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Treatment of Acute and Chronic Pain in the Outpatient Setting

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Bringing Pain Relief to Children

Abstract

Although there have been dramatic changes in attitude and practice in the treatment of children’ pain in the hospital, pain management in outpatient settings is treated essentially the way it was 20 years ago. It is quite remarkable that many common illnesses and procedures universally acknowledged to be associated with significant discomfort and anxiety have received minimal research attention. In this chapter, some of the more common pain problems (minor procedures and acute illnesses) encountered in office practice are reviewed, and suggestions for pain relief based on the limited literature are offered. The following areas are addressed: (1) pain associated with immunization, the most common painful procedure in office practice; (2) pain associated with common illnesses, specifically otitis media, pharyngitis, and viral mouth infections; and (3) chronic and recurrent pains, which require an alternative paradigm than acute pain. Through the uniform use of relatively simple strategies, much of the pain associated with these common problems can be significantly reduced.

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References

  1. Schechter NL, Berde CB, Yaster M. Pain in infants, children, and adolescents: an overview. In: Schechter NL, Berde CB, Yaster M, eds. Pain in Infants, Children, and Adolescents, 2nd ed. Philadelphia: Lippincott, Williams, and Wilkins; 2003, pp. 3–18.

    Google Scholar 

  2. Anand KJS, Sippell WG, Aynsley-Green A. Randomized trial of fentanyl anesthesia in preterm babies undergoing surgery: effects on stress response. Lancet 1987;1:243–248.

    Article  CAS  PubMed  Google Scholar 

  3. Goldschneider KR, Anand KJS. Long term consequences of pain in neonates. In: Schechter NL, Berde CB, Yaster M, eds. Pain in Infants, Children, and Adolescents, 2nd ed. Philadelphia: Lippincott,Williams, and Wilkins; 2003, pp. 58–67.

    Google Scholar 

  4. World Health Organization. Cancer Pain and Palliative Care in Children. Geneva: World Health Organization; 1998.

    Google Scholar 

  5. Ljungman G, Gordh T, Sorensen S, et al. Pain in paediatric oncology: interviews with children, adolescents, and their parents. Acta Paediatr 1999;88:623–630.

    Article  PubMed  CAS  Google Scholar 

  6. Tohill J, McMorrow O. Pain relief in the neonatal intensive care unit. Lancet 1996;336:569.

    Article  Google Scholar 

  7. Anand KJ. International Evidence-Based Group for Neonatal Pain. Consensus statement for the prevention and management of pain in the newborn. Arch Pediatr Adolesc Med 2001;155:173–180.

    PubMed  CAS  Google Scholar 

  8. McGrath PJ, Finley GA. Chronic and Recurrent Pain in Children and Adolescents. Progress in Pain Research and Management. Vol. 13. Seattle, WA: IASP Press; 1999.

    Google Scholar 

  9. Pickering LK. Red Book: 2003 Report of the Committee on Infectious Diseases. 26th ed. Elk Grove, IL: American Academy of Pediatrics; 2003.

    Google Scholar 

  10. Committee on Infectious Diseases, American Academy of Pediatrics. Red Book: 2003 Report of the Committee on Infectious Diseases. 26th ed. Elk Grove Village, IL: American Academy of Pediatrics; 2003.

    Google Scholar 

  11. Fassler D. The fear of needles in children. Am J Orthopsychiatry 1985;55:371–377.

    Article  PubMed  CAS  Google Scholar 

  12. Menke E. School-aged children’s perception of stress in the hospital. Child Health Care 1981;9:80–86.

    Article  PubMed  CAS  Google Scholar 

  13. Ornstein P, Manning EL, Pelphrey KA. Children’s memory for pain. J Dev Behav Pediatr 1999;20:262–277.

    Article  PubMed  CAS  Google Scholar 

  14. Taddio A, Katz J, Ilersich AL. Effect of neonatal circumcision on pain response during subsequent routine vaccination. Lancet 1997;349:599–603.

    Article  PubMed  CAS  Google Scholar 

  15. Fitzgerald M, Millard C, McIntosh N. Cutaneous hypersensitivity following peripheral tissue damage in newborn infants and its reversal with topical anaesthesia. Pain 1989;39:31.

