[Position document of the spanish association of paediatrics group for the study of paediatric pain on the recording of pain as fifth vital sign]

Effectiveness of Non-Pharmacological Interventions in the Management of Pediatric Chronic Pain: A Systematic Review

(1) Background: Chronic pain in children remains an under-researched area, especially compared to acute pain. This systematic review aims to evaluate the effectiveness of non-pharmacological interventions in the management of pediatric chronic pain and their impact on the well-being of both children and their families. Given the growing interest in integrative treatments to reduce reliance on pharmacological solutions, this review addresses the need for alternative therapeutic approaches. (2) Methods: A systematic review was conducted following the PRISMA guidelines, covering studies published between 2019 and 2024 from PubMed, Cochrane Library, Web of Science, and Scopus. Eligible studies included children aged 2 to 18 years with chronic pain who received non-pharmacological interventions. Data were extracted on intervention types, participant characteristics, and outcomes. The risk of bias was assessed using RoB2 for randomized trials and ROBINS-I for non-randomized studies. (3) Results: A total of 11 studies involving 1739 children were included, assessing interventions such as cognitive behavioral therapy, personalized psychosocial follow-up programs, hypnotherapy, music therapy, and digital tools. The results demonstrated significant reductions in pain severity, improvements in emotional and physical well-being, and high patient satisfaction. However, the generalizability of findings was limited by the small sample sizes and variability in study designs. (4) Conclusions: Non-pharmacological interventions appear effective in managing pediatric chronic pain, offering improvements in pain reduction and quality of life. Further research is needed to optimize these approaches and confirm their long-term benefits across diverse populations. These interventions represent promising alternatives or complements to pharmacological treatments in pediatric pain management.

Multicenter study. Nursing professionals' perception of training needs in pain assessment in pediatric patients with cognitive dysfunction

INTRODUCTION

Pediatric patients with cognitive dysfunction are at greater risk of pain than typically developing children. Pain assessment in these patients is complex and could generate uncertainty in health professionals about what the key aspects are.

AIM

To determine the training needs perceived by nursing professionals regarding acute pain assessment in pediatric patients with cognitive dysfunction.

METHODS

A descriptive, cross-sectional, and multicenter study was performed using a survey addressed to nursing professionals who work in pediatrics during the months of August and September 2022.

RESULTS

163 responses were obtained. Most of the professionals who responded were female (92.6%, n = 151), with a mean age of 38.98 ± 10.40 years. The most frequent work unit was the pediatric intensive care unit (PICU), in 36% (n = 58). Most of the participants reported not having previously received training on pain assessment in pediatric patients with cognitive disabilities (85.9%, n = 139). However, 70.4% (n = 114) considered it "very necessary" for the development of their work to receive specific training on this topic. Knowing how to assess acute pain in this population (85.3%, n = 139) and knowing the clinical and behavioral manifestations of pain in this type of patient (84.7%, n = 138) were the aspects that obtained higher scores.

CONCLUSION

This research notes more than 90% of participants consider "quite necessary" and "strong necessary" to be training in pediatric cognitive dysfunction patients pain assessment. Furthermore, work experience, academic education and to be pediatric specialist obtain statistical significance data.

Challenges and current status of children pain management in Spain

Pain in children population is prevalent, but its proper diagnosis and management are frequently insufficient in pediatrics daily practice. Lack of knowledge of the professionals in charge is a recognized barrier to ensure an appropiate approach to pain in this population. Our present study reflects the current status of pain management and the challenges in diagnosis and treatment that pediatricians face in their daily work. This information is obtained from a survey made with a voluntary questionaire, desinged and distributed online by "Grupo Español para el Estudio del Dolor Pediátrico (GEEDP)" to pediatricians in Spain from october 2021 to march 2022. The final objective of the questionaire was to shed some light into the problem and find out which areas of pain management knowledge are in need of improvent.

A Comprehensive Assessment of The Eight Vital Signs

The term “vital sign” has been assigned to various phenomena with the presumptive intent to emphasize their importance in health care resulting in the emergence of eight vital signs with multiple designations and overlapping terms. This review developed a case definition for vital signs and identified and described the fifth through eighth vital signs. PubMed/Medline, Google and biographical databases were searched using the individual Medical Subject Headings (MeSH) terms, vital sign and fifth, vital sign and sixth, vital sign and seventh, and vital sign eighth. The search was limited to human clinical studies written in English literature from 1957 up until November 30, 2021. Excluded were articles containing the term vital sign if used alone without the qualifier fifth, sixth, seventh, or eighth or about temperature, blood pressure, pulse, and respiratory rate. One hundred ninety-six articles (122 for the fifth vital sign, 71 for the sixth vital sign, two for the seventh vital sign, and one for the eighth vital sign) constituted the final dataset. The vital signs consisted of 35 terms, classified into 17 categories compromising 186 unique papers for each primary authored article with redundant numbered vital signs for glucose, weight, body mass index, and medication compliance. Eleven terms have been named the fifth vital sign, 25 the sixth vital sign, three the seventh, and one as the eighth vital sign. There are four time-honored vital signs based on the case definition, and they represent an objective bedside measurement obtained noninvasively that is essential for life. Based on this case definition, pulse oximetry qualifies as the fifth while end-tidal CO2 and cardiac output as the sixth. Thus, these terms have been misappropriated 31 times. Although important to emphasize in patient care, the remainder are not vital signs and should not be construed in this manner.

Planificación de un modelo integral de cuidados en una adolescente sometida a biopsia renal

Descripción caso: adolescente de 14 años que presentaba hematuria y proteinuria aisladas desde hace apenas un año, en tratamiento farmacológico. Candidata para ser sometida a la técnica, ingresa en la unidad de nefrología pediátrica. En la valoración inicial, se detectó un posible caso de trastorno de la conducta alimentaria (TCA), puesto en conocimiento del equipo de salud. Descripción del plan de cuidados: Se llevó a cabo un plan de cuidados integral que se centraba tanto en los aspectos físicos como psicosociales del individuo. En cuanto a los diagnósticos seleccionados, previo a la biopsia primó el temor y, tras ella, el deterioro de la integridad tisular y de estos a su vez derivaron los de disposición para mejorar los conocimientos, disposición para mejorar el afrontamiento, riesgo de sangrado, riesgo de infección, retención urinaria y dolor agudo. Evaluación del plan: La paciente estuvo hospitalizada durante 48 horas, ya que después de la prueba presentó globo vesical. Durante su ingreso, quiso manejar su régimen terapéutico y conocer medidas para controlar el estrés ante la punción. Fue dada de alta con los problemas físicos resueltos y motivada para seguir aprendiendo sobre su proceso de enfermedad. Conclusiones: A la vista de nuestros resultados podemos concluir que el plan de cuidados aplicado a esta paciente adolescente fue efectivo respecto a todos los resultados esperados (NOC).