Pain therapy in children and adolescents

Abstract

Introduction: In children, acute pain occurs predominantly during infectious illnesses or after surgery. Chronic pain, especially headache and abdominal pain, is becoming increasingly common among children and adolescents.

Methods: Selective literature review, also including evidence-based guidelines and recommendations.

Results: Simple self-reporting and behavioral pain scales are easy to use to assess the intensity of acute pain. To evaluate chronic pain, on the other hand, more complicated, multi-dimensional instruments are necessary (e.g., semi-structured interviews). The most commonly used analgesics are ibuprofen and paracetamol (acetaminophen). When paracetamol is used, its narrow therapeutic window should be kept in mind. Perioperative pain should be treated with balanced analgesia involving a combination of non-pharmacological treatment strategies, non-opioid drugs, opioids, and regional anesthesia. Chronic pain in children can only be treated successfully over the long term with multidisciplinary team intervention based on this biopsychosocial model.

Discussion: Pain not only causes children momentary suffering but also threatens to impair their normal development. Therefore, every effort should be made to prevent pain and to treat it effectively once it arises.

Keywords: adolescents; children; medication; pain; pain scale; treatment.

Figures

Figure: Faces Pain Scale for children aged about 5 years onwards (7)

Instructions for taking a medical history of the child’s pain situation: "These faces show how much something can hurt. This face (point to left-most face) shows no pain. The faces show more and more pain (point to each from left to right) up to this one (point to right-most face) – it shows very much pain. Point to the face that shows how much you hurt (right now)." To convert to a points system and document in the patient curve, score the chosen face 0, 2, 4, 6, 8 or 10, counting left to right. From a score of four onwards there is an analgesic requirement for acute pain. (www.painsourcebook.ca). Figure with kind permission of ISAP