Pediatric emergency medicine trisk 4268 4268

is evidence that for long-bone fractures and abdominal pain, children of
Black and Hispanic background are less likely to receive opioid analgesia
than White children. Furthermore, in a busy ED, physicians are often forced
to concentrate on other aspects of resuscitation and care before managing
pain. Plans for pain control, therefore, may be overlooked because of other
priorities. Some physicians avoid analgesics because they do not want to
mask symptoms. Topical anesthetics may be avoided because it is
inconvenient to wait for them to take effect. This can delay care, so some
physicians may underuse analgesics and convince a young child that a
painful procedure or repositioning of an extremity fracture will hurt only
“for a minute.” Forceful restraint (instead of medication) is then used, and
more pain is inflicted on an already uncomfortable child.

Impact of Pain and Importance of Successful Pain
Management
Emergency physicians must understand that pain is an individual experience
and many factors contribute to the degree of pain that a child experiences for
any given condition. Children of all ages can experience pain; it is believed
that even neonates by 26 weeks’ gestation respond to tissue injury with
specific behavior and with autonomic, hormonal, and metabolic signs of
distress. Newborns feel pain and react to painful stimuli (e.g., circumcision)
with wiggling motions and crying. Young children often have an
exaggerated fear of needles, while older children may be better able to
understand the need for a painful procedure; they are usually less anxious
and better able to tolerate the inflicted pain. However, an older child may
have a better understanding of the significance of an injury or an illness that
could cause depression, anxiety, and more pain. Similarly, parental response
(anxiety or reassuring calm) may affect a child’s perception of pain.
Caregivers can experience elevated heart rate, blood pressure, and anxiety
during painful procedures. Not surprisingly, parental distress–promoting
behaviors may increase childhood distress. Other psychological factors, such

as the child’s emotional state, personality traits, gender, or cultural
background, may impact their anxiety, and this can also alter the degree of
pain. Some children seem to have a hypersensitivity to pain, whereas others
tolerate it well. Certain genotypes, such as the CYP2D6 polymorphisms and
opioid receptor OPRM1, can mediate the metabolism and efficacy of certain