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GEEDP&#41; of the Asociaci&#243;n Espa&#241;ola de Pediatr&#237;a &#40;Spanish Association of Paediatrics&#41; was formed in 2017 to address this patent need&#46; It consists of 10 paediatricians working in coordination with another 16 professionals that include paediatric anaesthesiologists&#44; paediatric nurses&#44; psychologists and social workers&#44; among others&#46; It advocates for integrative pain management in paediatrics&#44; recommending the application of up-to-date scientific evidence to optimise the diagnosis and management of pain&#44; both acute and chronic&#44; in the different paediatric subpopulations&#44; with the aim of offering standardised solutions to its management&#44; efficacious and applicable in clinical practice&#44; and support for the professionals&#44; relatives&#44; educators and caregivers that live with children suffering from pain&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Definition and types of paediatric pain</span><p id="par0015" class="elsevierStylePara elsevierViewall">In 1973&#44; the International Association for the Study of Pain &#40;IASP&#41; defined pain as &#8220;an unpleasant sensory and emotional experience associated with actual or potential tissue damage&#44; or described in terms of such damage&#46;&#8221;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">2</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Although this definition has remained widely used to present&#44; it has been subject to revisions&#44; criticism and proposals for change during this time&#46; The most recent revision accepted by the IASP was proposed by Amanda Williams and Kenneth Craig in 2016&#58; &#8220;Pain is a distressing experience associated with actual or potential tissue damage with sensory&#44; emotional&#44; cognitive&#44; and social components&#46;&#8221;<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">3</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">This new definition is more comprehensive and&#44; in our opinion&#44; more in line with the concept of total pain&#44; as it describes pain as a distressing and disturbing experience&#44; includes both its emotional and sensory components&#44; and brings up the cognitive and social aspects that had hitherto been missing from the definition&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Williams and Craig highlighted the need to recognise that pain has functional&#44; adaptive value through a broader range of nonverbal behaviours&#46; Macknik and Martinez-Conde<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">4</span></a> have explained how the field of neuroscience has accumulated data on the emotional&#44; cognitive and social dimensions of the experience of pain to the point that the latter could be conceived&#44; rather than as a sensory experience&#44; as a socially shared emotion&#44; taught and learned &#40;thus of a cognitive nature&#41;&#46; In other words&#44; while pain generally results from a physical ailment&#44; its primary root is the individual and shared emotion that emerges at the actual or potential presence of tissue damage&#46; This is the source of the substantial diversity and variability that exists in the way that individuals perceive and handle pain&#46; This suggests that while the management of pain can be approached from an organic perspective&#44; for instance with the use of drugs&#44; among other possible interventions&#44; tools for cognitive&#44; psychological and social care are also of vital importance&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Pain in the paediatric population did not start gaining notice until the 1980s&#44; when evidence emerged on the benefits of the intraoperative administration of opiates&#44; compared to non-administration&#44; in the surgical correction of patent ductus arteriosus&#44;<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">5</span></a> and&#44; as is the case in adults&#44; can be classified in different ways depending on the aspect under consideration for its definition &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#58;<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">-</span><p id="par0040" class="elsevierStylePara elsevierViewall">Duration&#58; <span class="elsevierStyleItalic">acute pain</span> is defined as pain of limited duration resulting from a normal and predictable physiological response to a noxious stimulus&#59; <span class="elsevierStyleItalic">chronic pain</span> is pain lasting more than 3 months that cannot be attributed to an identified organic cause&#59; and <span class="elsevierStyleItalic">procedural pain</span> is pain secondary to diagnostic or therapeutic procedures&#46;</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">-</span><p