The Problem of Pediatric Pain

  • Betty R. Kasson
  • Sandra K. Sentivany
  • Pamela M. Kato
Part of the The Plenum Series in Culture and Health book series (PSCH)


The management of pain in children has lagged far behind advances in other areas of medical achievement. In 1968, physicians Swafford and Allen stated, “Pediatric patients seldom need relief of pain after general surgery. They tolerate discomfort well” (p. 133) and reported that during a 4-month period, 96% of the postoperative pediatric patients in their intensive care unit did not receive any analgesics for pain. As recently as the 1980s and 1990s, many infants and children were not receiving any analgesia during and after major surgery (Anand, Brown, Bloom, & Aynsley-Green, 1985). Indeed, postoperative children and those with disease-related pain frequently received no analgesic medication at all (Gauntlet, 1987). When compared with adults undergoing similar surgeries, infants and children received fewer doses and smaller amounts of analgesic medication per kilogram of body weight (Beyer, Ashley, Russell, & DeGood, 1983; Eland & Anderson, 1977; Schechter, Allen, & Hansen, 1986). The undertreatment of children’s pain is still routine and is striking considering pervasive evidence of children’s experience of physiological, behavioral, and emotional effects of pain.


Pain Relief Pain Management Pain Assessment Reflex Sympathetic Dystrophy Painful Procedure 
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  1. Acute Pain Management Guideline Panel. (1992). Acute pain management: Operative or medical procedures and trauma. Clinical practice guideline (Publication No. 92-0032). Rockville, MD: Agency for Health Care Policy and Research, U.S. Department of Health and Human Services, Public Health Service.Google Scholar
  2. Alex, M. R., & Ritchie, J. B. (1992). Schoolaged children’s interpretation of their experience with acute surgical pain. Journal of Pediatric Nursing, 7, 171–180.PubMedGoogle Scholar
  3. Anand, K. J. S. (1986). Hormonal and metabolic functions of neonates and infants undergoing surgery. Current Opinion in Cardiology, 1, 681.CrossRefGoogle Scholar
  4. Anand, K. J. S., Brown, M. J., Bloom, S. R., & Aynsley-Green, A. (1985). Studies on hormonal regulation of fuel metabolism in the human newborn infant undergoing anesthesia and surgery. Hormonal Research, 22, 115–128.Google Scholar
  5. Anand, K. J. S., & Hickey, P. R. (1987). Pain and its effects on the human neonate and fetus. New England Journal of Medicine, 317, 1321–1329.PubMedCrossRefGoogle Scholar
  6. Aradine, C., Beyer, J., & Tompkins, J. (1988). Children’s perceptions before and after analgesia: A study of instrument construct validity. Journal of Pediatric Nursing, 3, 15–23.Google Scholar
  7. Benson, H. (1975). The relaxation response. New York: William Morrow.Google Scholar
  8. Beyer, C. R., & Tompkins, J. M. (1988). Children’s pain perception before and after analgesia: A study of instruments, construct validity and related issues. Journal of Pediatric Nursing, 13, 11–23.Google Scholar
  9. Beyer, J. E., & Aradine, C. R. (1986). Patterns of pediatric intensity: A methodological investigation of a self-report scale. Clinical Journal of of Pain, 3, 130–141.CrossRefGoogle Scholar
  10. Beyer, J. E., Ashley, L. C., Russell, G. A., & DeGood, D. E. (1983). Patterns of postoperative analgesic use with adults and children following cardiac surgery. Pain, 17, 71–81.PubMedCrossRefGoogle Scholar
  11. Beyer, J. E., & Beyer, M. L. (1985). Knowledge of pediatric pain: The state of the art. Children’s Health Care, 13, 150–157.CrossRefGoogle Scholar
  12. Beyer, J. E., & Bournaki, M. (1989). Assessment and management of postoperative pain in children. Pediatrician, 16, 30–38.PubMedGoogle Scholar
  13. Bhatt-Mehta, V., & Rosen, D. A. (1991). Management of acute pain in children. Clinical Pharmacology, 10, 667–671.Google Scholar
  14. Brewster, A. B. (1982). Chronically ill hospitalized children’s concepts of their illness. Pediatrics, 69, 355–362.PubMedGoogle Scholar
  15. Brody, H. (1982). The lie that heals: The ethics of giving placebos. American Journal of Internal Medicine, 97, 112–118.Google Scholar
