title: Assessment and management of pain in pediatric otolaryngology.
abstract: BACKGROUND
  Pain is a disease by itself and it's a public health concern of major implication in children, not just because of the emotional component of the child and his family, but also due to the potential morbidity and mortality involving it. A proper assessment of pain it's a challenge in the pediatric population, due to their lack of understanding and verbalization of hurt. Additionally, a satisfactory treatment of pediatric pain can be arduous due to a lack of clinical knowledge, insufficient pediatric research, and the fear to opioid side effects and addiction.
  
  
  OBJECTIVE
  The aim of this review is to address the current definitions of pain, its physiological mechanisms and the consequences of its inadequate management, as well as, to guide the clinicians in the assessment and management of pain in the pediatric population at otolaryngology services.
  
  
  METHODS
  Narrative review by selective MeSH search terms: Children, Pediatrics, Otolaryngology, Pain measurement, Pain Management, Analgesics and Analgesia, from databases: MEDLINE/PubMed, Cochrane, ISI, Current Contents, Scielo and LILACS, between January 2000 and May 2016.
  
  
  RESULTS
  129 articles were reviewed according to the requirements of the objectives. Pain measurement is a challenge in children as there are no physical signs that constitute an absolute or specific indicator of pain, and its diagnosis must rely on physiological, behavioral and self-report methods. Regarding treatment, a suitable alternative are the non-pharmacological cognitive/behavioral therapies helped by pharmacological therapies tailored to the severity of pain and the child's age. We provide evidence-based recommendations on pain treatment, including non-opioid analgesics, opioid analgesics and adjuvant medicines to improve the management of pain in children in otolaryngology services.
  
  
  CONCLUSIONS
  We present a global review about assessment and management of pain in pediatric otolaryngology, which leads to future specific reviews on each topic. Research gaps on pain assessment and pharmacological interventions in neonates, infants and children are very wide and it should be promoted ethical and safe research on pain control in this population.
authors.affiliation: Department of Otolaryngology, Hospital Infantil de San José, Fundación Universitaria de Ciencias de la Salud, Bogotá, Colombia.
authors.forename: Maria Claudia
authors.initials: MC
authors.lastname: Rodríguez
authors.affiliation: Department of Otolaryngology, Hospital Infantil de San José, Fundación Universitaria de Ciencias de la Salud, Bogotá, Colombia. Electronic address: perlviro@hotmail.com.
authors.forename: Perla
authors.initials: P
authors.lastname: Villamor
authors.affiliation: Department of Otolaryngology, Hospital Infantil de San José, Fundación Universitaria de Ciencias de la Salud, Bogotá, Colombia.
authors.forename: Tatiana
authors.initials: T
authors.lastname: Castillo
mesh_terms: D000700:Analgesics / Q000627:therapeutic use*; D018712:Analgesics, Non-Narcotic / Q000627:therapeutic use; D000701:Analgesics, Opioid / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D015928:Cognitive Behavioral Therapy; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008876:Middle Ear Ventilation; D010036:Otolaryngology; D010146:Pain / Q000188:drug therapy*; D059408:Pain Management; D010147:Pain Measurement; D010149:Postoperative Pain / Q000628:therapy*; D010372:Pediatrics; D014068:Tonsillectomy
chemical_list: D000700:Analgesics; D018712:Analgesics, Non-Narcotic; D000701:Analgesics, Opioid
keywords: Analgesia; Children; Otolaryngology; Pain management; Pain measurement; Pediatrics