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Maximizing Pain Relief in Pediatric Patients

by Andrea Calvani, BSN, Paula Bylaska-Davies, BSN, MSN

Research Problem:  

Pain management is a complex issue that has become increasingly significant in the nursing profession; so much so that the assessment of pain has become known as the fifth vital sign. This issue becomes even more crucial when attempting to manage pain in pediatric patients. Assessing pain becomes complicated with children as the nurse must account for the child’s developmental stage and chronological age.  Though it is important for the nurse to monitor physical findings, such as pulse and blood pressure, it is even more necessary to receive a self-report from the child regarding her pain due to the fact that pain is a subjective experience (Pillitteri, 2010).  A recent study by Kortesluoma, Nikkonen, and Serio (2008), focused on the subjective nature of pain and declared that children should be considered an “expert” on managing their pain; therefore, it is crucial for nurses to inquire information regarding how the child relieves his pain, and attempt to include this in the child’s plan of care.   

            Hospitalized pediatric patients often undergo procedures which cause pain; therefore, nurses must have knowledge regarding various pain management methods. Recently, a study was conducted that explored the rationale for the poor management of pediatric pain by nurses.  According to Twycross (2010), nurses today have a knowledge deficit concerning pediatric pain and continue to believe many fallacies regarding pain management in children. Nurses continue to disregard the subjective aspect of pain, and according to Kortesluoma et al., (2008), there have been limited studies that have addressed a child’s preferred pain management strategies and less is understood about the strategies performed by pediatric patients themselves. Little attention has been given to the pediatric patient’s perception of pain, nor to the interventions that the nurse can provide in order to effectively manage a child’s pain.  

Most current studies have focused primarily on pain relief methods initiated by healthcare workers rather than the pediatric patient’s perception of pain or her preferred pain management strategies (Kortesluoma et al., 2008). The purpose of this paper will be to explore the importance of inquiring about the patient’s self-imposed pain relief methods, and the role of the nurse in assisting the child to minimize his pain.  For this paper, the term self-imposed will be used to identify any strategy initiated by the pediatric patient himself to relieve pain. 

Review of the Literature: 

            Pain management in pediatric patients has been extensively examined by many researchers, although, less is known about the pediatric patient’s perception of pain relief and the self-imposed methods the patient uses to relieve pain.  A study completed by Kortesluoma et al., in 2008 studied the pediatric patient’s self-help strategies for pain relief. The authors concluded that hospitalized children utilized a variety of self-help methods during episodes of pain. Nineteen self-imposed pain relief methods were identified including strategies such as:  massaging the painful site, deep breathing, changing body position, exercise, positive self-talk, crying, applying ice and/or heat, and attention diversion.

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