id="par0045" class="elsevierStylePara elsevierViewall">Pathogenesis&#58; pain may be <span class="elsevierStyleItalic">neuropathic</span> if it results from a direct stimulus on the central nervous system or a lesion in the peripheral nervous system&#44; characterised by sensory abnormalities such as burning sensations&#44; allodynia or dysesthesias&#44; among others&#59; <span class="elsevierStyleItalic">nociceptive</span>&#44; which itself can be classified into <span class="elsevierStyleItalic">somatic</span>&#44; which develops at the musculoskeletal level&#44; the skin or blood vessels as sharp and localised pain&#44; and <span class="elsevierStyleItalic">visceral</span>&#44; which results from the abnormal stimulation of visceral receptors and may radiate beyond the region where it originates&#59; and <span class="elsevierStyleItalic">mixed pain</span>&#44; which combines characteristics of neuropathic and nociceptive pain&#46;</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">-</span><p id="par0050" class="elsevierStylePara elsevierViewall">Course&#58; pain is <span class="elsevierStyleItalic">continuous</span> if it persists through the day and does not relent&#59; <span class="elsevierStyleItalic">intermittent</span> if it comes and goes&#59; <span class="elsevierStyleItalic">incident</span> if it develops in association with a specific and avoidable cause&#59; and&#47;or <span class="elsevierStyleItalic">irruptive</span> &#40;or perhaps <span class="elsevierStyleItalic">irruptor</span><a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">6</span></a>&#41;&#44; when there is a transient exacerbation of pain without an identifiable incident cause in a context of adequate pain control&#46;</p></li><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">-</span><p id="par0055" class="elsevierStylePara elsevierViewall">Intensity&#58; there is <span class="elsevierStyleItalic">mild</span>&#44; <span class="elsevierStyleItalic">moderate</span> and <span class="elsevierStyleItalic">intense pain</span> classified based on assessment by means of intensity scales validated for the specific age group &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46;</p></li></ul></p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0060" class="elsevierStylePara elsevierViewall">However&#44; despite this classification being identical to that of pain in adults&#44; the substantial diversity encompassed in the paediatric age range &#40;from newborns to adolescents&#41; entails a physical and cognitive variability that has a direct impact on the subjective experience of pain&#46; Furthermore&#44; we must take into account that when a painful stimulus persists during critical stages in brain development&#44; the neuroanatomical changes that it may drive could be permanent&#44; predisposing the child to have a lower threshold for pain for life&#44; a phenomenon known in paediatrics as <span class="elsevierStyleItalic">chronic hyperalgesia</span>&#46;<a class="elsevierStyleCrossRefs" href="#bib0200"><span class="elsevierStyleSup">1&#44;7</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">These are aspects that need to be considered by health professionals that care for paediatric patients with pain in order to initiate pharmacological and nonpharmacological treatment with minimum delay&#46; Furthermore&#44; providers must adapt these treatments to the individual characteristics and previous experiences of each patient&#46; Thus&#44; patients will receive adequate analgesia and be provided with a high degree of comfort in situations where they experience pain&#44; be it mild&#44; moderate or intense&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Scope of the problem</span><p id="par0070" class="elsevierStylePara elsevierViewall">Determining the prevalence of pain in the paediatric population is a challenge&#44; not only due to its multiple possible presentations &#40;acute&#44; chronic&#44; nociceptive&#44; neuropathic&#44;&#8230;&#41;&#44; causes &#40;diseases&#44; procedures&#44; surgery&#41; or the broad age range that makes this population so diverse &#40;newborns&#44; infants&#44; school-aged children&#44; adolescents&#41;&#44; but also&#44; and more importantly&#44; due to the sheer scarcity of studies focused on paediatric patients in the literature&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">We now proceed to summarise prevalence data for paediatric pain classified by aetiology &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Pain in emergency departments</span><p id="par0080" class="elsevierStylePara elsevierViewall">Pain is a common symptom in children seeking care in emergency departments&#44; with the prevalence ranging&#44; depending on the author&#44; from 30&#37; to 78&#37; of emergency visits