Paediatric Pain Medicine - DRAFT0308 Discussion
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Previously ANZCA WebMaster wrote:
Please post your comments for Paediatric Pain Medicine DRAFT_ 0308 below.
I assume the purpose of this document is an introduction to this area of pain medicine aimed at trainee level.
Brief thoughts on first reading:
- If it is to only address acute and procedure-related pain and pain management, then this should be explicit in the title. I only recognised the limitation of its scope half way through when a separate document on persistent pain is mentioned.
- The neurobiology and psychology developmental sections are good. I have an additional reference that may be helpful for outlining the cognitive developmental stages that influence children's understanding/interpretation of the meaning of pain. I will locate this and send Tuesday.
- In the "Types of pain" section, it may be helpful to include trauma-related and post-operative pain as separate categories (?currently assumed to be within disease-related). Also I found headings "treatment-related" and "procedural pain" confusing. This could be clarified by changing the order and calling them "Pain related to diagnostic procedures" and "Pain related to therapeutic procedures".
- The Pain Assessment Section would benefit from restructuring. I suggest:
1) Factors that make assessment challenging (currently 1,2, 4-6) - also suggest expanding on these points to help the reader gleen their significance;
2) General approach to assessment - this must include assessment of general health, pain history from child or parent/carer including multiple dimensions (onset, time course, location etc) besides severity (section 3), psychosocial assessment, assessment of functional impactof pain and examination;
3) Specific tools for developmentally appropriate severity assessment (also include the Faces Pain Scale - Revised).
- Before the "Pain management techniques" section, I suggest adding a section outlining the Principles of Management. This would include the following general statements that seem to be missing in the present draft:
1) One major difference between adults and children is that we work in partnership with parents in the care of their child;
2) Even in acute paediatric pain medicine, multidisciplinary liaison is important. We often work in formal or informal teams with parents, nurses, the child's GP or primary hospital team (paed physciains, surgeons, anaesthetists), play therapists and other allied health professionsals. In particular, trainees may be unfamiliar with the important role of play therapists and this might be outlined in this or another document.
I shall send other thoughts/reference when at work next week.
Susie Lord
Faculty of Pain Medicine forums
