Providing pain management via prescribed medications is one solution for helping our patients overcome their pain. The risk/benefit ratio of some pain meds, however, and the fact that giving general anesthesia is overkill requires us to be familiar with other forms of pain management. This is especially true for children. An adult may understand the reason why the pain lessens but doesn’t go away but a child just feels uncomfortable and doesn’t know why.

Non-Drug Pain Management

According to one pain management survey, only 4 out of 177 nurses used non-drug pain management to assist patients with pain (Wessman & McDonand, 1999). There is certainly room for all nurses and nursing students to invest more time into learning about alternative pain management methods.

Methods with strong research backing their efficacy in adults (Tracey et al., 2006):

• Massage
• Music
• Guided Imagery
• Distraction
• Patient Education

Which methods translate well to pediatric pain management? Are some more effective or time-efficient than others?

Patient Education

Having a well informed patient should be every nurse’s goal but with pediatric patients, that may not be practical. Depending on the developmental level of the child, however, some level of understanding of their illness and the causes of their pain may be attainable.

Older children can be informed of various pain management methods and may be able to self treat pain. They will be able to understand more complex instructions and be able to follow up on those instructions. Younger children possess varying levels of understanding but even toddlers can be taught to communicate to caregivers about their pain.

The key is to devise an instructional program that is age and developmentally appropriate, involves family members or care givers, teaches that pain is manageable through a variety of treatments, encourages open communication regarding intensity and quality of pain.

Massage

Massage is a time honored intervention used by nurses. There is ample evidence that it is a useful tool for pain management in children when combined as part of an integrated pain management plan (Van Cleve et al., 2004).

Massage may range from a foot or hand massage to a back or scalp massage. It is essential to explain what you are planning in terms the child understands such as calling it a “foot rub” instead of a massage. As with many other non-drug pain management interventions, this can be taught and subsequently delegated to other caregivers including family members. Giving this and other tasks to family members may also offer them a feeling of having more control over an out of control situation with their children.

Distraction

Distraction as a pain management tool encompasses a host of possible interventions. This includes music, guided imagery, game playing, and watching TV. One nurse involved in pediatric pain studies found that the use of distraction was so effective that the research became contaminated by caregivers using it more frequently than called for in the study (Stubenrauch, 2007).

It makes sense to anyone who works with kids. They are easily distracted (especially the younger ones). This may explain the mistaken belief dating back to the 60’s that children didn’t experience pain in the same way as adults and therefore didn’t need aggressive pain management (Swafford & Allen, 1968).  That children can be temporarily distracted from their pain doesn’t mean that they don’t experience pain or that the pain doesn’t return once the distraction is removed.

Distraction has varying levels of effectiveness depending on the patient. It does have the benefit that it can be utilized by every member of the pediatric patient’s care team, including the patient herself. In fact, providing the patient with a choice of distractions may allow for the most effective distraction to be chosen.

Distractions that have shown promising results as a pain management intervention include:

• Game playing
• Singing
• Storytelling
• Reading
• Watching a favorite video
• Blowing bubbles
• Favorite Toys

The use of this pain management tool is not limited to the treatment of existing and chronic pain. Distraction prior to and during a painful procedure has shown promise in lessening reported and observable pain levels (Stubenrauch, 2007).

Conclusions

Pediatric pain management requires an integrated approach using a variety of interventions. Non-drug interventions start with patient education to their level of comprehension and follow with massage, and various methods of distraction.

Involving the entire care team including family members and friends will improve the effectiveness and response of these methods. A planned approach, documentation of interventions and their effect, and continuity of care between the care team will ensure the best methods for each individual have been used and the goal of adequate pain management has been met.

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Check out the first article in our pediatric pain series here at the Nursing Show, Pediatric Pain Assessment Tips for Nurses and Nursing Students.

Also, listen to this episode of the MedicCast EMS podcast on Pediatric Sports Injuries featuring an interview segment with Pediatrician Dr. Mike of the Pediacast podcast.

Written by Jamie Davis, RN, EMT-P, B.A., A.S. Jamie is the host of the popular online radio programs for medical professionals, the MedicCast and the Nursing Show. He is also a nationally recognized speaker on the use of online media and web tools in higher education and a consultant on new media and podcasting for organizations and business. Contact Jamie to comment on this article here.

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References:

• Stubenrauch, J. M. (2007). Striving for distraction: Two nurses are honored for research on an innovative approach to pain management. American Journal of Nursing, 107(3), 94-95.
• Swafford, L. I. & Allen D. (1968). Pain relief in the pediatric patient. Medical Clinics of North America, 52(1), 131-135.
• Tracey, S., Dufault, M., Kogut, S., & Valerie, M., Rossi, S., Willey-Temkin, C. (2006). Translating best practices in nondrug postoperative pain management. Nursing Research, 55(28), S57-S67.
• Van Cleve, L., Bossert, E., Beecroft, P., & Adlard, K., Alvarez, O., Savedra, M. (2004). The pain experience of children with leukemia during the first year after diagnosis. Nursing Research, 53(1), 1-10.
• Wessman, A.C., & McDonald, D. D. (1999). Nurses’ personal pain experiences and their pain management knowledge. Journal of Continuing Education in Nursing, 30(4), 152-157.

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Photo Credits

• photo 1: U.S. Department of Defense, (1998). Jones, Erika N. Project Hope Volunteer Registered Nurse (RN), Diane Speranza.
• photo 2: U.S. Department of Defense, (2008). Unknown.