pooling the data for presenting complaints involving pain secondary to episodic illness&#44; acute injury and exacerbations of chronic diseases&#46;<a class="elsevierStyleCrossRefs" href="#bib0235"><span class="elsevierStyleSup">8&#44;9</span></a></p><p id="par0085" class="elsevierStylePara elsevierViewall">Musculoskeletal injuries are the most frequent cause of pain associated with acute injury<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">10</span></a>&#59; in fact&#44; between 27&#37; and 42&#37; of children have a bone fracture before age 16 years&#46; Other common types of pain are headache&#44; ear pain&#44; throat pain and abdominal pain&#46;<a class="elsevierStyleCrossRefs" href="#bib0245"><span class="elsevierStyleSup">10&#8211;12</span></a> Furthermore&#44; more than half of these patients report pain of moderate to intense severity&#46;<a class="elsevierStyleCrossRefs" href="#bib0245"><span class="elsevierStyleSup">10&#44;13</span></a></p><p id="par0090" class="elsevierStylePara elsevierViewall">On the other hand&#44; it is important to take into account that being in a noisy and crowded emergency department may be a frightening experience to a child in pain&#44; especially if compounded by the need to undergo a diagnostic or therapeutic procedure&#46;<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">14</span></a></p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Pain during procedures</span><p id="par0095" class="elsevierStylePara elsevierViewall">A recent study in hospitalised paediatric patients found that up to 78&#37; undergo at least 1 painful procedure during their stay&#44; with a mean of 6 procedures or more per child&#44;<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">15</span></a> and despite the increased awareness at present&#44; authors still report that paediatric patients continue to receive insufficient analgesia when they undergo painful diagnostic or therapeutic procedures compared to adult patients&#44;<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">16</span></a> and worse still&#44; that up to 22&#37; of paediatric patients do not receive any type of care for pain prevention&#46;<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">17</span></a></p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Pain in paediatric inpatients</span><p id="par0100" class="elsevierStylePara elsevierViewall">Throughout the years&#44; numerous studies have reported that pain in hospitalised paediatric patients is both frequent and undertreated&#46;<a class="elsevierStyleCrossRefs" href="#bib0285"><span class="elsevierStyleSup">18&#44;19</span></a> Recent studies show that this situation has changed very little&#46;<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">20</span></a></p><p id="par0105" class="elsevierStylePara elsevierViewall">In addition to being a part of the situation leading to hospitalisation in children&#44; pain is an element associated with many interactions of paediatric patients with their health providers &#40;vaccinations&#44; collection of samples for analysis&#44; placement of vascular catheters&#44; diagnostic and therapeutic procedures&#8230;&#41;&#44; and some authors estimate that up to 77&#37; of paediatric inpatients experience pain during hospitalisation&#46;<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">21</span></a></p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Postoperative pain</span><p id="par0110" class="elsevierStylePara elsevierViewall">Adequate management of postoperative pain in children requires a dynamic approach encompassing the perioperative period&#44; any potential pain after discharge and the possible development of persistent pain after surgery&#46;<a class="elsevierStyleCrossRef" href="#bib0305"><span class="elsevierStyleSup">22</span></a> Numerous studies have described the multiple scenarios where this is not the case&#44; and have specifically collected data on the postoperative pain reported by paediatric patients after general and&#47;or urologic surgery&#44; experienced as moderate or moderate-to-intense by more than 70&#37;&#46;<a class="elsevierStyleCrossRefs" href="#bib0310"><span class="elsevierStyleSup">23&#44;24</span></a></p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Chronic pain</span><p id="par0115" class="elsevierStylePara elsevierViewall">Chronic pain&#44; as demonstrated by some authors&#44; is also a prevalent problem in the paediatric age group&#44; and it has been reported that up to 30&#37; of this entire population experiences pain daily&#46;<a class="elsevierStyleCrossRefs" href="#bib0320"><span class="elsevierStyleSup">25&#44;26</span></a> The most frequent complaints reported are headache &#40;65&#46;6&#37;&#41;&#44; abdominal pain &#40;47&#46;7&#37;&#41;&#44; pain in the