Summary: Pain is an unpleasant, subjective sensory experience associated with actual or potential tissue damage. Its anatomy and pathophysiology, subjected to multistage regulation, is very complex and not fully understood. The pathways of pain and inflammation cascade have similar mediators. That is why the key role in pain therapy is played by drugs that affect the arachidonic acid routes and cyclooxygenases.
Treatment should be carried out according to four principles developed by the World Health Organization: two-step strategy, by the clock, by the mouth, by the individual, which are discussed in detail in this paper. Nonsteroidal anti-inflammatory drugs (NSAIDs) are the first-line treatment in all age groups. However, it is recommended to use only acetaminophen and ibuprofen in children, due to their favorable safety profile. The acetaminophen and ibuprofen synergy of action makes the combination of these drugs also potentially beneficial in pain and fever management. In case of severe pain or a lack of treatment efficacy, morphine should be used. Other NSAIDs and opioids (e.g. codeine or tramadol) are not recommended due to the high risk of side effects. An assessment of pain intensity should always precede therapy, as it enables its optimization and effectiveness evaluation. The paper contains recommendations on how to assess and treat pain in the general pediatric practice in accordance with WHO standards.