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Module 6:Pain Management
CCEENNLLEEEnd-of-Life Nursing Education Consortium
Pediatric Palliative Care
CCEENNLLEE Pediatric Palliative Care
CCEENNLLEE Pediatric Palliative Care
Pain Defined
Pain is a subjective response
Pain in childhood can be acute or chronic
Children's pain is influenced by many factors
CCEENNLLEE Pediatric Palliative Care
Scope of the Problem
Children’s pain experience
Effect of pain on quality of life
CCEENNLLEE Pediatric Palliative Care
Populations at risk Chronic conditions Trauma/injury Neurological impairment Neonates/infants Non-English speaking Cultural, gender stereotyping
CCEENNLLEE Pediatric Palliative Care
Barriers to Pain Relief
Healthcare professionals
Healthcare system
Related to parents/children
CCEENNLLEE Pediatric Palliative Care
Myths Related to Pain and Pain Management in Children
Respiratory depression Addiction Child that is sleeping/or playing
does not have pain Presence of pain indicates
worsening of disease and approaching death
CCEENNLLEE Pediatric Palliative Care
Facts About Childhood Pain
Opioid addictions are rare Repeated exposure to painful
procedures leads to increased anxiety and perception of pain
Studies have shown that children as young as 3 years old can use pain scales
Carter et al., 2004; Goldman et al., 2006; Hockenberry & Wilson, 2006; Schecter, 2003
CCEENNLLEE Pediatric Palliative Care
Myths Related to Neonatal/Infant Pain
Incapable of feeling pain Immature nervous system Incomplete myelinization No memory Objective assessment
impossible Neonates cannot
communicate pain Analgesics unsafe
CCEENNLLEE Pediatric Palliative Care
Facts About Neonatal/Infant Pain
Pain perception occurs early in life
Neonates exhibit physiologic and behavioral cues
CCEENNLLEE Pediatric Palliative Care
Modifying Contextual Factors of Pain Expression in Infants
Behavioral state Postnatal age Severity of medical illness Technician effects/procedural modifiers Environmental stress Sensitization after repeated stimulation Total number of invasive procedures Time since last painful procedure
CCEENNLLEE Pediatric Palliative Care
Impact of Pain
Research asked ‘What is it like to have a child with pain?’ Unendurable Sense of helplessness Sense of total commitment Unprepared/unknowledgeable Horrible/frightening No pain in heaven
Ferrell et al., 1994a & 1994b
CCEENNLLEE Pediatric Palliative Care
Developmental Aspects of Pain
Infants
Toddlers
CCEENNLLEE Pediatric Palliative Care
Developmental Aspects of Pain
Pre-school School age
CCEENNLLEE Pediatric Palliative Care
Developmental Aspects of Pain
Adolescents
CCEENNLLEE Pediatric Palliative Care
Special Populations
Injury/trauma ER PICU
CCEENNLLEE Pediatric Palliative Care
Special Populations
Cancer pain
Chronic non-malignant pain
CCEENNLLEE Pediatric Palliative Care
Special Populations
Sickle cell Numerous complications of SCD
result in pain Vaso-occlusive crisis, priapism,
dactylitis, splenic sequestration, spinal cord compression and avascular necrosis of joints
CCEENNLLEE Pediatric Palliative Care
Special Populations
Pancreatitis Musculoskeletal/rheumatic
Juvenile Primary Fibromyalgia Juvenile Idiopathic Arthritis Complex Regional Pain Syndrome
CCEENNLLEE Pediatric Palliative Care
Special Populations
Neurocognitive impairment Pain experience Pain indicators Effect of uncontrolled pain Assessment
Knowing child Recognizing patterns Intersubjective process with HCP