extremities &#40;46&#46;4&#37;&#41; and back pain &#40;38&#46;6&#37;&#41;&#46; In addition&#44; in 35&#37; the pain lasts longer than 6 months&#44; which in itself is evidence of a prevalence of pain as an illness in itself that is greater than expected&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">Taking all of the above into account&#44; it is reasonable to surmise that paediatric pain&#44; in any of its forms&#44; is present in a great number of children&#46; We ought to underscore that this is what we have found by reviewing solely the findings of studies specifically designed to identify paediatric pain&#46; Its actual prevalence would probably turn out to be much higher if we assessed for the presence of pain routinely in everyday paediatrics clinical practice &#40;outpatient clinics&#44; primary care&#44; emergency departments&#8230;&#41;&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">Thus&#44; it is a fact that paediatric pain is a very prevalent condition that impacts quality of life in patients and their families&#46; Furthermore&#44; as evinced by some authors&#44; not experiencing pain during illness is of utmost importance for paediatric patients and their families&#44; who rank adequate pain relief as most important in satisfaction surveys second only to an accurate diagnosis&#46;<a class="elsevierStyleCrossRef" href="#bib0330"><span class="elsevierStyleSup">27</span></a></p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Definition of barriers &#40;awareness&#44; training&#44; myths&#44; heterogeneity of assessment scales&#46;&#46;&#46;&#41;</span><p id="par0130" class="elsevierStylePara elsevierViewall">While there has been evident improvement in the management and control of paediatric pain in the past few years and there is an increasing awareness and desire to be trained specifically on this subject on the part of health professionals&#44;<a class="elsevierStyleCrossRef" href="#bib0335"><span class="elsevierStyleSup">28</span></a> there are still numerous barriers and myths that hinder the adequate assessment and treatment of paediatric pain&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">Among the barriers&#44; from the Group on Paediatric Pain of the AEP&#44; based on what has been described by physicians and the nursing staff&#44;<a class="elsevierStyleCrossRef" href="#bib0340"><span class="elsevierStyleSup">29</span></a> we would like to highlight the challenges posed by the assessment of pain due to the inconsistency in its documentation&#44; the multiplicity of the scales available based on age group or the type of pain and the lack of training in their use and interpretation&#46; Other reported barriers include a lack of time&#44; excessive workloads and a lack of resources for the implementation of nonpharmacological interventions&#46; In some instances&#44; gaps in information-sharing between professionals can also impact the degree of adherence to pharmacological treatment and contribute to the difficulty reported by family members regarding their ability to assess pain in their children&#44; which results in a decreased involvement of the family in the pain management process&#46;<a class="elsevierStyleCrossRefs" href="#bib0345"><span class="elsevierStyleSup">30&#44;31</span></a></p><p id="par0140" class="elsevierStylePara elsevierViewall">Some of the myths that persist to date are that paediatric patients feel pain less intensely compared to adults&#44; that they may not remember pain depending on the stage of development when it is experienced&#44; or that pain during childhood does not have any future consequences&#46;<a class="elsevierStyleCrossRef" href="#bib0355"><span class="elsevierStyleSup">32</span></a> By now&#44; the concept of chronic hyperalgesia has been recognised&#44; and it is known that the immaturity of the central nervous system of newborns and infants&#44; far from entailing a reduced sensitivity to pain&#44; actually increases their vulnerability to it&#46; Even in preterm newborns delivered at 25 week&#39;s gestation&#44; in whom&#44; on one hand&#44; the ascending nociceptive afferent pathways are present and functional&#44; while the descending inhibitory pathways &#40;which modulate and regulate the input delivered by the ascending pathways&#41; are not functional until several weeks or months post birth&#44; and on the other&#44; they produce fewer concentrations of inhibitory neurotransmitters while the amounts of cortisol and catecholamine secreted in response to stress are the same as those in adults&#46;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">1</span></a></p><p id="par0145" class="elsevierStylePara elsevierViewall">To these barriers and myths we need to add the apprehension that inexperienced clinicians feel about prescribing analgesic