Medication is Only One Method of Managing Acute Pain in Children
Most people think first of drugs to curb or prevent the perception of
pain, but a multi-tiered approach that includes both pain medication and
cognitive-behavioral approaches may be more effective in managing acute
pediatric pain. Traditionally, health care practitioners have approached pain
management in children as an either/or proposition involving drugs or
"alternative approaches." However, cognitive-behavioral interventions such as
relaxation techniques, breathing exercises, transcutaneous electric nerve
stimulation (TENS), biofeedback, and even acupuncture can supplement
pharmacological methods. When these approaches are combined, there can be a
substantial reduction in the amount of pain and stress that a child
experiences during a brief painful episode.
Providing a child with preoperative information about surgery and what to
expect is a good first step to decrease postoperative pain. In one study,
toddlers who received such information before undergoing hernia surgery had
lower pain scores. However, children ages seven and younger do not retain
information provided earlier than one hour before surgery.
Distraction, Suggestion, Breathing
Children are highly responsive to pain-controlling strategies that involve
their imagination and sense of play. Behavioral techniques, such as
progressive muscle relaxation, breathing techniques and simple imagery can
help divert attention away from the painful occurrence. Younger children
benefit from patterned, shallow breathing using mental images, such as a
train. Older children may like to use rhythmic, deep-chest breathing while
they are reminded to relax and "push the tenseness out."
Toddlers can be distracted by blowing bubbles, playing with pop-up toys or
video games, or looking through a kaleidoscope. Children over age 6 engage
well in guided imagery, counting and breathing techniques, often coached by a
play therapist or child-life specialist. Children may imagine being in their
favorite place, complete with sounds and smells, or enjoying their favorite
activity. The "magic glove (or blanket)" cognitive technique asks the child
to imagine a covering of the area of discomfort that will magically lessen
the pain.
Progressive muscle relaxation, an acquired skill, is designed to help
children recognize and reduce body tension associated with pain and to
decrease anxiety and discomfort. Systematic tensing and relaxing of muscle
groups allows patients to differentiate painful stimuli and even allows
anxious patients to obtain deep relaxation.
Biofeedback, Hypnosis and More
Biofeedback uses instruments to detect and amplify specific physical states
in the body that one usually does not notice and help bring them under one's
voluntary control. Biofeedback reduces pain, in part, by causing relaxation
and changes in blood flow. Because it requires trained instructors and
specialized equipment, it is often more useful for chronic pain.
Hypnosis is another complementary form of pain management where an altered
state of consciousness is used in which a child's concentration is focused.
Researchers believe that hypnosis better captures the short attention span of
children than breathing or counting. Self-hypnosis, a learned technique, or
hypnosis typically performed by a licensed psychologist have been shown to
control pain and distress and reduce length of hospital stays.
Transcutaneous electric nerve stimulation can be a powerful addition to pain
management in pediatrics either as a free-standing therapy or when used in
combination with other approaches. TENS involves stimulation pulses produced
by a battery-operated unit delivered to skin electrodes surrounding the area
where pain is occurring. It has been proven effective in relieving
post-operative pain and other circumstances. It is thought that either TENS
stimulates the release of endorphins, natural pain killers, or that the
nerves are occupied with a non-painful, TENS stimulus and cannot carry a
painful stimulus simultaneously.
Acupuncture, in which fine needles are inserted into the skin at specific
points, has been shown in adults to reduce postoperative nausea and vomiting
and shows promise for tennis elbow, backache, headache and other conditions.
One study showed that electric acupuncture reduced stress response in
infants undergoing a specific ophthalmologic examination.
Overall, the incorporation of various techniques, rather than only medication, can lead to better pain management in children.
Lynn M. Rusy, MD
Assistant Professor of Anesthesiology
Medical College of Wisconsin
Children's Hospital of Wisconsin
Steven J. Weisman, MD
Professor of Anesthesiology
Jane B. Pettit Chair in Pain Management
Medical College of Wisconsin
Children's Hospital of Wisconsin
Article Created: 2000-08-10
Article Updated: 2001-10-02
MCW Health News presents up-to-date information on patient care and medical research by the physicians of the Medical College of Wisconsin.
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