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Evidence Repository

Pain Treatment

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Last Updated
Oct 2022

Topic
Pain Treatment

EVIDENCE REPOSITORIES

Evidence repositories are collections of best available resources and evidence (clinical guidelines, peer reviewed literature, systematic reviews, etc.), collated by our knowledge synthesis team and content advisors. This evidence repository is not intended to be an exhaustive list of resources for a topic, but rather a curated list of current, evidence-based resources, based on expert consensus of relevance and usability for a general emergency department setting. We search databases (Cochrane Library, PubMed, TRIP Database) and web search engines (Google, Google Scholar) to locate evidence. Additionally, hospital websites are browsed for guidance documents, such as clinical practice guidelines (CPG) for healthcare professionals.

Every effort is made to identify resources that are open access (i.e. publicly available, free of charge, not requiring a subscription).

More information about the creation of our evidence repositories can be found at https://pubmed.ncbi.nlm.nih.gov/28537762/

Content Team

Thank you to the following Knowledge Synthesis team who created this evidence repository:

Samina Ali, MDCM, FRCPC (PEM) Professor, Pediatrics & Emergency Medicine, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta

Corrie Chumpitazi, MD, MS Associate Professor of Pediatrics, Baylor College of Medicine, Division of Emergency Medicine, Texas  Children’s Hospital

Lisa Hartling, PhD Director, ARCHE, Faculty of Medicine & Dentistry, Pediatrics Dept, University of Alberta

Amy L. Drendel, DO, MS Professor of Pediatrics and Medical Director, Children’s Wisconsin Emergency Department Trauma Center, Medical College of Wisconsin

Naveen Poonai, MSC, MD, FRCPC Associate Professor, Pediatrics, Internal Medicine, Epidemiology & Biostatistics, Schulich  School of Medicine & Dentistry; Scientist, Child Health Research Institute; Research Director, Division of Pediatric Emergency Medicine

Key Resources

  1. World Health Organization. Dosing Chart: Analgesic starting dosages for children. 2012.
  2. International Association for the Study of Pain. Faces Pain Scale Revised. 2021.
  3. Korownyk C, Young J, Michael Allan G. Optimal pain relief for pediatric MSK injury. Can Fam Physician. 2015;61(6):e276.
  4. ARCHE. What are Opiods. (2021). Accessed September 1, 2022.
  5. ARCHE. Opiods don’t have to be scary. (2021). Accessed September 1, 2022.
  6. ARCHE. Opiods and children’s pain. (2021). Accessed September 1, 2022.

Clinical Guidelines

  1. Lieberthal AS, Carroll AE, Chonmaitree T, et al. The diagnosis and management of acute otitis media [published correction  appears in Pediatrics. 2014 Feb;133(2):346. Dosage error in article text]. Pediatrics. 2013;131(3):e964-e999.
  2. Tobias JD, Green TP, Coté CJ; SECTION ON ANESTHESIOLOGY AND PAIN MEDICINE; COMMITTEE ON DRUGS. Codeine: Time to Say “No”. Pediatrics. 2016;138(4):e20162396. doi:10.1542/peds.2016-2396
  3. Smith HAB, Besunder JB, Betters KA, et al. 2022 Society of Critical Care Medicine Clinical Practice Guidelines on Prevention and Management of Pain, Agitation, Neuromuscular Blockade, and Delirium in Critically Ill Pediatric Patients With Consideration of the ICU Environment and Early Mobility. Pediatr Crit Care Med. 2022;23(2):e74-e110. doi:10.1097/PCC.0000000000002873
  4. Chumpitazi CE, Chang C, Atanelov Z, et al. Managing acute pain in children presenting to the emergency department without opioids. J Am Coll Emerg Physicians Open. 2022;3(2):e12664. Published 2022 Mar 12. Doi:10.1002/Emp2.12664
  5. Joel A. Fein, William T. Zempsky, Joseph P. Cravero, THE COMMITTEE ON PEDIATRIC EMERGENCY MEDICINE AND SECTION ON ANESTHESIOLOGY AND PAIN MEDICINE, Kathy N. Shaw, Alice D. Ackerman, Thomas H. Chun, Gregory P. Conners, Nanette C. Dudley, Joel A. Fein, Susan M. Fuchs, Brian R. Moore, Steven M. Selbst, Joseph L. Wright, Carolyn F. Bannister, Joseph D. Tobias, Corrie T. M. Anderson, Kenneth R. Goldschneider, Jeffrey L. Koh, David M. Polaner, Constance S. Houck; Relief of Pain and Anxiety in Pediatric Patients in Emergency Medical Systems. Pediatrics. November 2012; 130 (5): e1391–e1405. 10.1542/peds.2012-2536
  6. Ruest S, Anderson A. Management of acute pediatric pain in the emergency department. Curr Opin Pediatr. 2016;28(3):298-304. Doi:10.1097/Mop.0000000000000347
  7. Annals of Emergency Medicine. July 2010. Optimizing the Treatment of Pain in Patients with Acute Presentations. V 56(1).Https://Doi.org/10.1016/J.annemergmed.2010.03.035
  8. Committee on Psychosocial Aspects of Child and Family Health, Task Force on Pain in Infants, Children, and Adolescents; The Assessment and Management of Acute Pain in Infants, Children, and Adolescents. Pediatrics. September 2001; 108 (3): 793–797. 10.1542/peds.108.3.793
  9. Young VB. Effective Management of Pain and Anxiety for the Pediatric Patient in the Emergency Department. Crit Care Nurs Clin North Am. 2017;29(2):205-216. doi:10.1016/j.cnc.2017.01.007

