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.

Assessing Pain

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.