Who helps with pain relief?
Within the hospital, a variety of providers may play a role in managing your child's pain. They include:
- Doctors. Your child's doctor will work with you to design a personalized plan for pain management that may include medicines and non-medicine techniques.
- Nurses. Your child's nurses provide pain-relief measures according to the pain management plan. They assess your child's condition and recommend any needed changes to the doctor.
- Complementary medicine providers. These practitioners use ancient techniques, such as massage, acupuncture and acupressure, as well as mind-body methods, such as meditation and hypnosis, to increase relaxation and lessen pain.
- Child life specialists. These professionals can engage your child in age-appropriate therapeutic play, as well as visualization and relaxation exercises, and may provide integrative therapies, such as hypnosis and biofeedback (a technique for reducing pain and stress by learning to control certain body functions, such as heart rate and breathing patterns).
- Physical and occupational therapists. When needed, these therapists can provide activities and exercises to increase your child's physical function and mobility, which may ease pain.
- Psychologists. Because anxiety and depression can intensify pain, psychologists offer therapeutic techniques that can help your child feel better emotionally and physically.
For every patient hospitalized at UCSF Benioff Children's Hospitals, we perform an assessment to determine whether that child is in pain. If this is the case for your child, we will talk with you about pain relief options and develop a pain management plan tailored to your child's needs and preferences.
Throughout the hospital stay, the health care team will check regularly to make sure your child is comfortable. If pain is reported, we respond quickly. We work with you to support your child and adjust the plan any time pain improves, worsens or changes.
We use various methods to gauge pain, depending on the child's age and ability to describe feelings. With infants and preverbal toddlers, we evaluate the child's facial expressions, movements, vocalizations and body language. If the child is old enough to talk, we ask them to rate their pain on a scale from 0 to 10 or from "mild" to "severe." For more information, see Signs a Child Is in Pain.
Non-medication pain management
Pain can often be effectively managed without medication. Your child's care team may start with simple measures, such as dimming the lights, changing the room temperature, applying ice or heat packs, repositioning your child in bed, or encouraging them to get up and move.
We also employ a variety of integrative therapies for pain relief. These include:
- Acupuncture or acupressure
- Biofeedback (learning techniques to control breathing patterns and heart rate)
- Relaxation techniques, such as deep breathing and meditation
- Transcutaneous electrical nerve stimulation (TENS), which delivers low-voltage electrical impulses to nerves near the painful area
Depending on the technique, your child may be treated by nurses, child life specialists or (with a doctor's referral) specialists at the Stad Center.
When drug-free methods aren't enough (for example, when surgery is performed), we use one or more child-safe pain medications. Often, medicines work better in combination – a practice that allows us to use opioids as little as possible. Pain medicines may be given either on a regular schedule or on an as-needed basis. The health care provider will determine the medication type and schedule, based on your child's needs.
Examples of pain medicines include:
- Over-the-counter pain relievers. Acetaminophen (Tylenol) or nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil) and naproxen (Aleve).
- Medications that have a pain-relieving effect. Lidocaine (Lidoderm patch) or gabapentin (Neurontin).
- Opioids. Morphine, hydromorphone or oxycodone. Short-acting opioids take effect quickly and relieve pain for less time than long-acting opioids, which are slower to take effect. We take an opioid-sparing approach, using lower doses of these drugs in combination with non-opioid medications to achieve the same pain relief with fewer risks and side effects.
Pain medicines can be administered in a variety of ways:
- Topical (applied to the skin). Numbing creams and lidocaine patches can reduce pain in the area where they're applied.
- Oral (by mouth). Many pain medicines come in liquid or pill form or as a lozenge that dissolves under the tongue.
- Intranasal. Some pain medications are delivered via nasal sprays.
- Intravenous (IV). Many pain relief medicines can be administered through an IV line, either on a regular schedule or when your child has pain.
- Patient-controlled analgesia (PCA). When appropriate for their age and developmental abilities, children may be taught to self-administer pain medication through a PCA pump. This method allows patients to dose themselves when they feel pain by pressing a button. Only the patient may press the button, and the device won't allow delivery of too much medicine. If your child has a PCA pump, the pain team will regularly check on its use, talk to your child about how it's working, and make adjustments as needed.
- Epidural catheter. A thin, flexible tube (catheter) placed in the lower back allows delivery of medicine to the area around the spinal nerves. This technique can numb a large area, such as the abdomen or legs, and is a safe and effective way to provide pain relief, even in small infants. The tube is placed by an anesthesiologist, usually during surgery, and can stay in place for several days.
Any pain medication can have side effects. Be sure to tell your child's health care team if a medicine is making your child feel unwell. Also, please talk with the care team if you have general concerns about the risks or side effects of pain medications or about opioid tolerance, dependence or addiction.
It may not be possible, or safe, to have total pain relief. But we will work to help find a realistic goal, so your child can feel better, get better and gradually get back to their normal activities.