    Article  PubMed  CAS  Google Scholar 

  16. Weisman SJ, Bernstein B, Schechter NL. Consequences of inadequate analgesia during painful procedures in children. Arch Pediatr Adolesc Med 1998;152:147–149.

    PubMed  CAS  Google Scholar 

  17. Schechter NL, Bernstein BA, Beck A, et al. Individual differences in children’s response to pain: role of temperament and parental characteristics. Pediatrics 1991;87:171–177.

    PubMed  CAS  Google Scholar 

  18. Beyer JE, Villarruel AM, Denyes MJ. The Oucher: User’s Manual and Technical Report. Bethesda, MD: Association for the Care of Children’s Health; 1995.

    Google Scholar 

  19. Katz ER, Kellerman J, Siegel SE. Distress behavior in children with cancer undergoing medical procedures: developmental considerations. J Consult Clin Psychol 1980;48:356–365.

    Article  PubMed  CAS  Google Scholar 

  20. Chen E, Craske MG, Katz ER, Schwartz E, Zeltzer LK. Pain-sensitive temperament: does it predict procedural distress and response to psychological treatment among children with cancer? J Pediatr Psychol 2000;25:269–278.

    Article  PubMed  CAS  Google Scholar 

  21. Lee LW, White-Traut RC. The role of temperament in pediatric pain response. Issues Compr Pediatr Nurs 1996;19:49–63.

    Article  PubMed  CAS  Google Scholar 

  22. Meyerhoff AS, Weniger BG, Jacobs J. Economic value to parents of reducing the pain and emotional distress of childhood vaccine injections. Pediatr Infect Dis 2001;20:s57–s62.

    Article  CAS  Google Scholar 

  23. Reis EC, Jacobson RM, Tarbell S, et al. Taking the sting out of shots: control of vaccination-associated pain and adverse reactions. Pediatr Ann 1998;27:375–386.

    PubMed  CAS  Google Scholar 

  24. Singer T, Seymour B, O’Doherty J, Kaube H, Dolan RJ, Frith CD. Empathy for pain involves the affective but not sensory components of pain. Science 2004;303:1157–1162.

    Article  PubMed  CAS  Google Scholar 

  25. Woodin KA, Rodewald LE, Humiston SG, et al. Are children becoming pincushions from immunizations? Arch Pediatr Adolesc Med 1995;149:845–849.

    PubMed  CAS  Google Scholar 

  26. Reis EC. Multiple scheduled injections contribute to missed opportunities to immunize during well care visits [abstract]. Ambul Child Health 1997;3(1, pt 2):172.

    Google Scholar 

  27. Fernald CD, Corry JJ. Empathic vs directive preparation of children for needles. Child Health Care 1981;10:44–46.

    Article  PubMed  CAS  Google Scholar 

  28. Zeltzer L, Jay SM, Fisher DM. The management of pain associated with pediatric procedures. Pediatr Clin North Am 1989;36:941–964.

    PubMed  CAS  Google Scholar 

  29. Royal College of Paediatrics and Child Health. Position Statement on Injection Technique. London Royal College of Paediatrics and Child Health, 2002.

    Google Scholar 

  30. World Health Organization. Expanded Programme on Immunization. Geneva: World Health Organization; 1998.

    Google Scholar 

  31. County of Los Angeles Department of Public Health. Immunizations: minimizing pain and maximizing comfort. Public Health 2001;1:3.

    Google Scholar 

  32. Ipp MM, Gold R, Goldebach M, et al. Adverse reactions to diphtheria, tetanus, pertussis-polio vaccination at 18 mo of age: effect of injection site and needle length. Pediatrics 1989;83:670–682.

    Google Scholar 

  33. Diggle L, Deeks J. Effect of needle length on incidence of local reactions to routine immunization in infants aged 4 mo: randomized controlled trial. BMJ 2000;321:931–933.

    Article  PubMed  CAS  Google Scholar 

  34. Cook IF, Murtagh J. Needle length required for intramuscular vaccination of infants and toddlers. Aust Fam Physician 2002;31:295–297.