  16. Broome, M. E., Lillis, P. P., McGahee, T. W., & Bates, T. (1992). The use of distraction and imagery with children during painful procedure. Oncology Nursing Forum, 19, 499–502.PubMedGoogle Scholar
  17. Broome, M. E., & Slack, J. F. (1990). Influences on nurse’s management of pain in children. Maternal Children Nursing, 1, 159–162.Google Scholar
  18. Burokas, L. (1985). Factors affecting nurses’ decisions to medicate pediatric patients after surgery. Heart Lung, 14, 375–379.Google Scholar
  19. Covelman, K. C., Scott, S., Buchanan, B., & Rosman, B. (1990). Pediatric pain control: A family systems model. Advances in Pain Research Therapy, 16, 225–236.Google Scholar
  20. Curkovic, B., Vitulic, V., Babic-Naglic, D., & Durrigl, T. (1993). The influence of heat and cold on the pain threshold in rheumatoid arthritis. Zeitschrift fur Rheumatologie, 52, 289–291.PubMedGoogle Scholar
  21. Denyes, M. J., Beyer, J. E., Villaruel, A. M., & Neuman, B. M. (1991). Issues in validation of culturally sensitive pain measures for young children (abstract). Journal of Pain and Symptom Management, 6, 174.CrossRefGoogle Scholar
  22. Dietz, F. R., Mathews, K. D., & Montgomery, W. J. (1990). Reflex sympathetic dystrophy in children. Clinical Orthopaedics and Related Research, 258, 225–231.PubMedGoogle Scholar
  23. Dinarello, C. (1984). Interleukia 1. Reviews of Infections Diseases, 6(1), 51–95.Google Scholar
  24. Donovan, M. I. (1992). A practical approach to pain assessment. In J. H. Watt-Watson & M. I. Donovan (Eds.), Pain management: Nursing perspective (pp. 59–78). St. Louis: Mosby.Google Scholar
  25. Edgar, L., & Smith-Hanrahan, C. M. (1992). Nonpharmacological pain management. In Watt-Watson and M. I. Donovan (Eds.), Pain management: A nursing perspective (pp. 162–199). St. Louis: Mosby.Google Scholar
  26. Egdahl, G. (1959). Pitituary-adrenal response following trauma to the isolated leg. Surgery, 46, 9–21.PubMedGoogle Scholar
  27. Eland, J., & Anderson, J. (1977). The experience of pain in children. In Jacox, A. (Ed.), Pain: A sourcebook for nurses and other professionals (pp. 453–473). Boston: Little, Brown.Google Scholar
  28. Eland, J. M. (1985). The role of the nurse in children’s pain. In L. A. Copp (Ed.), Recent advances in nursing: Vol. 11. Perspectives on pain. Edinburgh: Churchill Livingstone.Google Scholar
  29. Eland, J. M. (1990b). Pain in children. Nursing Clinics of North America, 25, 871–883.PubMedGoogle Scholar
  30. Eland, L. (1991). The use of TENS with children who have cancer pain. Journal of Pain and Symptom Management, 6(3), 137–209.CrossRefGoogle Scholar
  31. Ellis, J. A., & Spanos, N. P. (1994). Cognitive-behavioral interventions for children’s distress during bone marrow aspirations and lumbar punctures: A critical review. Journal of Pain and Symptom Management, 9, 96–108.PubMedCrossRefGoogle Scholar
  32. Fitzgerald, M., & Anand, K. J. S. (1993). Developmental neuroanatomy and neurophysiology of pain. In N. L. Schechter, C. B. Berde, & M. Yaster (Eds.), Pain in infants and children (pp. 11–31). Baltimore: Williams & Wilkins.Google Scholar
  33. Fletcher, A. B. (1987). Pain in the neonate. New England Journal of Medicine, 317(21), 1347–1348.PubMedCrossRefGoogle Scholar
  34. Freud, A. (1952). The role of bodily illness in the mental life of children. In R. S. Eissler, H. Hartmann, A. Freud, & E. Kris (Eds.), The Psychoanalytic study of the child (Vol. VII, pp. 69–81). New York: International Universities Press.Google Scholar
  35. Gaffney, A., & Duane, E. A. (1987). Children’s understanding of the causality of pain. Pain, 29(1), 91–104.PubMedCrossRefGoogle Scholar
  36. Galer, B. S. (1995). Neuropathic pain of peripheral origin: Advances in pharmacologic treatment. Neurology, 125(Supp. 9), 517–525.Google Scholar
  37. Gauntlett, I. S. (1987). Analgesic and anesthesia in newborn babies and infants. Lancet 1, 1090.CrossRefGoogle Scholar
  38. Goats, G. C. (1994). Massage—the scientific basis of an ancient art: Part 2. Physiological and therapeutic effects. British Journal of Sports Medicine, 28, 153–156.PubMedGoogle Scholar
  39. Gonsalves, S., & Mercer, J. (1993). Physiological correlates of painful stimulation in preterm infants. The Clinical Journal of Pain, 9, 88–93.PubMedCrossRefGoogle Scholar
