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Developing a pediatric pain service
Sabine Kost-Byerly1, George Chalkiadis
1Department of Anesthesiology/Critical Care Medicine, Charlotte Bloomberg Children's Center, Johns Hopkins University, Baltimore, MD 21287, USA. skbyerly@jhmi.edu
Insights
Establishing pediatric pain services requires addressing resource limitations and defining the scope of care. Optimizing pain management for children necessitates institutional commitment, funding, and tailored treatment approaches for acute, chronic, and palliative pain.
Area of Science:
- Pediatric healthcare
- Pain management
- Health services research
Background:
- Pediatric acute pain management has evolved significantly over the past two decades.
- Early pediatric pain services emerged in major centers due to prior challenges in pain control.
- Gaps persist in pain management for children in resource-limited settings.
Purpose of the Study:
- To highlight the need for improved pediatric pain management in underserved areas.
- To identify key objectives and obstacles in establishing pediatric pain services.
- To delineate the scope of services required for comprehensive pediatric pain care.
Main Methods:
- Review of historical development and current state of pediatric pain services.
- Analysis of challenges including institutional support, staffing, and funding.
- Discussion of essential components for effective pain management services.
Main Results:
- Pediatric pain services are established in many large centers but require expansion to resource-limited facilities.
- Key obstacles to establishing services include institutional will, staffing, and financial resources.
- Effective pain services require clear objectives for treating acute, chronic, procedural, and palliative pain.
Conclusions:
- Establishing pediatric pain services demands addressing resource disparities and defining service scope.
- Comprehensive services should ideally cover acute, chronic, procedural, and cancer/palliative pain.
- The specific resources and scope of practice must align with hospital capabilities and constraints.
Abstract:
Pediatric pain services were first established in larger pediatric centers over two decades ago. Children's acute pain was poorly managed at the time owing to misconceptions, safety concerns, and variability in practice. While many larger pediatric centers now have acute pain services, there remains a need for better pain management in facilities and geographic locations with fewer resources. Institutional acknowledgement and desire to change, appropriate staffing, and funding are major obstacles. Better recognition and assessment as well safer and more efficacious treatment of pain are the principal objectives when establishing a pain service. It is important to determine whether the proposed service intends to treat acute, chronic, procedural, and/or cancer and palliative pain as each requires different skills and resources. An ideal and comprehensive pediatric pain service should be equipped to diagnose and treat acute, persistent (chronic), procedural, and cancer/palliative pain. It is not feasible or necessary for every hospital to manage all. Establishing the scope of practice (based on case mix and caseload) in any given hospital will determine which resources are desired. Country-specific standards, local staffing, and fiscal constraints will influence which resources are available.
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