    PubMed  Google Scholar 

  35. Groswasser J, Kahn A, Bouche B, et al. Needle length and injection technique for efficient intramuscular vaccine delivery in infants and children evaluated through an ultrasonographic determination of subcutaneous and muscle layer thickness. Pediatrics 1997;100:400–403.

    Article  PubMed  CAS  Google Scholar 

  36. Zuckerman JN. The importance of injecting vaccines into muscle: different patients need different needle sizes. BMJ 2000;321:1237, 1238.

    Article  PubMed  CAS  Google Scholar 

  37. Lyons R, Howell F. Pain and measles, mumps, and rubella vaccination. Arch Dis Child 1991;66:346–367.

    PubMed  CAS  Google Scholar 

  38. Ipp M, Cohen E, Goldbach M, Macarthur C. Effect of choice of measles-mumps-rubella vaccine on immediate vaccination pain in infants. Arch Pediatr Adolesc Med 2004;158:323–326.

    Article  PubMed  Google Scholar 

  39. Bartfield JM, Crisafulli KM, Raccio-Robak N, Salluzzo RF. The effects of warming and buffering on pain of infiltration of lidocaine. Acad Emerg Med 1995;2:254–257.

    Article  PubMed  CAS  Google Scholar 

  40. Maiden MJ, Benton GN, Bourne RA. Effect of warming adult diphtheria-tetanus vaccine on discomfort after injection: a randomized controlled trial. Med J Aust 2003;178:433–436.

    PubMed  Google Scholar 

  41. Schichor A, Bernstein B, Weinerman H, et al. Lidocaine as a diluent for ceftriaxone in the treatment of gonorrhea: does it reduce the pain of injection? Arch Dis Pediatr Adolesc Med 1994;148:72–75.

    CAS  Google Scholar 

  42. Amir J, Ginat S, Cohen YH et al. Lidocaine as a diluent for the administration of benzathine penicillin G. Pediatr Infect Dis J 1998;17:890–893.

    Article  PubMed  CAS  Google Scholar 

  43. Blount RL, Bachanas P, Powers S, et al. Training children to cope and parents to coach them during routine immunizations: effects on child, parent, and staff behaviors. Behav Ther 1992;23:689–705.

    Article  Google Scholar 

  44. Cohen LL, Manimala MR, Blount RL. Easier said than done: what parents say they do and what they do during child’s immunizations. Child Health Care 2000; 29:79–86.

    Article  Google Scholar 

  45. Manimala MR, Blount RL, Cohen LL. The effects of parental reassurance vs distraction on child distress during immunizations. Child Health Care 2000;229:161–177.

    Article  Google Scholar 

  46. Manne SL, Redd WH, Jacobsen PB, et al. Behavioral intervention to reduce child and parent distress during venipuncture. J Consult Clin Psychol 1994;58:556–566.

    Google Scholar 

  47. French FM, Painter EC, Coury DL. Blowing away shot pain: a technique for pain management during immunization. Pediatrics 1994;93:384–388.

    PubMed  CAS  Google Scholar 

  48. Fowler Kerry S, Lander J. Management of injection pain in children. Pain 1987;30:169–175.

    Article  PubMed  CAS  Google Scholar 

  49. Sparks L. Taking the “ouch“ out of injections for children: using distraction to decrease pain. Am J Matern Child Nurs 2001;26:72–78.

    Article  CAS  Google Scholar 

  50. Cohen LL. Reducing infant immunization distress through distraction. Health Psychol 2002;21:207–211.

    Article  PubMed  Google Scholar 

  51. Kuttner L. Management of young children’s acute pain and anxiety during invasive medical procedures. Pediatrician 1989;16:39–44.

    PubMed  CAS  Google Scholar 

  52. Zeltzer L, LeBaron S. Hypnotic and nonhypnotic techniques for reduction of pain and anxiety during painful procedures in children and adolescents with cancer. J Pediatr 1982;101:1032–1035.

    Article  PubMed  CAS  Google Scholar 

  53. Ellis JA, Spanos NP. Cognitive-behavioral interventions for children’s distress during bone marrow aspirations and lumbar punctures: a critical review. J Pain Symptom Manage 1994;9:96–108.

