Results of an ethics case study presented in the AMA Journal of Ethics suggest that the assessment of pain in patients with burns should involve slightly similar approaches between adults and children, particularly at hospital admission as a means of developing a comprehensive pain management plan at the outset. Divergence between the patient groups may be necessary with regard to the level of verbal communication and education provided, considering children may only respond and understand on emotional vs practical levels.
The immediate attention received by children in pain from providers is often spurred by the vulnerability of the child and the willingness among adults to ease this suffering. Although adults with pain are equally valid, the emotional response toward care can vary. Many children may not understand why a painful procedure is necessary, further contributing to the often emotional conflicts within adult clinicians as they treat these patients compared with adults, who often comprehend the necessity of such a procedure.
In patients with burns, several different care guidelines exist for pain control in adults; few guidelines are available for children. Among children, pain is often exacerbated because of fear and anxiety, emotions that may be more effectively managed in adult patients. This brings into light the differences in caring for these disparate patient populations, suggesting the need to integrate a multifaceted approach in pediatric pain care. This approach may involve both pain control as well as psychological strategies to mitigate perceived pain.
The authors of the case study argue against heavy, anesthetic-grade sedation during procedures in pediatric patients, primarily because of its effect on patients’ reintegration into the home and school settings. Ultimately, this treatment suggestion may be adopted for adult patients, especially if they have at-home caretakers, are socially active, and/or are planning to go back to work. Because of the necessity of opioid medications in these patients, as well as the associated dependency risk, the authors suggest routine, detailed pain assessments at baseline as well as throughout the treatment course to determine the most optimal opioid dosing strategy during care. Ideally, the goal would be to decrease opioid needs throughout treatment, regardless of the patient’s age.
“Regardless of whether the patient is an adult or a child, assessing the patient’s pain needs thoroughly and systematically at the outset will allow the development of a comprehensive pain management plan that prevents these decisions from having to be made by covering or on-call physicians who might not have the time to devote to this endeavor and thus might be more likely to rely on shortcuts,” the authors concluded.
Dissanaike S. Is it ethical to treat pain differently in children and adults with burns? AMA J Ethics. 2018;20(6):531-536.