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Assessment and management of pain in pediatric otolaryngology
Maria Claudia Rodríguez1, Perla Villamor1, Tatiana Castillo1
1Department of Otolaryngology, Hospital Infantil de San José, Fundación Universitaria de Ciencias de la Salud, Bogotá, Colombia.
Insights
Effective pediatric pain management in otolaryngology requires accurate assessment using physiological, behavioral, and self-report methods. Evidence-based treatment combines non-pharmacological and pharmacological therapies tailored to the child
Area of Science:
- Pediatric Medicine
- Pain Management
- Otolaryngology
Background:
- Pediatric pain is a significant public health concern with potential for morbidity and mortality.
- Assessing and managing pain in children is challenging due to communication barriers and limited clinical knowledge.
- Fear of opioid side effects and addiction complicates satisfactory pediatric pain treatment.
Purpose of the Study:
- To review current definitions, mechanisms, and consequences of inadequate pain management in children.
- To guide clinicians in assessing and managing pain in pediatric otolaryngology services.
- To provide evidence-based recommendations for pediatric pain treatment.
Main Methods:
- A narrative review of 129 articles published between January 2000 and May 2016.
- Searched databases including MEDLINE/PubMed, Cochrane, ISI, Current Contents, Scielo, and LILACS.
- Utilized MeSH terms: Children, Pediatrics, Otolaryngology, Pain measurement, Pain Management, Analgesics, and Analgesia.
Main Results:
- Pain assessment in children relies on physiological, behavioral, and self-report methods due to lack of specific indicators.
- Effective pain management integrates non-pharmacological cognitive/behavioral therapies with age- and severity-tailored pharmacological treatments.
- Evidence-based recommendations cover non-opioid analgesics, opioid analgesics, and adjuvant medicines for pediatric otolaryngology.
Conclusions:
- A comprehensive review of pediatric pain assessment and management in otolaryngology is presented.
- Significant research gaps exist in pain assessment and pharmacological interventions for neonates, infants, and children.
- Promoting ethical and safe research is crucial for improving pain control in pediatric populations.
Introduction:
Pain is a disease by itself and it's a public health concern of major implication in children, not just because of the emotional component of the child and his family, but also due to the potential morbidity and mortality involving it. A proper assessment of pain it's a challenge in the pediatric population, due to their lack of understanding and verbalization of hurt. Additionally, a satisfactory treatment of pediatric pain can be arduous due to a lack of clinical knowledge, insufficient pediatric research, and the fear to opioid side effects and addiction.
Objectives:
The aim of this review is to address the current definitions of pain, its physiological mechanisms and the consequences of its inadequate management, as well as, to guide the clinicians in the assessment and management of pain in the pediatric population at otolaryngology services.
Methodology:
Narrative review by selective MeSH search terms: Children, Pediatrics, Otolaryngology, Pain measurement, Pain Management, Analgesics and Analgesia, from databases: MEDLINE/PubMed, Cochrane, ISI, Current Contents, Scielo and LILACS, between January 2000 and May 2016.
Results:
129 articles were reviewed according to the requirements of the objectives. Pain measurement is a challenge in children as there are no physical signs that constitute an absolute or specific indicator of pain, and its diagnosis must rely on physiological, behavioral and self-report methods. Regarding treatment, a suitable alternative are the non-pharmacological cognitive/behavioral therapies helped by pharmacological therapies tailored to the severity of pain and the child's age. We provide evidence-based recommendations on pain treatment, including non-opioid analgesics, opioid analgesics and adjuvant medicines to improve the management of pain in children in otolaryngology services.
Conclusions:
We present a global review about assessment and management of pain in pediatric otolaryngology, which leads to future specific reviews on each topic. Research gaps on pain assessment and pharmacological interventions in neonates, infants and children are very wide and it should be promoted ethical and safe research on pain control in this population.
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