  40. Gonzalez, J., & Gadish, H. (1990). Nurses’ decisions in medicating children postoperatively. In D. C. Tyler & E. J. Krane (Eds.), Advances in pain research therapy (pp. 37–42). New York: Raven Press.Google Scholar
  41. Goodwin, J., Goodwin, J., & Vogel, A. (1979). Knowledge and use of placebos by house officers and nurses. Annals of Internal Medicine, 91, 106–110.PubMedGoogle Scholar
  42. Hester, N. O. (1979). The preoperational child’s reaction to immunization. Nursing Research, 28, 250–255.PubMedCrossRefGoogle Scholar
  43. International Association for the Study of Pain. (1979). Pain terms: A list with definitions and notes on usage. Pain, 6, 249–252.Google Scholar
  44. Jacox, A., Carr, D. B., Payne, R., et al. (1994). Management of cancer pain. Clinical practice guideline no. 9 (AHCPR Publication No. 94-0592). Rockville, MD: Agency for Health Care Policy and Research, U.S. Department of Health and Human Services, Public Health Service.Google Scholar
  45. Johnston, C. C., Stevens, B., Craig, K. D., & Grunau, R. V. E. (1993). Developmental changes in pain expression in premature, full-term, two-and four-month old infants. Pain, 52, 201–208.PubMedCrossRefGoogle Scholar
  46. Jose, P. E. (1990). Just-world reasoning in children’s immanent justice judgments. Child Development, 61, 1024–1033.PubMedCrossRefGoogle Scholar
  47. Kaada, B., & Berde, C. (1989). Increase of plasma b-endorphins in connective tissue massage. General Pharmacology, 20, 487–489.PubMedGoogle Scholar
  48. Kaplan, M. (1988). Pain, the neonate and the neonatologist. Journal of Perinatology, 8, 354–355.PubMedGoogle Scholar
  49. Kehlet, H. (1982). The endocrine-metabolic response to post-operative pain. Acta Anaesthesiologica Scandinavia, 74, 173–175.CrossRefGoogle Scholar
  50. LaBaw, W. C., & Holton, C. (1975). Use of self-hypnosis in children with cancer. American Journal of Clinical Hypnosis, 17(4), 233–238.PubMedGoogle Scholar
  51. Larsson, B., & Melin, L. (1986). Chronic headaches in adolescents: Treatment in a school setting with relaxation training as compared with information-contact and self-registration. Pain, 25, 325–336.PubMedCrossRefGoogle Scholar
  52. Lynn, M. R. (1986). Pain in the pediatric patient: A review of research. Journal of Pediatric Nursing, 1(3), 198–201.PubMedGoogle Scholar
  53. Magill-Levreault, L. (1993). Music therapy in pain and symptom managment. Journal of Palliative Care, 9, 42–48.PubMedGoogle Scholar
  54. McBride, M. M. (1977). Can you tell me where it hurts? Pediatric Nursing, 3(4), 7–8.PubMedGoogle Scholar
  55. McCaffery, M. (1979). Nursing management of the patient with pain. Philadelphia: J. B. Lippincott.Google Scholar
  56. McCaffery, M., & Beebe, A. (1989). Pain clinical manual for nursing practice. St. Louis: C. V. Mosby.Google Scholar
  57. McGrath, P. A. (1987). An assessment of children’s pain: A review of behavioral, physiological and direct scaling techniques. Pain, 31, 147–176.PubMedCrossRefGoogle Scholar
  58. McGrath, P. J., & Craig, D. C. (1989). Developmental and psychological factors in children’s pain. Pediatric Clinics of North America, 36, 823–836.PubMedGoogle Scholar
  59. Mehta, M. (1986). Current views of noninvasive methods in pain relief. In M. Swerdlow (Ed.), The therapy of pain (3rd ed.) (pp. 115–131). Boston: MTP Press.Google Scholar
  60. Mercadante, S., Lodi, F., Sapio, M., Calliagara, M., & Serretta, R. (1995). Long-term ketamine subcutaneous continuous infusion in neuropathic cancer pain. Journal of Pain and Symptom Management, 10(7), 564–568.PubMedCrossRefGoogle Scholar
  61. Messner, J. T., Loux, P. C., & Grossman, L. B. (1979). Intraoperative transcutaneous po2 monitoring in infants (abstract). Anesthesiology, 51, S319.CrossRefGoogle Scholar
  62. Miller, R. R., & Jick, H. (1970). Clinical effects of meperidine in hospitalized medical patients. Journal of Clinical Pharmacology, 18, 180.Google Scholar
  63. Parton, D. A. (1976). Learning to imitate in infancy. Developmental Psychology, 47, 14–31.Google Scholar
  64. Perrin, E. C., & Gerrity, P. S. (1981). There’s a demon in your belly: Children’s understanding of illness. Pediatrics, 67, 841–849.PubMedGoogle Scholar
