Acute Pain

Acute pain, often caused by tissue damage or inflammation, tends to have a quick onset and gradually dissipates. Common sources of acute pain include cuts, bruises, scrapes, and surgery. A bee sting or a punch in the nose will also produce acute pain. Other types of acute pain include pain from medical procedures for example, needle pokes, or surgery. 

Of all pain types, acute pain is most associated with the alarm and warning benefit of pain. Initially, it is impossible to ignore. When acute pain begins, a child immediately knows what part of the body is affected and can respond quickly to minimize damage. This response, for example pulling his hand away from a flame, happens reflexively. 

As a response to acute pain, the body releases adrenaline and noradrenaline, which act to create the fight or flight response to pain. At the same time, the body’s own pain relievers, called endorphins, are released to help relieve pain. The fight or flight hormones, while helpful in the beginning, take a toll on the body. We are beginning to understand that continuing acute pain can cause lasting changes in the nervous system. If not properly treated, acute pain may lead to chronic pain.

Acute pain is most commonly described as sharp or stinging. A child’s own language can often identify the type of injury he has sustained. Children are also very good at describing their pain with pictures, which is one of the techniques health care providers use to gain a better understanding of what is going on with a child in pain.

Anticipating acute pain

While most acute pain comes from accidents people are not expecting, for example scraping a knee as a result of a fall, some acute pain can be predicted. Pain during some procedures and following most surgeries is common. In these cases, because pain is anticipated, often something can be done about the pain before it occurs.

Acute procedural pain

Procedural pain is a type of acute pain that is created by a procedure of some type. Because the pain is anticipated, there is opportunity for fear and anxiety to build up. Some children may experience anxiety-related symptoms such as nausea, vomiting, loss of appetite, skin rashes, insomnia, and nightmares. High levels of fear and anxiety can increase the intensity of the pain.

While procedural pain can be traumatic, it provides an opportunity to put preventive pain management strategies in place before the procedure begins. These protective or pre-emptive measures can include the use of medication such as local anesthetic cream to numb the skin. Other strategies include physical measures such as rubbing or using ice, and age appropriate psychological strategies such as distraction or blowing bubbles. The choice of which strategy to use depends on the type of procedure and the age of the child.

The most common painful procedures that children undergo include needle pokes for taking blood or putting in an intravenous line, lumbar puncture (spinal tap), and circumcision.

For more about lumbar punctures, procedural pain and how it is relieved, please go to Other Types of Pain

Acute Postoperative Pain

The type of pain relief prescribed by the child’s anesthesiologist will be determined by the procedure and the child’s condition. The child may receive an epidural (similar to a lumbar puncture but inserted just outside of the spinal fluid), or a nerve block, meaning numbing medications directed around the nerves supplying the area affected by the surgery, or may receive other oral, rectal or intravenous pain medications.

The goal is to make the child as comfortable as possible after the surgery, while minimizing side effects, and allowing the child to more comfortably participate in activities. Treatment of acute postoperative pain changes over the time after surgery and with the child.  It is an ongoing effort for the team(s) in charge of the child’s care, as well as for the family.

 
 

Lisa Isaac, MD, FRCPC

9/18/2009


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