As defined by International Association for the Study of Pain: “An unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage”
“The most reliable indicator of the existence and intensity of acute pain” is the patient's self-report (Emerg Med Clin North Am 2005;23:393).
- For nonverbal or cognitively impaired children, use behavioral and physiologic indicators or scales.
- Pain intensity and response to treatment must be continually monitored and reassessed regularly.
- Pain assessment should be individualized, taking into account age, race, gender, culture, emotions, development, expectations, and prior experiences.
- Pain prevention is better than treatment; anticipate procedure-related pain and prepare patient and parents.
- Poorly controlled pain can have short- and long-term physical and psychological consequences.
- Adequate pain prevention and control can have short- and long-term benefits.
- Unexpected intense pain, especially if associated with altered vital signs, should be evaluated for other possible diagnoses.
- World Health Organization Analgesic Ladder: Physical measures, nonopioid analgesics, oral opiates, and IV opiates may be used in a stepwise manner.
- Other adjuncts, including local anesthetics, anxiolytics, antidepressants, muscle relaxants, anticonvulsants, and cognitive/behavioral therapies should be used with analgesics for an integrated approach to pain management.
- The goal is to reduce pain to acceptable levels while considering the possible adverse reactions and side effects of each medication.
Physiologic parameters: Tachycardia, vasoconstriction, diaphoresis, pupil dilatation, increased minute ventilation, hypertension
0–10 scale; 0 = no pain, 10 = worst pain you could ever imagine
Children who understand the concepts of numbers, rank, and order; generally older than 8 years of age
Beiri and Wong-Baker scales
Six faces that range from no pain to the worst pain you can imagine
Younger children who have difficulty with numeric scale; cognitive age, 3–7 years
Five categories: face, legs, activity, cry, and consolability; range of total scores is 0–10; score ≥7 is severe pain
Nonverbal children older than 1 year of age
CRIES†, NIPS, PIPP
Rates a set of standard criteria and gives a score
Nonverbal infants younger than 1 year of age
No particular expression or smile
Occasional grimace or frown, withdrawn, disinterested
Frequent to constant frown, clenched jaw, quivering chin
Normal position or relaxed
Uneasy, restless, tense
Kicking or legs drawn up
Lying quietly, normal position, moves easily
Squirming, shifting back and forth, tense
Arched, rigid, or jerking
No cry (awake or asleep)
Moans or whimpers, occasional complaint...
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