    Article  PubMed  CAS  Google Scholar 

  54. Chen E, Joseph MH, Zeltzer LK. Behavioral and cognitive interventions in the treatment of pain in children. Pediatr Clin North Am 2000;47:513–525.

    Article  PubMed  CAS  Google Scholar 

  55. Kazak AE, Penati B, Brophy P, Himelstein B. Pharmacologic and psychologic interventions for procedural pain. Pediatrics 1998;102(1, pt 1):59–66.

    Article  PubMed  CAS  Google Scholar 

  56. Halperin DL, Koren G, Attias D, et al. Topical skin anesthesia for venous, subcutaneous drug reservoir and lumbar punctures in children. Pediatrics 1989;84:281–284.

    PubMed  CAS  Google Scholar 

  57. Reis EC, Holobukov R. Vapoocoolant spray is equally effective as EMLA cream in reducing immunization pain in school-aged children. Pediatrics 1997;100:e1025–e1029.

    Article  Google Scholar 

  58. O’Brien L, Taddio A, Ipp M, et al. Topical 4% amethocaine gel reduces the pain of subcutaneous measles-mumps-rubella vaccination. Pediatrics 2004;114:6:e720–e724.

    Article  PubMed  Google Scholar 

  59. Blass E, Hoffmeyer LB. Sucrose as an analgesic for newborn infants. Pediatrics 1991;87:215–218.

    PubMed  CAS  Google Scholar 

  60. Barr RG, Young SN, Wright JH, et al. Sucrose analgesia” and diphtheria-tetanuspertussis immunizations at 2 and 4 mo. J Dev Behav Pediatr 1995;16:220–225.

    Article  PubMed  CAS  Google Scholar 

  61. Blass EM, Cramer CP, Fanselow MS. The development of morphine-induced antinociception in neonata rats: a comparison of forepaw, hindpaw, and tail retraction from a thermal stimulus. Pharmacol Biochem Behav 1993;44:643–649.

    Article  PubMed  CAS  Google Scholar 

  62. Barnhill BJ, Holbert MD, Jackson NM, Erickson RS. Using pressure to decrease the pain of intramuscular injections. J Pain Symptom Manage 1996;12:52–58.

    Article  PubMed  CAS  Google Scholar 

  63. Chung JWY, Ng WMY, Wong TKS. An experimental study on the use of manual pressure to reduce pain in intramuscular injections. J Clin Nurs 2002;11:457–461.

    Article  PubMed  Google Scholar 

  64. Horn MI, McCArthy AM. Children’s responses to sequential vs simultaneous immunization injections. J Pediatr Health Care 1999;13:18–23. sai]65._Bogin FJ, Bernstein BA, Payton JS, Schechter NL, Ristau B. A comparison of the pain associated with simultaneous (SIM) vs sequential (SEQ) immunization injection given at the 9 and 12 mo well child visits. Pediatr Res 2004;55:210A.

    Article  PubMed  CAS  Google Scholar 

  65. Rosenfeld R, Bluestone C. Evidence-based otitis media. St. Louis, MO: Decker; 1999.

    Google Scholar 

  66. Schappert SM. Office Visits for Otitis Media: United States, 1975–-2000. Hyattsville, MD: National Center for Health Statistics; 1–18. Data from Vital and Health Statistics of the Centers for Disease Control No. 214, 2003.

    Google Scholar 

  67. Paradise JL, Rockette JE, Colborn K, et al. Otitis media in 2253 Pittsburgh area infants: prevalence and risk factors during the first 2 yr of life. Pediatrics 1997;99:318–333.

    Article  PubMed  CAS  Google Scholar 

  68. Del Mar C, Glaszious P, Hayem M. Are antibiotics indicated as initial treatment for children with acute otitis media: a meta analysis. BMJ 1997;314:1526–1529.

    PubMed  Google Scholar 

  69. Damoiseaux RAMJ, van Balen FAM, Hoes AW, et al. Primary care based randomised double blind trial of amoxicillin vs placebo for acute otitis media in children under 2 yr. BMJ 2000;320:350–354.

