Essay on Non-Pharmacologic Pain Management Techniques for Children in Acute Procedures

Question: what are the various ways that the utilization of non-pharmacologic pain management techniques can influence pain outcomes in children patients during acute procedures?

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Description of the Health Care Problem

Pain is one of the most feared things in a hospital setting. Many children fear to get medical attention due to the pain that is associated with it. Acute pain related procedures that are used in children such as lad draws and IV insertions are some of the greatest sources of anxiety and stress for children who seek medical attention in inpatient settings. The studies used in this study show that it is possible to reduce pain for the children by utilizing non-pharmacological pain management techniques. These techniques reduce anxiety and pain, therefore, offering a better experience for the patient's and their families (Bice, Gunther, & Wyatt, 2014). Studies also show that quality improvement implementation can be used to offer education and increase the proper utilization of these non-pharmacologic resources.

The Significance of the Problem

There are a large number of pediatric patients undergoing acute pain procedures in hospitals. In the recent past, there has been increased growth in the field of pain management among children as well as the attitudes surrounding it. Concerns today are focused on how best to address pain and anxiety among pediatric patients. In the current medical field, pain is seen as a symptom which deserves independent treatment as opposed to an inevitable mere consequence of disease. It is the moral obligation of the clinicians to reduce the suffering of pediatric patients by reducing the pain experienced by children. Enough pain management reduces the child and parent anxiety and also increases cooperation and compliance (Bice, Gunther, & Wyatt, 2014). If pain is left untreated it may result in some long term effects such as increased morbidity and mortality, and also create hyperalgesia.

Current Health Care Practices Related to the Problem

There are different means of managing pain in children today. While these methods differ from one place to the other there are some that are commonly used in the management of pain among children. Some acute procedures performed in hospitals such as lab draws, dressing changes and IV insertions create a lot of anxiety and stress in children (Bice, Gunther, & Wyatt, 2014). To manage pain and anxiety, pharmacological methods are mostly used. This involves the use of medicines to treat pain. Some institutions like pediatric oncology clinics usually give several options although many of them are painful such as bone marrow aspiration or lumbar puncture. Pain medicine is usually given through several ways such as orally, by a catheter in the back, by intravenous (IV) or through a patch on the skin.

How the Problem Affects the Organization and Patient's Cultural Background

Pain management using pharmacological means has a lot of effects on the patient. Children may experience more pain through the insertion of some instruments such as the catheter. Besides, some children may develop tolerance to pain medicines and sedatives. Some of these medicines also affect the values of the patient's family. Some medicines such as narcotics may cause addiction which may be against some cultural values (Canbulat, Ayhan, & Inal, 2015). Besides, some pharmacological pain-relieving methods deteriorate the health of the patient. For example, overuse of opioid medicines such as oxycodone and morphine may negatively affect the health of the patient.

Literature Review

Al, Brenner, Shorrab and Docherty (2016) cited that pharmacological means of pain management among children result in some negative health consequences. Health care professionals are tasked with the responsibility of ensuring that children do not get exposed to intense pain while undergoing treatment. As such, they have the obligation of ensuring that pain is managed in the best way possible. The authors advocate for some more developmentally appropriate distraction methods which can be used in place of pharmacological means. Aldington and Eccleston (2019) used secondary sources to look at evidence-based pain management. The authors cited that most of the commonly used pain management practices do not offer the required relief to children, thus the need to have some other forms which may perform better.

Ilyuk, Block, and Faro (2014) cited that misuse of pharmacological products in the treatment of pain is a major concern thus the need for non-pharmacological practices to manage pain.

Recommend a Practice Change That Addresses the PICO Question

Following the inefficiency of pharmacological means of in pain management among the children, evidence-based research advocates for the usage of non-pharmacological means of pain management among children. Bice, Gunther and Wyatt (2014) reported that non-pharmacologicla procedural pain management is effective in the reduction of pain outcomes. The authors advocate for the impenttaion of the non-pharmacological pain management practices. Canbulat, Ayhan and Inal (2015) cited that children can use "Buzzy" cold and vibration therapy as means of reducing pain. These methods are better than the usual pharmacological methods. Al, Brenner, Shorrab and Docherty (2016) argued that the consistent use of pharmacological methods to reduce pain in children is no longer effective. As a result, they proposed for the use of non-pharmacological means which tend to be healthier and more effective when used on pediatric patients.

Kahsay (2017) cited that pediatric patients experience pain but it becomes hard for them to report the pain. As such, clinicians must strive to address the pain as this is beneficial to the children. Some of the non-pharmacological pain management methods discussed by the author are the use of sucrose, distraction, skin-to-skin contact and breast feeding. Chotolli and Luize (2015) addressed the methods of pain control among pediatric cancer patients. The study was aimed at assessing the non-pharmacological methods which are used to treat pediatric cancer patients. The study identifies that there is an increased usage of non-pharmacological methods for pediatric cancer patients as they are seen to be more effective.

Process for implementing the Practice Change

In the decision to implement the usage of non-pharmacological means to manage pain among the children, three stakeholders will be required. These are the parent, the health care provider and pain experts. The parents would be a useful resource in ensuring that the non-pharmacological means of pain management proposed are fit for the child. The health care provider would be useful in identifying the right method to use of the child depending in the condition of the child. The pain expert would be necessary to distinguish the different types of pains and address each of the in the right manner.

Some barriers that might be encountered in the implementation of non-pharmacological means of pain management are unavailability of pain experts and some cultural limitations that may discourage the use of non-pharmacological pain management techniques. The reduced acute procedure-related pain and stress can be measured by self-reporting for children who can express themselves. However, for those who are too young to express themselves well, observing the behavior of the patients can be used.

References

Al, Y. N., Brenner, M., Shorrab, A. A., & Docherty, C. (2016). Play distraction versus pharmacological treatment to reduce anxiety levels in children undergoing day surgery: a randomized controlled non-inferiority trial. Child: Care, Health & Development, 42(4), 572-581. https://doi.org/10.1111/cch.12343

Aldington, D., & Eccleston, C. (2019). Evidence-Based Pain Management: Building on the Foundations of Cochrane Systematic Reviews. American Journal of Public Health, 109(1), 46-49. https://doi.org/10.2105/AJPH.2018.304745

Bice, A. A., Gunther, M., & Wyatt, T. (2014). Increasing Nursing Treatment for Pediatric Procedural Pain. Pain Management Nursing, 15(1), 365-379. doi:10.1016/j.pmn.2012.06.00

Canbulat, N., Ayhan, F., & Inal, S. (2015). Effectiveness of External Cold and Vibration for Procedural Pain Relief During Peripheral Intravenous Cannulation in Pediatric Patients. Pain Management Nursing, 16(1), 33-39. doi:10.1016/j.pmn.2014.03.003

Chotolli, M. R., & Luize, P. B. (January 01, 2015). Non-pharmacological approaches to control pediatric cancer pain: nursing team view. Revista Dor, 16, 2.)

Ilyuk, V., Block, L., & Faro, D. (2014). Is It Still Working? Task Difficulty Promotes a Rapid Wear-Off Bias in Judgments of Pharmacological Products. Journal of Consumer Research, 41(3), 775-793. https://doi.org/10.1086/677562

Kahsay, H. (2017). Assessment and treatment of pain in pediatric patients. Curr Pediatr Res 2017; 21 (1): 148-157