drugs at doses or for indications that are off-label for the treatment of pain in the paediatric population&#44; as poor management of such medication could result in unwanted and harmful side effects that may be difficult to manage&#46;<a class="elsevierStyleCrossRef" href="#bib0355"><span class="elsevierStyleSup">32</span></a></p><p id="par0150" class="elsevierStylePara elsevierViewall">In the long term&#44; barriers and myths result in paediatric patients with pain being undertreated&#44; with an increase in morbidity and mortality and a higher frequency of deleterious pathophysiological effects after suffering acute pain compared to paediatric patients with pain that have received adequate analgesia &#40;acute hyperalgesia&#41;&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Justification of the fifth vital sign&#58; &#8220;that which we do not diagnose properly&#44; we do not treat properly&#8221;</span><p id="par0155" class="elsevierStylePara elsevierViewall">With the support of the World Health Organization&#44; many scientific associations are advocating for the recognition of pain relief as a human right&#44; and multiple documents and studies also corroborate the importance of assessing and management of paediatric pain&#46;<a class="elsevierStyleCrossRefs" href="#bib0360"><span class="elsevierStyleSup">33&#44;34</span></a> This unquestionably requires the documentation of pain in a prominent space in the health records to make this information visible to all other professionals involved in care&#44; detailing the degree and type of pain of the patient at a given time or through the entire care process&#44; both in outpatient and inpatient care&#46;</p><p id="par0160" class="elsevierStylePara elsevierViewall">This necessity has been set as a priority by different organizations and accreditation programmes&#46; Thus&#44; for instance&#44; Joint Commission for the Accreditation of Health Care Organizations &#40;JCAHO&#41; established standards for pain assessment and management in 2001 and currently requires for hospitals in the United States to have established policies regarding the assessment and management of pain and to ensure that the staff is adequately informed of and adheres to them&#46;<a class="elsevierStyleCrossRefs" href="#bib0370"><span class="elsevierStyleSup">35&#44;36</span></a> Similarly&#44; the Statement on Patient&#39;s Rights to Pain Management of the Australian and New Zealand College of Anaesthetists &#40;ANZCA&#41;&#44; in its third point&#44; affirms that in addition to having the right to pain assessment&#44; patients also have the right to have the results of such assessments recorded periodically&#46;<a class="elsevierStyleCrossRef" href="#bib0380"><span class="elsevierStyleSup">37</span></a></p><p id="par0165" class="elsevierStylePara elsevierViewall">Thus&#44; pain&#44; in requiring initial and thereafter periodic assessment in the approach to the clinical process&#44; has tacitly become the de facto fifth vital sign documented in clinical charts along with the temperature&#44; heart rate&#44; respiratory rate and blood pressure&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Position of the AEP through its working group</span><p id="par0170" class="elsevierStylePara elsevierViewall">Pain is a reality in the paediatric age group&#44; and its management must be a priority in health care practice&#46;</p><p id="par0175" class="elsevierStylePara elsevierViewall">From the Group on Paediatric Pain of the AEP&#44; in considering health care professionals responsible for the health of paediatric patients and recognising that adequate management of paediatric pain is part of correct and necessary practice&#44; we view the appropriate management of pain in the paediatric age group as a moral imperative&#46; Consequently&#44; we recommend including the assessment of pain as the fifth vital sign in each minor receiving health care of any kind&#44; irrespective of the presenting complain&#44; underlying disease or care setting&#46;</p><p id="par0180" class="elsevierStylePara elsevierViewall">We also deem it essential to develop health care protocols for the documentation and treatment of pain as the fifth vital sign in paediatric clinics&#44; as has been done in the hospitals that serve as a reference to justify the usefulness of such records and their application in clinical practice&#46;<a class="elsevierStyleCrossRef" href="#bib0385"><span class="elsevierStyleSup">38</span></a></p><p id="par0185" class="elsevierStylePara elsevierViewall">We propose rating the severity of pain in paediatric patients using a scale applicable to the specific age group and clinical circumstances and that is widely used&#44; and from that point documenting in the chart the nature of the pain according to the following