PedsCases: Pediatric Education Online · PedsCases Team

Évaluation et traitement de la douleur chez l'enfant – CPS Podcast

July 13, 2024·22 min·2 clips

Multimodal pain management combines physical, psychological, and pharmacological interventions with teamwork for optimal results.

This episode reviews the Canadian Paediatric Society's 2022 practice point document on best practices for assessing and treating pain in children and adolescents. The host is Audrey Slater, a medical student at the Université de Montréal, translating an original podcast by Dr. Alexis Fong-Leboeuf, with contributions from Drs. Evelyne Des Trottiers, Marie-Joëlle Doré-Bergeron, and Samina Ali. Historically, pediatric pain has been under-recognized and under-treated, leading to risks of chronic pain and medical avoidance. The episode uses a case study of an 8-year-old girl, Alana, who has chronic neuropathic pain from chemotherapy and presents with an acute forearm fracture. It defines pain according to the International Association for the Study of Pain as a subjective experience modulated by emotions, development, and prior experiences. For verbal children, recommended self-assessment tools include the Numerical Rating Scale-11, the Faces Pain Scale–Revised, and the Colour Analog Scale. For preverbal or non-verbal children, observational measures like the NIPS, NFCS, FLACC, EVENDOL, CHEOPS, or COMFORT scales are used. Pain management should be multimodal, combining physical, psychological, and pharmacological interventions with help from nurses and child life specialists. For mild to moderate pain, over-the-counter analgesics like ibuprofen or acetaminophen are first-line, with evidence showing early treatment does not hinder diagnosis. Ibuprofen's anti-inflammatory properties make it a first-line option, and it is noted to be comparable to oral morphine in some studies for sprains or simple fractures. For moderate to severe acute pain, opioids can be considered, with intranasal fentanyl highlighted as a fast, effective option in hospital settings. Chronic pain, defined as persisting over three months, requires a multimodal approach focusing on functional autonomy rather than just cure. Psychological therapies include psychoeducation, biofeedback, and cognitive skills training, while physiotherapy uses graded movement exposure. Pharmacological management for chronic pain may include antidepressants like amitriptyline or antiepileptics like gabapentin, though quality evidence is limited. A surprising claim is that ibuprofen can be comparable in efficacy to oral morphine for specific acute conditions. A key insight is that adequate pain relief actually facilitates a better physical exam and simpler investigations. The case of Alana demonstrates the concurrent management of two distinct pain types: her acute fracture and her chronic neuropathy. The episode stresses that a child's pain should always be self-assessed when possible, and never assumed to be unquantifiable due to cognitive or physical limitations. The tone is educational and clinical, structured around a detailed case study to illustrate core principles. It is conversational in its direct address to the listener, prompting them to pause and consider their own approach. This episode is ideal for medical students, pediatric residents, nurses, and any clinician seeking a structured update on pediatric pain guidelines. Listeners looking for entertainment, non-medical parenting advice, or a debate on pain management philosophies should skip this clinical tutorial.

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A compact clinical refresher on pediatric pain assessment and treatment.

This episode treats pediatric pain as something that is often missed or minimized, then explains why that matters for both immediate care and later outcomes.

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Need a clean pediatric pain refresher?

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