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Pain Management in Special Populations: Children and the Elderly

2.0 Contact Hours
Target Audience: Nurses, healthcare professionals, and interested individuals
Purpose/Goal: The outcome of this course is for the learner to describe issues unique to the pain management of the pediatric or geriatric patient, including assessing and managing pediatric pain, physiologic changes in aging, behavioral strategies for pain relief, nonpharmacological options for pain control in pediatric and geriatric patients, and pain management in the client with an altered mental status.
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Helping pediatric and geriatric populations manage their pain requires special consideration regarding the types of medications and strategies chosen, the route through which medications are delivered, and specific comorbidities or metabolic issues that may be present.

Upon completion of the course, you will be able to do the following:

  • Describe the pain management issues unique to the pediatric client.
  • Describe how to assess a child for pain.
  • Identify pain behaviors unique to specific age groups.
  • Identify pain management strategies for the pediatric client.
  • Describe physical strategies and behavioral approaches to managing pain in children.
  • Identify causes of pain in the elderly client.
  • Describe normal physiological changes in aging and their effects on the perception of pain in the elderly individual.
  • Identify useful strategies for choosing and administering medication to the elderly client.
  • Identify nonpharmacological options for pain control in elders.
  • Describe specific pain management considerations in the client with an altered mental status.
  • Identify compliance issues related to the elderly client.

The management of pain can be a complex process. Special populations, such as children or the elderly, can provide additional unique challenges. For example, a child’s developmental stage and age can affect the type, route, and metabolic process of pain medication. The elderly client may have comorbidities that affect what drug is selected, the route of administration, and how the drug is metabolized. Both age groups can be affected by communication difficulties, and both groups of patients may require varied methods of providing comfort, social support, and strategies for pain relief.

PAIN MANAGEMENT IN CHILDREN

It is now well accepted by neuroscientists and pain specialists that the human nervous system is well developed before birth, so children are assumed to be able to experience pain from birth onward (Andrews, & Fitzgerald, 1999). Neonates have the same number of pain nerve endings per square millimeter of skin as adults. They are present in the fetus from the second trimester of pregnancy. Cortical interconnections with the thalamus (the tracts that play a role in the higher perception of pain) are complete by 24 weeks’ gestation, and the central nervous system tracts are completely myelinated by 30 weeks’ gestation (Mathews, 2011).

In fact, infants and children have a more robust inflammatory response than adults and do not have a central inhibitory influence because the descending inhibitory controllers of pain are not fully developed in the neonate. Thus, neonates and young children may actually experience a greater neural response to pain (i.e., more pain sensation and pain-related distress following a noxious stimulus) than adults. The impact of painful experiences on the young nervous system is so significant that long-term effects can occur, including lasting changes to developing somatosensory and pain systems (Schwaller, & Fitzgerald, 2014).

These long-term effects include lowered pain tolerance for several months after a pain-producing experience and negatively affected visual-perceptual abilities in school-aged children (Doesburg, et al., 2013; Mathews, 2011; Palermo, Koh, & Zeltzer, 2011; Taddio, Katz, Hersch & Koren, 1999). Other effects include greater pain and perceptual sensitization to noxious stimulation, reduced brain white matter, reduced subcortical grey matter, delayed corticospinal development, and lower postnatal growth (Schwaller, & Fitzgerald, 2014).

Knowing that neonates and pediatric patients most certainly experience pain, their long history of undertreatment cannot be justified by the lack of easy communication with them (Mathews, 2011; Schechter, 1989). Fortunately for patients and caregivers alike, the way this issue is addressed is changing (Roofthooft, et al., 2014).

Pediatric clients make up a group with very special needs when it comes to pain management. Communication issues, their neurophysiology in relation to their development, the influence and involvement of their parents and families, and ways these patients respond to adverse events make assessment for pain different and more challenging than pain assessment in adults (Palermo, Koh, & Zeltzer, 2011).

Complete the course post exam (CE Test) with a score of 80% or greater. Complete all fields of the course evaluation form. Certificate of Completion is provided once the course post exam is passed per criteria above.

  • American Board of Managed Care Nursing
  • ANCC - American Nurses Credentialing Center
  • AOTA - American Occupational Therapy Association
  • ASWB - Association of Social Work Boards
  • California Board of Registered Nursing
  • California Department of Health, Aid, and Technician Certification Section
  • District of Columbia Board of Nursing
  • Florida Board of Nursing
  • Florida Board of Nursing - Certified Nursing Assistants
  • Florida Board of Respiratory Care
  • Florida Council of Dietetics and Nutrition
  • Florida Council of Licensed Midwifery
  • NAADAC - The National Association of Alcohol and Drug Abuse Counselors
  • Florida Board of Massage Therapists
  • NCBTMB -National Certification Board for Therapeutic Massage & Bodywork
  • California Board of Behavioral Sciences
AOTA CEUs:

0.2

Practice Level:

Intermediate

Content Focus:

Domain of OT

Course Expires:

June 01, 2020

Instructor(s):
  • Cyndie Koopsen, RN, BSN, MBA, HNB-BC, RN-BC, HWNC-BC
  • Caroline Young, MPH
Jurisdictional Requirements:

Continuing education (CE) licensing requirements vary by jurisdiction, are not well defined, and may change. These CE requirements may vary in terms of the number of hours required to the types of courses that must be taken. ALLEGRA Learning Solutions, LLC recommends you contact your licensing board or accrediting organization for the latest continuing education requirements of your state or territory. Compliance with CE requirements is the responsibility of the individual health care provider. Health care providers must understand the CE requirements in their jurisdictions, and be sure they are up-to-date on any rule changes that affect their license. For further information, please see our Accreditation Information.

Accommodations for Disabilities:

Every effort will be made to accommodate your special needs. To request accommodations, please contact us.

Conflicts of Interest and Relevant Financial Relationships:

The authors/planning committee members have no conflicts of interests or relevant financial relationships to declare relevant to this activity.

Commercial Support:

No commercial support has been received for this activity.

Non-endorsement of products:

Accreditation refers to recognition of continuing nursing education only and does not imply ALLEGRA Learning Solutions, LLC approval or endorsement of any commercial product.

Off-label Use of Products:

None of the authors intend to discuss off-label uses of drugs, mechanical devices, biologics, or diagnostics not approved by the FDA for use in the United States.

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