  65. Porter, F. (1989). Pain in the newborn. Clinical Perinatology, 16, 549–564.Google Scholar
  66. Pothman, R. (1991). TENS for tension headaches in children. Pain and Symptom Management, 6, 137–209.CrossRefGoogle Scholar
  67. Pothman, R., & Goepel, R. (1984). Acupuncture therapy of childhood migraine. In R. Rizzi & M. Visentin (Eds.), Pain (pp. 335–339). Padua, Italy: Piccin/Butterworths.Google Scholar
  68. Rasco, C. (1992). Using music therapy as distraction during lumbar punctures. Journal of Pediatric Oncology Nursing, 9, 33–34.PubMedCrossRefGoogle Scholar
  69. Rogers, A. (1989). Analgesics: The physician’s partner in effective pain management. Virginia Medical 116, 164–170.PubMedGoogle Scholar
  70. Ross, D. M., & Ross, S. A. (1984). Childhood pain: The schoolaged child’s viewpoint. Pain, 20, 179–191.PubMedCrossRefGoogle Scholar
  71. Savedra, M., Gibbons, P., Tesler, M., Ward, J., & Wegner, C. (1982). How do children describe pain? A tentative assessment. Pain, 14, 95–104.PubMedCrossRefGoogle Scholar
  72. Schechter, N. L., & Allen, D. A. (1986). Physician’s attitudes toward pain in children. Developmental and Behavioral Pediatrics, 7, 350–354.Google Scholar
  73. Schechter, N. L., Allen, D. A., & Hansen, M. A. (1986). Status of pediatric pain control: A comparison of hospital analgesic use in children and adults. Pediatrics, 77, 11–15.PubMedGoogle Scholar
  74. Seligman, M. E. P. (1975). Helplessness: On depression, development, and death. Freeman: San Francisco, CA.Google Scholar
  75. Stroebel, C. F. (1982). Qr, the quieting reflex. New York: G. P. Putnam.Google Scholar
  76. Swaford, L. I., & Allen, D. (1968). Pain relief in the pediatric patient. Medical Clinics of North America, 52, 133.Google Scholar
  77. Tesler, M. D. (1994). Children’s pain: Part 1. Nurseweek, 7, 10–11.Google Scholar
  78. Tyler, D. (1992). Post-operative pain management in children. Part 1: History and pain measurement. Hospital Physician, July, 38–41.Google Scholar
  79. Valente, A. M. (1991). Using hypnosis with children for pain management. Oncology Nursing Forum, 18, 699–704.PubMedGoogle Scholar
  80. Villaruel, A. M., & Denyes, M. J. (1991). Pain assessment in children: Theoretical and empirical validity. Advances in Nursing Science, 14, 32–41.Google Scholar
  81. Warga, C. (1985). Little swamis. Psychology Today, 19, 16–17.Google Scholar
  82. Watt-Watson, J. H., & Donovan, M. I. (Eds.). (1992). Pain management: Nursing perspective. St. Louis: C. V. Mosby.Google Scholar
  83. Webb, C., Stergios, D. A., & Rodgers, B. M. (1989). Patient controlled analgesia as postoperative pain treatment in children. Journal of Pediatric Nursing, 4, 162–171.PubMedGoogle Scholar
  84. Weisenberg, M. (1987). Psychological intervention for the control of pain. Behavioral Research and Therapeutics, 25, 301–312.CrossRefGoogle Scholar
  85. Wong, D., & Whaley, L. (1986). Clinical handbook of pediatric nursing (2nd ed.). St. Louis: C. V. Mosby.Google Scholar
  86. Yaster, M. (1987). Analgesia and anesthesia in neonates. British Journal of Pediatrics, 111, 394–396.CrossRefGoogle Scholar
  87. Yaster, M., & Deshpande, J. K. (1988). Management of pediatric pain with opioid analgesics. Journal of Pediatrics, 113, 421–429.PubMedCrossRefGoogle Scholar
  88. Zeltzer, L. A., Barr, R. G., McGrath, P. A., & Schechter, N. (1992). Pediatric pain: Interacting behavioral and physical factors. Pediatrics, 90, 816–821.PubMedGoogle Scholar
  89. Zeltzer, L. K., Anderson, C., & Schechter, N. (1990). Pediatric pain: Current status and new direction. St. Louis: Mosby-Year Book.Google Scholar

Copyright information

© Plenum Press, New York 1996

Authors and Affiliations

  • Betty R. Kasson
    • 1
  • Sandra K. Sentivany
    • 2
  • Pamela M. Kato
    • 3
  1. 1.Departments of Nursing and Pediatric SurgeryLucile Salter Packard Children’s Hospital at StanfordPalo Alto
  2. 2.Departments of Nursing and Pain ManagementLucile Salter Packard Children’s Hospital at StanfordPalo Alto
  3. 3.Department of Psychiatry and Behavioral SciencesStanford University School of MedicineStanford

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