pain assessment C D A J O U R N A L , V O L 5 0 , Nº 8
How Do We Protect a Child’s Psychological Health During Procedures That Use Protective Stabilization? Dennis Paul Nutter, DDS
abstract Background: If a child experiences pain during procedures while protective stabilization is in place, they will experience suffering, central sensitization and classical fear conditioning in direct proportion to the duration and intensity of their procedure pain. Rigorous and reliable procedure pain assessment during procedures is imperative if children’s psychological health is to be protected when protective stabilization is deployed. Types of studies reviewed: A review of pain assessment guidelines and best practice recommendations, their supporting literature and the pain assessment practices of pediatric dentists was undertaken to determine if current pediatric dental pain assessment methodology conforms to best practice recommendations. Results: Best practice recommendations for pain assessment in pediatrics allow the child to determine their own procedure pain intensity level, either by self-report or, for children younger than age 7, by observation of their distress behavior. Current practice in pediatric dentistry is to target behavior for assessment during invasive procedures and allow the dentist to decide the level of a child’s procedure pain that is associated with that behavior. Dentists, physicians and nurses all tend to underestimate their patients’ pain if they are allowed to make that determination. Practical implications: Many pediatric dentists practice a method of procedure pain assessment that does not conform to best practice recommendations. Three practice recommendations are proposed to improve pain outcomes and protect the psychological health of children during potentially painful procedures, especially those involving the use of protective stabilization. Keywords: Protective stabilization, papoose board, restraint, sensitization, fear, conditioning, pain, behavior management, pain justification, medical ethics
AUGUST 2 0 2 2
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