Pain is the presenting complaint in about half of patients seeking care in the emergency department,1 and the subjective nature of pain can often make pain management a frustrating goal for the emergency physician. Unfortunately, literature demonstrates that there exists a disconnect between a physician’s goals of pain management and a patient’s expectations of pain management in the emergency department.2
Numerous studies have shown that despite traditonal beliefs, practically everyone has the ability to feel pain3 and other studies have disproven the myth that “masking” pain with analgesia may cause diagnostic uncertainty, which was once a barrier leading to the under-treatment of pain.3
This issue of pain management in the pediatric population is often unsatisfactorily addressed.4
Nonetheless, inadequacies in pediatric pain management continue to be seen across the scope of emergency department care, despite an increasing recognition of the associated long-term psychosocial risk to the child that could result from improperly managed pain.5
Currently, there is a campaign in pediatric pain management that recognizes a large area for improvement that exists in the care of our youngest patients.6
Optimizing the Environment
There is a clear relationship between anxiety and perceived pain in children; additionally, the hospital can carry a stigma formed from prior encounters, acquaintances and the media. To combat anxiety, the physical environment should be bright. One study showed that sunlight, windows, odor, and seating arrangements when well-executed most consistently generated positive review.8 Age-appropriate themes should be utilized to bring familiarity to the new situation.8
This can be achieved when optimizing a dedicated pediatric space in a general emergency department.
Adequate pain assessment in the emergency department is the first step in addressing pain. Furthermore, this step is a requirement of The Joint Commission.9 Because pain is intrinsically a subjective concept that is affected by society, experience and psychological factors, one of the most convenient and practical methods that is used by providers is a self-report of pain. Converting subjective reports to objective measurement is currently the clinical standard, and this is accomplished by using a variety of pain scales.