Pain Management

Pain is often under-recognised and under treated in children. It is a fundamental part of the clinical care of children in hospital, and is a duty of the ward teams. This is a summary of the most useful information in managing pain.

The palliative care team is available to help any child with a pain management problem – do not hesitate to consult the team for advice.

Examples of common painful conditions

Diagnosing the cause of pain may identify a reversible cause, and always helps in managing the pain.

Acute causes of pain

Chronic causes of pain

Pain assessment

Take history from child and carer– position, quality, severity, timing, provoking and relieving factors, response to analgesics. Ask about behaviour changes which suggest chronic pain: decreased appetite, sleep disturbance, and lack of interest in play. Observe for evidence of pain. Assume that a condition that would be painful for you is painful for the child.

Pain management

Reverse cause if possible.

Give analgesia regularly (not PRN), and by mouth rather than injection.

For painful procedures give morphine 0.2mg/kg 1 hour prior.

Non drug measures like explanation, distraction and play are useful.

In chronic pain, use the analgesic ladder which has 2 steps for children

Step 1 – for mild/moderate pain

Step 2 – for severe pain, and pain not controlled with step 1 analgesics

Morphine liquid 1mg/ml - prescribe on the drug chart in the usual way.
Morphine is kept in the drug cupboard on Paed Special Care Ward, Oncology, Surgical ward, and in the drug store off the corridor near the annexe. If morphine requirement persists, let the palliative care team know about the child so that the carer can be taught how to give morphine 4 hourly.