There are several validated pain scales for children to use to self-report. Some of the most popular and best validated scales include the Wong-Baker FACES® pain rating scale, the FACES and FACES-revised pain scales, and the OUCHER™ pain scale.¹⁰ If a child is unable to self-report pain, there are behavioral pain scales such as the Faces, Legs, Activity, Cry and Consolability (FLACC) Scale, which utilizes a child’s presenting history and physical exam to assess pain.¹¹

However, regardless of which pain scale is chosen, the most valuable information is gathered from the changes in the pain score upon reassessment using the same scale. In this way, the provider may determine the efficacy of interventions.

Noninvasive Pain Management

Origins of pain are both somatic and psychological. Acute pain is frequently associated with anxiety and hyperactivity of the sympathetic nervous system (e.g., tachycardia, tachypnea, elevated BP, diaphoresis). Chronic pain tends to manifest in more subtle signs and less sympathetic activity (e.g., fatigue, loss of appetite, depressed mood). As the cause of pain is multi-factorial, the approach to pain management should be multidisciplinary.

Studies have demonstrated that using a multidisciplinary approach to pain management in pediatrics can increase patient satisfaction and decrease reported pain scores.¹³ Complementary methods of pain management include bio-feedback, guided imagery, relaxation therapy, massage, acupuncture, art therapy, music therapy, meditation and others. Many of these adjunctive measures are now being used in the emergency department setting.

One noteworthy method of pain and anxiety management is the use of everyday technology in the art of distraction. Distraction is a practical and inexpensive method of pain and anxiety management that has been found to be successful in multiple forms (e.g., games, toys, music, videos). One publication reports success using our now ubiquitous smartphones for successful induction of anesthesia.¹³

Another novel publication by McQueen et al. (2012) documents a successful distraction technique using an iPad in the emergency department, thereby decreasing or eliminating the need for restraint or sedation in several typically painful situations.¹⁴

At other times, avoidance of the painful procedure may be the best approach. Thus, medical professionals should always consider alternatives to any potentially painful procedure for children, as the most commonly indicated procedure is not always necessary for a favorable outcome.

For example, tissue adhesive and Steri-Strips™ in the right context are painless alternatives to suture repair.¹⁵ Also, oral rehydration is shown to be an effective alternative in many children.¹⁶