2 inhibitors and patientcontrolled analgesia morphine offer advantages over morphine alone? / N. Elia, C. Lysakowski, M. R. Tramer //Anesthesiology.- 2005. - № 10. –P. 1296-1304. PMID:16306743
A randomized trial of oral versus intravenous opioids for treatment of pain after cardiac surgery / K. Ruetzler, C. Blome , S. Nabecker [et al.] // J Anesth. – 2014. - № 28. – P. 580-586. doi:10.1007/s00540-013-1770-x
Safety and efficacy of fentanyl administered by patient controlled analgesia in children with cancer pain. /A. Ruggiero, G. Barone, L. Liotti, [et al.] // Support Care Cancer . – 2007. - № 15. – P.569-573. Doi: 10.1007/s00520-006-0193-8
American Society for Pain Management Nursing Guidelines on Monitoring for Opioid-Induced Sedation and Respiratory Depression / D. Jarzyna, C.R. Jungquist, C. Pasero [et al.] // Pain Manag Nurs.- 2011.- № 12ю – P. 118-145. doi: 10.1016/j.pmn.2011.06.008.
Single-dose intravenous paracetamol or propacetamol for prevention or treatment of postoperative pain: A systematic review and meta-analysis / E.D. McNicol, A. Tzortzoloulou, M. S. Cepeda // Br J Anaesth. – 2011. - № 106. – P. 764-775. doi:10.1093/bja/aer107
Ketamine for perioperative pain management in children: a meta-analysis of published studies /S. Dahmani, D. Michelet, P.S. Abback [et al] //Pediatr Anesth. – 2011. - № 21. – P. 636 – 652. doi: 10.1111/j.1460-9592.2011.03566.x.
Systemic lidocaine to improve quality of recovery after laparoscopic bariatric surgery: A randomized double-blinded placebo-controlled trial / G.S . De Oliveira, K. Duncan, P. Fitzgerald // Obes Surg. – 2014. - № 24. – P. 212-218. doi: 10.1007/s11695-013-1077-x.
Krishna S. Postoperative hemorrhage with nonsteroidal anti-inflammatory drug use after tonsillectomy: a metaanalysis / S. Krishna, L. Hughes, S. Lin // Arch Otolaryngol Head Neck Surg. – 2003. -№129. – P. 1086–1089. doi:10.1001/archotol.129.10.1086
Pain relief for strabismus surgery in children: a randomised controlled study of the use of preoperative sub-Tenon levobupivacaine / B. Morris, P. Watts, T. Zatman[et al.] // Br J Ophthalmol. – 2009. - №93. – P. 329–332. doi:10.1136/bjo.2008.145268
Fredrickson M. J. Improved analgesia with the ilioinguinal block compared to the transversus abdominis plane block after pediatric inguinal surgery: a prospective randomized trial / M.L. Fredrickson, C. Paine, J. Hamill // Paediatr Anaesth. – 2010. - № 20. – P. 1022–1027. doi: 10.1111/j.1460-9592.2010.03432.x.
Ponde V. C. Continuous infraclavicular brachial plexus block: a modified technique to better secure catheter position in infants and children / V. C. Ponde // Anesth Analg. – 2008. - № 106. – P. 94–96. doi: 10.1213/01.ane.0000289633.81407.65
Double epidural catheter with ropivacaine versus intravenous morphine: a comparison for postoperative analgesia after scoliosis correction surgery / S. Blumenthal, K. Min, M. Nadig [ et al.] // Anesthesiology.- 2005. - № 102. – P. 175–180. PMID: 15618801
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