Systematic Reviews

  1. Murphy A, O’Sullivan R, Wakai A, Grant TS, Barrett MJ, Cronin J, McCoy SC, Hom J, Kandamany N. Intranasal fentanyl for the management of acute pain in children. Cochrane Database of Systematic Reviews 2014, Issue 10. Art. No.: Cd009942. Doi: 10.1002/14651858.Cd009942.Pub2
  2. Black KJL, Bevan CA, Murphy NG, Howard JJ. Nerve blocks for initial pain management of femoral fractures in children. Cochrane Database of Systematic Reviews 2013, Issue 12. Art. No.: Cd009587. Doi: 10.1002/14651858.Cd009587.Pub2
  3. Murphy A, O’Sullivan R, Wakai A, et al. Intranasal fentanyl for the management of acute pain in children. Cochrane Database Syst Rev. 2014;2014(10):CD009942. Published 2014 Oct 10. doi:10.1002/14651858.CD009942.pub2
  4. Poonai N, Paskar D, Konrad SL, et al. Opioid analgesia for acute abdominal pain in children: A systematic review and meta-analysis. Acad Emerg Med. 2014;21(11):1183-1192. doi:10.1111/acem.12509
  5. Black KJ, Bevan CA, Murphy NG, Howard JJ. Nerve blocks for initial pain management of femoral fractures in children. Cochrane Database Syst Rev. 2013;(12):CD009587. Published 2013 Dec 17. Doi:10.1002/14651858.Cd009587.Pub2
  6. Ali S,Ali H. Treating Abdominal Pain in Children: What Do We Know?, Clinical Pediatric Emergency Medicine,Volume 11, Issue 3,2010,Pages 171-181, Issn 1522-8401,Https://Doi.org/10.1016/J.cpem.2010.06.001
  7. Tomlinson D, von Baeyer CL, Stinson JN, Sung L. A systematic review of faces scales for the self-report of pain intensity in children. Pediatrics. 2010;126(5):e1168-e1198. doi:10.1542/peds.2010-1609
  8. Atkinson P, Chesters A, Heinz P. Pain management and sedation for children in the emergency department. Bmj. 2009;339:B4234. Published 2009 Oct 30. Doi:10.1136/Bmj.b4234
  9. Bailey B, McManus BC. Treatment of children with migraine in the emergency department: a qualitative systematic review. Pediatr Emerg Care. 2008;24(5):321-330. doi:10.1097/PEC.0b013e31816ed047
  10. Bromberg R, Goldman RD. Does analgesia mask diagnosis of appendicitis among children?. Can Fam Physician. 2007;53(1):39-41.
  11. Bauman BH, McManus JG Jr. Pediatric pain management in the emergency department. Emerg Med Clin North Am. 2005;23(2):393-Ix. Doi:10.1016/J.emc.2004.12.008
  12. Damen L, Bruijn JK, Verhagen AP, Berger MY, Passchier J, Koes BW. Symptomatic treatment of migraine in children: a systematic review of medication trials. Pediatrics. 2005;116(2):e295- e302. doi:10.1542/peds.2004-2742
  13. Berde CB, Sethna NF. Analgesics for the treatment of pain in children [published correction appears in N Engl J Med. 2011 May 5;364(18):1782. Dosage error in article text]. N Engl J Med. 2002;347(14):1094-1103. doi:10.1056/NEJMra012626
  14. Castarlenas E, Jensen MP, von Baeyer CL, Miró J. Psychometric Properties of the Numerical Rating Scale to Assess Self-Reported Pain Intensity in Children and Adolescents: A Systematic Review. Clin J Pain. 2017;33(4):376-383. Doi:10.1097/Ajp.0000000000000406
  15. Faber AJ, Lagman-Bartolome AM, Rajapakse T. Drugs for the acute treatment of migraine in Children And Adolescents. Paediatr Child Health. 2017;22(8):454-458. Doi:10.1093/Pch/Pxx170
  16. Birnie KA, Hundert AS, Lalloo C, Nguyen C, Stinson JN. Recommendations for selection of self- report pain intensity measures in children and adolescents: a systematic review and quality assessment of measurement properties. Pain. 2019;160(1):5-18. doi:10.1097/j.pain.0000000000001377
  17. Le May S, Ali S, Khadra C, et al. Pain Management of Pediatric Musculoskeletal Injury in the Emergency Department: A Systematic Review. Pain Res Manag. 2016;2016:4809394. doi:10.1155/2016/4809394
  18. Harling L, Ali S, Dryden DM, Chordiya P, et al. How safe are common analgesics for the treatment of acute pain for children: A systematic review. Pain Research and Management. 2016;2016, https://doi.org/10.1155/2016/5346819
  19. Abebe Y, Hetmann F, Sumera K, Holland M, Staff T. The effectiveness and safety of paediatric prehospital pain  management: a systematic review. Scand J Trauma Resusc Emerg Med. 2021;29(1):170. Published 2021 Dec 11.  doi:10.1186/s13049-021-00974-3
  20. Rocchio RJ, Ward KE. Intranasal Ketamine for Acute Pain. Clin J Pain. 2021;37(4):295-300. doi:10.1097/AJP.0000000000000918
  21. Parri N, Lazzeri S. Efficacy of ibuprofen in musculoskeletal post-traumatic pain in children: A systematic review. PLoS One. 2020;15(12):e0243314. Published 2020 Dec 3. doi:10.1371/journal.pone.0243314

