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Pain is a common presenting symptoms of a wide variety of disorders and injuries in the pediatric patient. It is usually divided into two categories:
Addressing the pain a patient is experiencing depends on the origin of that pain and the personal characteristics of the patient themselves (history of pain, personal beliefs, developmental stage, etc.) as well as associated symptoms such as anxiety. This pathway was designed to address pain regardless of source for emergent management. If the source of pain is not readily available it is pertinent to investigate that source, but not necessarily at the expense of providing adequate pain management in the ensuing time period.
Our model is based on the World Health Organization (WHO) stepwise approach to pain. This model emphasizes:
There are many strategies other than medication which have been shown to improve acute pain in pediatric patients. These strategies have variable levels of success. These include:
The assessment of pain intensity is one of the primary drivers of pain management and thus should be quickly and repeatedly completed during evaluation of a pediatric patient with pain. Quantification of the pain intensity may be accomplished through self-report (1-10 pain scales, Wong-Baker FACES) or through observational tools for non-verbal patients. There are many observational tools which have been developed, however our pathway utilizes the Revised Face, Legs, Activity, Cry, Consolability (r-FLACC) scale as it has been shown to have the highest clinical utility in comparative studies. Patient with neurologic or developmental disabilities may be difficult to quantify, however r-FLACC may be useful in these children as well as clinical assessment and caregiver input. However, it should be noted that underreporting of pain with observational tools have been show as compared to self-report in children 3-7 years old.