The Challenges of Providing Effective Pain Management for Children in the Pediatric Intensive Care Unit.

Providing effective pain management is necessary for all patients in the intensive care unit (ICU). Because of developmental considerations, caring for children may provide additional challenges. The purpose of this literature review is to describe key challenges in providing effective pain management in pediatric intensive care units (PICUs), with the aim of bringing about a better understanding by health care providers caring for children. Challenges of providing effective pain management in the PICU can be categorized into four levels. These levels are informed by the Nursing Pain Management Model and include challenges (1) to be considered before pain assessment, (2) related to pain assessment, (3) related to pain treatment, and (4) related to post-treatment. This review mainly discusses the challenges of the first three levels because the fourth (post-treatment) relates to reassessment of pain, which shares the same challenges of level two, pain assessment. Key challenges of level one are related to health care provider's characteristics, patients and their families' factors, and PICU setting. The main challenges of the assessment and reassessment levels are the child's age and developmental level, ability to self-report, relying on behavioral and physiological indicators of pain, selecting the appropriate pain assessment scale, assessing pain while the patient is being treated with sedative and paralytic agents, mechanical ventilation, and changes in patients' level of consciousness. In the treatment level (level three), nonpharmacological interventions factors; alterations in the pharmacokinetics and pharmacodynamics of medications to be used for pain management in critically ill children; and the complexity of the administration of sedatives, analgesics, and paralytic agents in critically ill children are the main challenges. Health care providers can bear in mind such important challenges in order to provide effective pain management. Health care providers can increase the use of available evidence for pain management.