Key Studies

  1. Chang CD, Saidinejad M, Atanelov Z, et al. Emergency department strategies to combat the opioid crisis in children and adolescents. J Am Coll Emerg Physicians Open. 2021;2(4):e12512. Published 2021 Jul 21. doi:10.1002/emp2.12512
  2. Richer L, Billinghurst L, Linsdell MA, et al. Drugs for the acute treatment of migraine in children and adolescents. Cochrane Database of Systematic Reviews. 2016, Issue 4. Art. No.: CD005220. DOI: 10.1002/14651858.CD005220.pub2. Accessed 29 August 2022.
  3. Frenkel O, Liebmann O, Fischer JW. Ultrasound-guided forearm nerve blocks in kids: a novel method for pain control in  the treatment of hand-injured pediatric patients in the emergency department. Pediatr Emerg Care. 2015;31(4):255-259.  doi:10.1097/PEC.0000000000000398
  4. Winner P, Farkas V, Štillová H, et al. Efficacy and tolerability of zolmitriptan nasal spray for the treatment of acute  migraine in adolescents: Results of a randomized, double-blind, multi-center, parallel-group study (TEENZ). Headache.  2016;56(7):1107-1119. doi:10.1111/head.12859
  5. Aravamuthan BR, Mar SS, Williams KG. Factors Associated With Discharge After Initial Emergency Treatment of Pediatric  Migraine. Pediatr Emerg Care. 2017;33(9):620-629. doi:10.1097/PEC.0000000000000533
  6. Daoust R, Paquet J, Bailey B, et al. Vital Signs Are Not Associated with Self-Reported Acute Pain Intensity in the Emergency Department. CJEM. 2016;18(1):19-27. doi:10.1017/cem.2015.21
  7. Poonai N, Bhullar G, Lin K, et al. Oral administration of morphine versus ibuprofen to manage postfracture pain in children: a randomized trial. CMAJ. 2014;186(18):1358-1363. doi:10.1503/cmaj.140907
  8. Johnson TJ, Weaver MD, Borrero S, et al. Association of race and ethnicity with management of abdominal pain in the emergency department. Pediatrics. 2013;132(4):e851-e858. doi:10.1542/peds.2012-3127
  9. Tsze DS, Hirschfeld G, von Baeyer CL, Suarez LE, Dayan PS. Changes in Pain Score Associated With Clinically Meaningful Outcomes in Children With Acute Pain. Acad Emerg Med. 2019;26(9):1002-1013. doi:10.1111/acem.13683
  10. Le May S, Ballard A, Khadra C, et al. Comparison of the psychometric properties of 3 pain scales used in the pediatric emergency department: Visual Analogue Scale, Faces Pain Scale-Revised, and Colour Analogue Scale. Pain. 2018;159(8):1508-1517. doi:10.1097/j.pain.0000000000001236
  11. Tsze DS, Hirschfeld G, Dayan PS, Bulloch B, von Baeyer CL. Defining No Pain, Mild, Moderate, and Severe Pain Based on the Faces Pain Scale-Revised and Color Analog Scale in Children With Acute Pain. Pediatr Emerg Care. 2018;34(8):537-544. doi:10.1097/PEC.0000000000000791
  12. Brudvik C, Moutte SD, Baste V, Morken T. A comparison of pain assessment by physicians, parents and children in an outpatient setting. Emerg Med J. 2017;34(3):138-144. doi:10.1136/emermed-2016-205825
  13. Sylvie Le May, Samina Ali, Amy C. Plint, Benoit Mâsse, Gina Neto, Marie-Christine Auclair, Amy L. Drendel, Ariane Ballard, Christelle Khadra, Edith Villeneuve, Stefan Parent, Patrick J. McGrath, Grégoire Leclair, Serge Gouin, on behalf of Pediatric Emergency Research Canada (PERC); Oral Analgesics Utilization for Children With Musculoskeletal Injury (OUCH Trial): An RCT. Pediatrics. November 2017; 140 (5): e20170186. 10.1542/peds.2017-0186

Other Resources

  1. World Health Organization. Is your child in pain? Poster. 2012.