Pain management is a crucial component of surgical recovery for any patient, but there are unique concerns and challenges that comes with managing pain in pediatric patients. While the inherent vulnerability of children is deeply felt by clinicians and families alike, postoperative pain is nevertheless undertreated in this population. A major driver of this issue is that many common procedures require little time in the hospital, leaving most of the recovery to happen at home. Neglected postoperative pain creates short-term issues of sleep disruption, stress, and delayed recovery but can also lead to serious long-term consequences, or even disability.
A central barrier to effectively managing pain following a procedure is reliably assessing a young patient’s pain level.  This task most often falls to parents and other caregivers, and is deceptively difficult. Research reveals two major challenges in pain reporting: a child’s ability to identify and name their pain, and the reliability of measurement instruments to consistently guide a clinical response. Opioids are unsurprisingly a central tool for effectively treating pain in children. For acute pain in particular, they are a powerful option that can provide uniquely immediate relief. However, there are known risks and side effects associated with opioid use that merit heightened caution when opiods are being used by children. Understanding a child’s experience of pain is key to responding with the appropriate balance of analgesics, and this can place an immense amount of pressure on caregivers at home.
Self-reporting is the clinically preferred way to assess pain in children. However, this approach to pain measurement can be difficult among children for reasons that any parent could probably guess—a child may be afraid that sharing about their pain will cause them to return to the hospital, for example, or their social environment might cause them to overstate or understate their pain level. Commonly used instruments take various forms of visual and verbal rating scales, but the evidence is mixed on which tools are the most rigorous and widely applicable across the many developmental stages of childhood.
What if there was a way to solicit a child’s experience of pain through a familiar, less clinical and engaging instrument? This is where the recently developed Panda pain management mobile app is poised to make a difference. The Panda app seeks to improve pediatric postoperative pain management through an engaging and easy-to-use platform. Parents or other caregivers use the app’s walkthrough design to assess and record important aspects of their child’s pain. Then, the app guides them in making decisions about when and how to administer pain medication, tracking when medication is administered to keep families on schedule for future dosages. Users receive medication alerts directly from their phone, much like the many apps families already use to schedule and track their commitments and routines.
Panda was developed by researchers at the University of British Columbia and has already seen promising results in the controlled setting of in-hospital use. Parents piloting the app with the guidance of clinical staff reported that the app was easy to use and could see themselves using it in the home setting. The app is currently being evaluated for in-home use.
Providing families with an easy-to-navigate tool to not just identify pain in children following surgery, but also connect those pain measurements to a medication schedule, could be an important step in better addressing this neglected area of pain management. Pain management is a complex aspect of clinical care for patients regardless of age, and the special concerns of pediatric patients demand innovation beyond merely adapting adult guidelines for younger patients. There are exciting possibilities for the use of smartphone apps like Panda in better describing and alleviating pain in children. Tools that fit neatly into a familiar routine, like a smartphone app, may reduce some of the stress parents face in managing complex pain without clinical support.
 Porter FL, Grunau RE, Anand KJ: Long-term effects of pain in infants. J Dev Behav Pediatr 1999; 20:253–61Porter, FL Grunau, RE Anand, KJ
 Chou, Roger, et al. “Management of Postoperative Pain: a clinical practice guideline from the American pain society, the American Society of Regional Anesthesia and Pain Medicine, and the American Society of Anesthesiologists’ committee on regional anesthesia, executive committee, and administrative council.” The Journal of Pain 17.2 (2016): 131-157.