Pain-Less Practice: Techniques to Reduce Procedural Pain and Anxiety in Pediatric Acute Care

Strategies for controlling procedural pain and anxiety are critical in the pediatric patient. Evolving tools and techniques allow the pediatric acute care provider to have an array of pharmacologic and nonpharmacologic options to aid in procedural care. Optimizing noninvasive pain and anxiety management can help providers in urgent care and ambulatory settings to perform procedures that may otherwise require care in an emergency department or anesthesia suite. This article introduces the concept of a “PainLESS Practice”-an evidence-based, tiered approach to procedural pain and anxiety management in acute care. The goal of a PainLESS Practice is not necessarily to eliminate patients' pain, but rather, to reduce pain and anxiety to a level that is tolerable and facilitate the performance of procedures. We will discuss methods of procedural pain control in the pediatric acute care setting starting from less invasive and progressing to more invasive, keeping in mind that multiple modalities may be used simultaneously or in sequence. These techniques vary depending on the patient's age, procedure being performed, and the patient's individual circumstances.