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Acute Pain Management in Children: A Systematic Review and GRADE-Based Recommendations
Gregorio Paolo Milani1, Matteo Riccò2, Massimo Agosti3
1Società Italiana di Medicina di Emergenza e Urgenza Pediatrica (SIMEUP), Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, Rende-Pediatric Unit, Annunziata Hospital, 87100 Cosenza, Italy.
Journal of Clinical Medicine
|August 13, 2026
Summary
Effective acute pediatric pain management requires structured assessment and multimodal strategies. Validated pain scales and first-line treatments like paracetamol and ibuprofen are recommended, with non-pharmacological interventions as adjuncts.
Area of Science:
- Pediatric Pain Management
- Evidence-Based Medicine
- Systematic Review
Background:
- Acute pain in children is often under-recognized and undertreated.
- Validated assessment tools and therapies exist but are underutilized.
- This review addresses the recent evidence on pediatric acute pain management.
Purpose of the Study:
- To systematically review and synthesize recent evidence on the assessment and management of acute pain in children.
- To provide an updated overview of current practices and identify gaps in knowledge.
Main Methods:
- Systematic review following PRISMA 2020 guidelines.
- Evidence certainty assessed using the GRADE framework.
- Searched PubMed and Embase for studies from 2016-2025, with input from Italian pediatric societies.
Main Results:
- 13 studies included; validated pain scales demonstrated high reliability.
- Paracetamol and ibuprofen showed comparable efficacy for mild-to-moderate pain; combination therapy reduced rescue analgesia.
- Non-pharmacological interventions reduced anxiety, but evidence certainty was low; opioid evidence was limited.
Conclusions:
- Routine use of validated pain scales and multimodal strategies is crucial for acute pediatric pain.
- Paracetamol and ibuprofen are first-line treatments; non-pharmacological methods are useful adjuncts.
- Further high-quality research is needed on various analgesic strategies and administration routes.
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