    Article  PubMed  CAS  Google Scholar 

  70. Cantekin EI. Time to stop misuse of antibiotics [letter]. BMJ 2000;321:765.

    Article  PubMed  CAS  Google Scholar 

  71. Bertin L, Pons G, D’Athis P, et al. A randomized, double-blind, multicentre controlled trial of ibuprofen vs acetaminophen and placebo for symptoms of acute otitis media in children. Fundam Clin Pharmacol 1996;10:378–392.

    Article  Google Scholar 

  72. Hauswald M, Anison C. Prescribing analgesics: the effect of patient age and physician specialty. Pediatr Emerg Care 1997;13:262, 263.

    Article  PubMed  CAS  Google Scholar 

  73. Sarrell EM, Mandelberg A, Cohen HA. Efficacy of naturopathic extracts in the management of ear pain associated with acute otitis media. Arch Pediatr Adolesc Med 2001;155:796–799.

    PubMed  CAS  Google Scholar 

  74. Hoberman A, Paradise JL, Reynolds EA, et al. Efficacy of Auralgan for treating ear pain in children with acute otitis media. Arch Pediatr Adolesc Med 1997; 151:675–678.

    PubMed  CAS  Google Scholar 

  75. Poses RM, Cebul RD, Collins M, et al. The accuracy of experienced physicians’ estimates for patients with sore throats: implications for decision-making. JAMA 1985;254:925–929.

    Article  PubMed  CAS  Google Scholar 

  76. Bertin L, Pons G, d’Athis P, et al. Randomized double-blind multi-center, controlled trial of ibuprofen vs acetaminophen for symptoms of tonsillitis and pharyngitis in children. J Pediatr 1991;119:811–814.

    Article  PubMed  CAS  Google Scholar 

  77. Sagarin MJ, Roberts J. Acute Pharyngitis [correspondence]. N Engl J Med 2001;344:1479–1480.

    Article  PubMed  CAS  Google Scholar 

  78. Bisno AL. Primary care: acute pharyngitis. N Engl J Med 2001;344:205–211.

    Article  PubMed  CAS  Google Scholar 

  79. Del Mar C, Glasziou P. Antibiotics for the symptoms and complications of sore throat. In: Cochrane Collaboration. Cochrane Library. Issue 3. Oxford, UK: Update Software; 1998.

    Google Scholar 

  80. Eccles R, Loose I, Jawad M, et al. Effects of acetylsalicylic acid on sore throat pain and other pain symptoms associated with acute upper respiratory infection. Pain Med 2003;4:118–124.

    Article  PubMed  Google Scholar 

  81. Moore N, LeParc JM, van Ganse E, et al. Tolerability of ibuprofen, aspirin and paracetamol for the treatment of cold and flu symptoms and sore throat pain. Int J Clin Pract 2002;56:732–734.

    PubMed  CAS  Google Scholar 

  82. Marvez-Valls EG, Ernst AA, Gray J, Johnson WD. The role of betamethasone in the treatment of excudative pharyngitis. Acad Emerg Med 1998;5:567–572.

    Article  PubMed  CAS  Google Scholar 

  83. Bulloch B, Kabani, Tenenbein M. Oral dexamethasone for the treatment of pain in children with acute pharyngitis. Ann Emerg Med 2003;41:601–608.

    Article  PubMed  Google Scholar 

  84. Amir J, Harel L, Smetana Z. Treatment of herpes simplex gingivostomatitis with acyclovir in children. BMJ 1997;314:1800–1803.

    PubMed  CAS  Google Scholar 

  85. Peter JR, Haney HM. Infections of the oral cavity. Pediatr Ann 1996;25:573.

    Google Scholar 

  86. Freeman SB, Markwell JK. Sucralfate in alleviating post-tonsillectomy pain. Laryngoscope 1992;102:1242–1246.

    Article  PubMed  CAS  Google Scholar 

  87. Innocenti M, Moscatelli G, Lopez S. Efficacy of Gelclair in reducing pain in palliative care patients with oral lesions: preliminary findings from an open pilot study. J Pain Symptom Manage 2002;24:456–457.

