Pediatric clinics of North America
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The science of pain assessment for infants and children has grown substantially in the past several decades to the point that valid and reliable methods for pain assessment are available for use in clinical settings. Accurate pain assessment requires consideration of children's developmental level, type of pain experienced, history and context of pain, family influences, and interaction with the health care team. Research is needed to improve the sensitivity, specificity, and generalizability of pain-assessment tools and to more fully incorporate contextual factors into the objective assessment process. Finally, the improvement of pain assessment in the clinical setting can be viewed as a patient care quality issue, and continuous quality improvement methods can be used effectively to incorporate pain assessment as an integral component of every infant's and child's health care.
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The past decade has brought about an explosion of knowledge about the physiology of nociception and many new techniques for pain relief, new analgesic drugs, and new applications of old analgesic drugs. These techniques include methods of opioid administration by transdermal and transmucosal absorption and the use of neuraxial analgesia for the management of pain in children. ⋯ Given the unprecedented interest in pain management in adults and children, physicians can now look forward to the development of new methods of drug delivery and of receptor-specific drugs that divorce analgesia from the untoward side effects of existing analgesics. Improvement in the quality of life of hospitalized children also will occur.
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Pediatr. Clin. North Am. · Jun 2000
ReviewOffice-based pain management. The 15-minute consultation.
Pain is a ubiquitous component of pediatric illness and injury. Unfortunately, the treatment of pain has remained secondary to the diagnosis and treatment of the disease state. ⋯ Presently available modalities, when used appropriately, can significantly reduce the pain associated with medical encounters. Careful attention to such approaches may reduce the anxiety about pain, which is often an undercurrent at most health care visits, and allows clinicians and children to focus on getting well and staying healthy.
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The challenge for emergency medicine physicians in the new millennium is to use these drugs and drug combinations to make ED visits pain-free and safe experiences. With dedication to research, a willingness to take the time to explore new options, and expansion of pharmacologic and nonpharmacologic interventions, physicians can make this lofty dream a reality.
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Pediatr. Clin. North Am. · Jun 2000
ReviewWeak analgesics and nonsteroidal anti-inflammatory agents in the management of children with acute pain.
The PSIs include acetaminophen, NSAIDs, and salicylates. They can be used alone for the treatment of mild pain or as an adjunct to opioid analgesia. In children, most experience is with acetaminophen and ibuprofen. ⋯ When using oral analgesics, factors that may interfere with effective analgesia include a child's refusal to take the medication, ineffective doses and dosing regimens, decreased bioavailability following PO administration, inability to tolerate PO medications because of nausea or vomiting, altered GI motility, and a delayed onset caused by slow absorption. With such caveats in mind, the PO route provides an effective and cost-effective means for many patients. It should be considered as the primary route for pediatric patients in the treatment of mild to moderate pain, even in the hospital setting.