Registered Nurses' Association of Ontario

Pain in Special Populations

  • Each person’s attributes (age, developmental stage, health condition, culture) and pain characteristics must be considered before strategies are proposed and incorporated into pain management plans
  • Untreated pain in infants and children, for example, places them at risk of adverse effects and long-term health and wellness problems
  • Nurses must use strategies appropriate for the child’s age and development to assess and manage his or her pain. See Appendix N: Strategies Recommended for Infant and Children Pain (Acute) Management
  • To view the Strategies Recommended for Infact and Children Pain Management click here
  • The table below identifies some other key assessment and pain management considerations based on population groups; preterm and newborn infants; infants and young children; and older adult.
Population Key Considerations
Preterm and Newborn Preterm and sick infants are exposed to numerous painful
Infants Procedures during their hospitalization. Prevention and consistent management of pain is important to reduce adverse effects affiliated with repeated painful procedures. When planning drug dose, infant weight must be taken into consideration.
Infants and Young Children

Both sick and healthy infants and young children are exposed to multiple painful procedures during hospitalization and early childhood immunizations. Young children lack understanding and coping skills and often exhibit high levels of pain, distress and fear.

Consistent effective management of pain caused by needles has the potential to reduce subsequent fear of medical care. Strategies are available to reduce pain and distress associated with immunization in infants and children.

Older Adult

The older adult may experience communication challenges associated with:

Under reporting of pain,

Speaking a different language, and

Communication barriers (aphasia, cognitive impairments such as dementia, visual and hearing impairments).

When planning pharmacological interventions, the impact of age-related changes such as co-morbidities, co-existent diseases and use of multiple medications must be considered, as they put the older adult at high risk for medication-related adverse events.

Critically ill Many critically ill patients are unable to self-report due to multiple factors such as mechanical ventilation, administration of high doses of sedative agents, and altered levels of consciousness. In addition to their reason for admission often related to pain, they are exposed to many painful procedures during hospitalization in a critical care unit. A high proportion of critically ill patients experience moderate to severe pain. Therefore, pain management includes the use of opioids, mainly through parenteral route. Continuous monitoring of physiologic parameters is necessary to ensure adequate surveillance of patients. Moreover, multi-modal approaches are strongly recommended but have to be carefully established taking according to the complex patient’s condition and use of other medications. Non-pharmacological interventions are also suggested to maximize pain relief.
Clinical Management
Assessment and Management of Pain - 3rd Edition
Point of Care Resources