Background: Information regarding pediatric pain management appears in many forms, but rarely in a concise location. Much of the emphasis is on invasive therapies due to their efficacy without a full understanding of the psychological trauma inflicted on individuals unable to understand the larger purpose behind invasive pain medication administration. More information needs to be readily available regarding non-invasive methods as a step toward better patient care.
Purpose: To present in an unbiased format, a summary of the information available for pediatric pain control in outpatient settings. The primary focus is on non-invasive methods that can lessen the psychological trauma received by our smallest of customers on a daily basis and in a variety of settings.
Methods: Utilizing a literature search conducted on The Cochrane Database of Systematic Reviews, CINHAL, The Database of Abstracts of Reviews of Effects, Medline-OVID, MedlinePubMed, Medline-plus, Psyc-Info, and UpToDate, 26 articles were highlighted for review. Of those articles highlighted, 7 were found to have information pertaining only to adult methods or were incomplete. The final 19 articles were found to have pertinent and current information regarding the non-invasive pain management for children and the psychological benefits of pain management in children. All tables and data analyses were directly transferred from annotated sources.
Discussion: The sum total of children evaluated was well over 9300 patients in various formats ranging from well randomized and double-blinded to intent-to-treat single method trials. The validity of each article is discussed below and due to a paucity of articles and information; several were included as supporting evidence only. In conjunction, eight different methods of pain control and their respective results were discussed to include: four different topical methods, various oral/rectal and inhalation methods and cognitive behavioral therapies.
Conclusion: Literature evidence clearly supports the use of topicals, especially EMLA, LET, and LMX, as efficacious and . efficient in the control of pre-procedural or immunization pain. Oral/rectal is well known and is still of limited value due to the variability of pediatric response based on age and agent, especially to narcotics. For the inhalation agents, significant evidence is present to support the use of nitrous oxide for emergent and urgent procedural and preprocedural pain control. Lastly are the cognitive behavioral therapies which show that simple' distraction verses other options (hypnosis, imagery, education, and self-coping statements for example) can be very effective but is also age dependent and cap be time consuming.
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