Statement on the Practice of Pediatric Pain Medicine

Developed by: Committee on Pain Medicine
Original Approval: October 18, 2023

The treatment of pain in the pediatric population requires a multidisciplinary approach that embodies a comprehensive course of treatment. Pediatric pain management requires highly specialized skills to develop safe and effective, diagnosis-specific, treatment plans. Pediatric Pain Medicine requires specialized training which may be obtained during or developed after pain fellowship training. Its complex approach may require non-pharmacological, pharmacological, or an intervention spectrum of therapeutical measures based upon expert diagnostic skills. The Accreditation Council for Graduate Medical Education (ACGME) defines specific requirements for Pain Medicine fellowships creating oversight and a benchmark for training in pain management. Children, some of the most vulnerable patients, deserve chronic pain care from trained pediatric pain experts working within multidisciplinary teams.
 
Formal training in Pain Medicine minimizes harm and maximizes functional recovery and symptom relief for patients. Pediatric Pain Medicine leverages a broad spectrum of therapeutic approaches that include non-pharmacologic, pharmacologic, and targeted interventional treatments when appropriate. Such care requires knowledge and skill that crosses multiple disciplines and often involves a team-based approach. 

The use of procedural sedation or anesthesia services is often necessary for interventional procedures in pediatric patients. Risk assessment is coupled with an understanding of sedation requirements and the impact that depth of sedation will have on patient feedback during interventional procedures. This necessitates a level of technical expertise from both the anesthesiologist and pain physician that ensures safety steps are utilized to maximally reduce risk when deeper levels of sedation are required for patient comfort. When deep sedation and/or general anesthesia are deemed necessary for a procedure, it should be provided by an anesthesiologist who is not involved in performing the pain procedure. This allows for some patients to be interactive but remain comfortable and immobile for the procedure. 

A board-certified, pain specialist trained in pediatric pain provides optimal diagnosis and management and provides interventional procedures when appropriate. Pediatric pain medicine training informs on the differences in anatomy, physiology, pharmacology, treatment selection and procedural nuance that can separate a successful procedure or treatment from an unsafe or injurious one. 

In preserving our patients’ best interests, the ASA maintains an ongoing commitment to the delivery of safe, multidisciplinary, physician-led pain care for pediatric patients.