Pediatric Pain Management
Pain
• Definition: Physiological response transmitted
through the nervous system that notifies your body
that something is wrong
• Acute
• Chronic
• Gate control theory: pain is a complex
phenomenon that includes both physiological and
psychological input
• *emotional factors (e.g., anxiety) can increase pain
perception in children
Distress
• Definition: an increase in the amount of pain
“experienced” by the patient often caused by
psychological factors
• The emotional experience of pain
• Variables that influence distress
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Age
Prior experience
Parent anxiety/response
Coping skills
• Approach (try to deal) vs. avoidance (hide, run, pull away)
Biobehavioral Model
Precipitants
Disease
Injury
Stress
Procedures
Pain
Perception
Behavior
Intervening Variables
Biological Predisposition
Family Environment
Cognitive Appraisal
Coping Strategies
Perceived Social Support
Functional Status
Activities of Daily Living
School Attendance
Depressive Symptoms
Anxious Symptoms
Behavioral Problems
Interpersonal Relations
Categories of Pediatric Pain
• Associated with chronic illness
• Sickle cell, arthritis
• Associated with physical injury/trauma
• Burns, broken bones
• Not associated with illness or injury
• Headache
• Associated with medical/dental procedures
• Injections, surgeries
Common Referral Issues
• If the treating team believes the procedure
to be highly painful or distressing
• If the treating team has concerns about the
child ability to cope with the procedure
• If the child has experienced more than
expected pain and distress during previous
procedures
Pain Assessment
• Self Report
• Visual Analog Scale
• Faces Pain Scale
• *pain is personal and subjective
• Other report
• Parent
• Staff
• *advantage of comparisons
Pain Assessment
• Behavioral Observation
• Child-Adult Medical Procedure Interaction Scale
(CAMPIS)
• Adult vocalizations: Praise, Commands, Criticism
• Child vocalizations: Cry, Information Seeking
• Behavioral Approach-Avoidance and Distress Scale
(BAADS)
• Physiological
• Heart rate
• Blood pressure
• Breathing rate
Pain Assessment
• Reading: Blount et al (2006)
• Child distress most often preceded by adults’
reassuring comments, apologies, empathy,
criticism of child
• Child distress inversely correlated with adults’
coaching of the children to cope and child
coping behaviors (I..e, distraction, breathing,
making coping statements)
Cognitive Behavioral Management
of Chronic Pain
• Framework: Gate control theory and
biobehavioral model
• 1. Pain Perception Regulation
• Progressive Muscle Relaxation
• Deep Breathing
• Guided Imagery
Cognitive Behavioral Management
of Chronic Pain
• 2. Pain Behavior Modification
• Encourage adaptive behaviors – HOW?
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Pain behaviors: crying, resting
Coping
Relaxation
Distraction
• Discourage maladaptive behaviors – HOW?
• Pain behaviors: secondary gain
• Helplessness
Cognitive Behavioral Management
of Chronic Pain
• 3.Intervening variables
• Family environment and Social Support
• Establish support systems
• Encourage parent to empower child
• Coping skills
• Filmed modeling
• Coaching
• Incentives
• Cognitive appraisals
• Blame: “I deserve this.”
• Anticipated pain: “This is going to hurt REALLY bad – I can’t do it!”
• CBT has been found to be more cost-effective than medications
• Although medications do also help
Conclusions
• Children can accurately report their pain
• Pharmacological and psychological
treatments often are both necessary
• Cognitive-behavioral therapy can increase
children’s coping and decrease their distress
• Adequate pain control is a measure of the
quality of treatment