Pain management in pediatric age. An update

Assessing Caries Removal Efficacy and Pain Perception in Children, Using Smart Bur Versus Carbide Bur: A Randomized Clinical Study

BACKGROUND Dental caries removal is conventionally done using carbide burs, but non-metallic polymer burs have recently been developed with the aim of being more selective and causing less pain. The objective of the study is to evaluate and compare the effectiveness of caries removal, time taken, and patient compliance during restorations using smart bur and carbide burs in pediatric patients. MATERIAL AND METHODS A clinical study was designed and conducted at the Pedodontics Outpatient Department, with a focus on 40 children between 6 and 12 years old, who were split into 2 groups consisting of 20 children each: group 1, using a carbide conventional rotary bur, and group 2, using a smart bur. Efficiency of caries removal was assessed using the Ericson scale. The Face Leg Activity Cry Consolability (FLACC) and Wong-Baker FACES pain rating scale (WBS) were used to assess the intensity of pain, and the behavior of children was assessed using the Frankel behavior rating scale (FBRS). RESULTS A statistically significant difference (P<0.001) was noted in the time taken for caries excavation and Ericson scale (P=0.04), with higher scores observed in the smart bur group. The smart bur group generally reported lower WBS and FLACC scores than the carbide bur group, during caries excavation, restoration and local anesthesia administration, and this difference was very highly significant (P<0.001). CONCLUSIONS Pain perception among children was lesser and overall satisfaction was higher in smart bur group whereas caries removal efficiency was higher in conventional carbide bur group.

Effect of Laser Photobiomodulation on Postoperative Pain After Single-Visit Endodontic Treatment in Children: A Randomized Control Trial

BACKGROUND

This study aimed to assess the effectiveness of laser photobiomodulation (PBM) in reducing postoperative pain following single-visit endodontic treatment in children aged 5-9 years.

METHODS

Forty children aged 5-9 years with acute irreversible pulpitis in deciduous molars requiring single-visit pulpectomy were included in the study. Pulpectomy was performed according to a standard endodontic protocol. The participants were randomly allocated to two groups: group A received laser photobiomodulation using an 810 nm diode laser applied to the periapical area of the treated tooth postoperatively, and group B received blue light LED, applied at similar points to the control teeth. This was a placebo intervention. Pain scores were measured using a 10-point Visual Analog Scale (VAS) at 4, 12, 24, and 48 h post-treatment. The Friedman test was used to compare the VAS scores within groups over time, and the Mann-Whitney U-test was used to compare the VAS scores between the two groups. The significance level was fixed at p < 0.05.

RESULT

The mean VAS scores were significantly lower in the PBM group compared to the placebo group at the 4th h, 12th h, and 24th h post-treatment (p ≤ 0.05). The pain levels remained stable over time in the PBM group, with no significant difference in pain scores from 4 h to 48 h (p = 0.57). In the placebo group, the pain gradually decreased from the 4th h to the 48th h, with a significant reduction in pain observed between the 12th h and 48th h (p = 0.05).

CONCLUSIONS

Laser photobiomodulation (PBM) was found to be effective in reducing postoperative pain following single-visit endodontic treatment in children. This non-invasive approach could offer a valuable alternative for pain management in pediatric endodontics, particularly given its effectiveness without the need for systemic medications.

Virtual reality vs. tablet for procedural comfort using an identical game in children undergoing venipuncture: a randomized clinical trial

Introduction

Recent research has explored the effectiveness of interactive virtual experiences in managing pain and anxiety in children during routine medical procedures, compared to conventional care methods. However, the influence of the specific technology used as an interface, 3-dimensions (D) immersive virtual reality (VR) vs. 2D touch screens, during pediatric venipuncture, remains unexamined. This study aimed to determine if immersive VR is more effective than a tablet in reducing pain and anxiety during short procedures.

Methods

An interactive game was designed by clinicians and psychologists, expert in pain theory, hypnosis, and procedural pain and anxiety relief, and was tailored for both VR and tablet use. Fifty patients were randomly assigned to either the Tablet or VR group. The primary outcome measures were pain and anxiety levels during the procedure. Secondary outcome measures included the need for physical restraint, duration of the procedure, enjoyment levels, and satisfaction ratings from both parents and nurses.

Results

Participants, in both groups, had low levels of pain and anxiety. Physical restraint was infrequently used, procedures were brief, and high satisfaction levels were reported by patients, parents, and nurses.

Discussion

This study suggests that the type of technology used as a support for the game has a minimal effect on the child's experience, with both groups reporting low pain and anxiety levels, minimal physical restraint, and high enjoyment. Despite immersive VR's technological advancements, this study underscores the value of traditional tablets with well-designed interactive games in enhancing children's wellbeing during medical procedures.

Clinical Trial Registration

[ClinicalTrials.gov], identifier [NCT05065307].

Timeline of diagnosed pain causes in children with severe neurological impairment

Objective

Pain's causes in children with severe cognitive impairment may be challenging to diagnose. This study aimed to investigate if there is a relationship between pain causes and the age of children.

Methods

We conducted a multicenter retrospective study in three Italian Pediatric Units. Eligible subjects were patients from 1 to 18 years with severe neurological impairment. We collected data regarding diagnoses, pain causes and medical or surgical procedures. The timing of pain episodes was categorized into age-related periods: infants and toddlers (0-24 months), preschool children (3-5 years), schoolchildren (6-12 years), and adolescents (13-17 years).

Results

Eighty children with severe neurological impairment were enrolled. The mean age was 11 years (±5.8). Gastroenterological pain was most common in the first years of life (p = 0.004), while orthopaedic and tooth pain was the most typical in schoolchildren and adolescents (p = 0.001 and p = 0.02). Concerning surgical procedures, PEG placement and gastric fundoplication were significantly more common in the first 5 years of age (p = 0.03), and heart surgery was typical of infants (p = 0.04). Orthopaedic surgery was more commonly reported in older children and adolescents (p < 0.001).

Conclusions

Some causes of pain are more frequent in children with severe neurological impairment in defined age-related periods. Specific age-related pain frequencies may help physicians in the diagnostic approach.

Methadone for Cancer Pain Management in Children: A Review of Literature

Pain associated with cancer is a common feature among children and adolescents. Among opioids, methadone is a unique drug for its multiple mechanisms of action. Methadone is currently underutilized in children. The use of methadone for cancer pain management in children was assessed in a systematic review. Altogether, 141 children receiving methadone were examined, and another 126 children were assessed for QT prolongation. In the clinical studies, modalities of use, dosing, and duration of assessment were highly variable. In general, methadone was effective and well tolerated with a limited tendency for dose increases. QT prolongation was reported in a percentage of patients independently of the dosages or other variables. The majority of studies considered the use of methadone to be safe and effective in children. Despite methadone possessing interesting properties that make this drug unique in a pediatric context, data is limited, and the literature available is based on retrospective studies. Methadone could be an effective, inexpensive, and versatile medication in children with cancer who have pain. This drug deserves more interest and should prompt studies of better quality with a larger number of patients.