    Article  PubMed  CAS  Google Scholar 

  88. Gonzalez del Rey J, Wason S, Druckenbrod RW. Lidocaine overdose: another preventable case? Pediatr Emerg Care 1994;10:344–346.

    Article  PubMed  CAS  Google Scholar 

  89. American Pain Society. Principles of Analgesic Use in the Treatment of Acute and Cancer Pain. 4th ed. Glenview, IL: American Pain Society; 1999, p. 4.

    Google Scholar 

  90. Goodman JE, McGrath PJ. The epidemiology of pain in children and adolescents: a review. Pain 1991;46:247–264.

    Article  PubMed  CAS  Google Scholar 

  91. Kristjansdottir G. Prevalence of pain combinations and overall pain: a study of headache, stomach pain and back pain among schoolchildren. Scan J Soc Med 1997;25:58–63.

    CAS  Google Scholar 

  92. Palmero TM. Impact of recurrent and chronic pain on child and family daily functioning: a critical review of the literature. J Dev Behav Pediatr 2000;21:58–69.

    Google Scholar 

  93. Perquin CW, Hazebrpel-Kampschreur AA, Hunfeld JA, et al. Pain in children and adolescents: a common problem. Pain 2000;87:51–58.

    Article  PubMed  CAS  Google Scholar 

  94. Eccleston C, Malleson P. Managing chronic pain in children and adolescents. BMJ 2003;326:1408–1409.

    Article  PubMed  Google Scholar 

  95. Engelbert RH, Bank RA, Sakkers RJ, Helders PJ, Beemer FA, Uiterwaal CS. Pediatric generalized joint hypermobility with and without musculoskeletal complaints: a localized or systemic disorder? Pediatrics 2003;111:e248–e254.

    Article  PubMed  Google Scholar 

  96. Barron DF, Cohen BA, Geraghty MT, Violand R, Rowe PC. Joint hypermobility is more common in children with chronic fatigue syndrome than in healthy controls. J Pediatr 2002;141:421–425.

    Article  PubMed  Google Scholar 

  97. Grahame R. The revised (Beighton 1998) criteria for the diagnosis of benign joint hypermobility syndrome. J Rheumatol 2000;27:1777–1779.

    PubMed  CAS  Google Scholar 

  98. Walco GA, Cassidy RC, Schechter NL. Pain, hurt, and harm. The ethics of pain control in infants and children. N Engl J Med 1994;331:541–544.

    Article  PubMed  CAS  Google Scholar 

  99. Herzog DB, Harper G. Unexplained disability: diagnostic dilemmas and principles of management. Clin Pediatr 1981;20:761–768.

    CAS  Google Scholar 

  100. Lewin DS, Dahl RE. Importance of sleep in the management of pediatric pain. J Dev Behav Pediatr 1999;20:244–252.

    Article  PubMed  CAS  Google Scholar 

  101. Weydert JA, Ball TM, Davis MF. Systematic review of treatments for recurrent abdominal pain. Pediatrics 2003;111:e1.

    Article  PubMed  Google Scholar 

  102. Sherry DD, Wallace CA, Kelley C, Kidder M, Sapp L. Short-and long-term outcomes of children with complex regional pain syndrome type I treated with exercise therapy. Clin J Pain 1999;15:218–223.

    Article  PubMed  CAS  Google Scholar 

  103. Eccleston C, Yorke L, Morley S, et al. Psychological therapies for the management of chronic and recurrent pain in children and adolescents. Cochrane Database of Systematic Reviews 2004.

    Google Scholar 

  104. Walco GA, Sterling CM, Conte PM, Engel RG. Empirically supported treatments in pediatric psychology: disease-related pain. J Pediatr Psychol 1999;24:155–167.

    Article  PubMed  CAS  Google Scholar 

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Schechter, N.L. (2006). Treatment of Acute and Chronic Pain in the Outpatient Setting. In: Finley, G.A., McGrath, P.J., Chambers, C.T. (eds) Bringing Pain Relief to Children. Humana Press. https://doi.org/10.1007/978-1-59745-125-3_2

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