parameters&#58; intensity&#44; location&#44; characteristics and duration of pain&#46; These observations should be recorded at admission and discharge and at least once per shift in inpatient care and once per visit in outpatient care&#46; It would also be convenient for clinical software applications in health care facilities to include a section for recording specific information about pain episodes&#58; side effects&#44; treatment&#44; nonpharmacological interventions&#44; etc&#46;</p><p id="par0190" class="elsevierStylePara elsevierViewall">As asserted in the document published by the Ministry of Health&#44; Social Policy and Equality of Spain&#44; <span class="elsevierStyleItalic">Unidad del tratamiento del dolor&#58; est&#225;ndares y recomendaciones</span> &#40;&#8220;The pain management unit&#58; standards and recommendations&#8221;&#41;&#58; &#8220;if these data were recorded routinely&#44; we would be able to established unified criteria and establish protocols for the management of paediatric pain that could be applied by all professionals and that could be documented and reviewed at any point in care delivery to assess the baseline of pain and the level that is achieved after each intervention&#46;&#8221;<a class="elsevierStyleCrossRef" href="#bib0390"><span class="elsevierStyleSup">39</span></a></p><p id="par0195" class="elsevierStylePara elsevierViewall">To conclude&#44; from the Group on Paediatric Pain of the AEP&#44; we propose that&#44; once the charting of paediatric pain is included as the fifth vital sign in health records&#44; indicators be formulated to assess whether the criteria used to define adherence to the protocol are being met&#46;</p><p id="par0200" class="elsevierStylePara elsevierViewall">The strategies discussed will not only help ensure the delivery of comprehensive care to patients in the area of paediatric pain&#44; but will also result in the availability of detailed&#44; accessible&#44; standardised and real information on the condition of patients as regards pain&#44; which will in turn help professionals apply uniform standards in the assessment and management of pain&#46;</p></span></span></span>"
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      "en" => array:2 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">The Spanish Group for Children&#39;s Pain Study was created in 2017 in an aim to prevent&#44; remove or reduce pain in neonates&#44; infants&#44; children and adolescents&#46; Along with a diagnosis of pain&#44; a paediatric patient may suffer from acute or chronic pain&#44; neuropathic&#44; nociceptive&#44; or mixed pain&#44; as well as pain from procedures&#44; and post-surgical pain&#46; Pain suffering is too often ignored and not diagnosed&#46; As a result of this&#44; pain prevention and pain treatment fails&#46; Acute pain prevalence in scientific literature is estimated to be between 22&#37; &#40;procedures pain&#41; and 77&#37; &#40;pain on patients in emergency departments and in hospital wards&#41;&#46; Furthermore&#44; up to 30&#37; of children could suffer from chronic pain during their childhood&#46; Among the barriers detected in pain management are&#58; difficult assesment caused by a lack of unity in pain registry&#44; difficulties due to the choice of an assessment pain scale &#40;according to age and type of pain&#41;&#44; and the absence of training in the management and interpretation of these pain scales&#46; Additionally&#44; in some health areas there is a high workload pressure and generally there are communication difficulties between professionals&#44; and between them and families&#46;</p><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">From this AEP working group our clear positioning is expressed in the recommendation of the systematic assessment and recording of pain in all children treated in the health system&#44; thus considering pain as the fifth constant to be determined after the other vital signs&#46;</p></span>"
      ]
      "es" => array:2 [
        "titulo" => "Resumen"
        "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">El Grupo Espa&#241;ol para el Estudio del Dolor Pedi&#225;trico &#40;GEEDP&#41; se forma en 2017 con el objetivo de ayudar a reducir o eliminar el dolor de los neonatos&#44; lactantes&#44; ni&#241;os y adolescentes&#46; Ante un mismo diagn&#243;stico de dolor&#44; los pacientes pueden padecer dolores agudos&#44; cr&#243;nicos&#44; por procedimientos&#44; postoperatorio&#44; nociceptivos&#44; neurop&#225;ticos o mixtos&#46; Sin una adecuada valoraci&#243;n cl&#237;nica basada en la edad&#44; la enfermedad de base y el tipo de dolor sospechado&#44; este sufrimiento pasa desapercibido con demasiada frecuencia y como consecuencia es infratratado y poco prevenido&#46; La prevalencia del dolor agudo en Pediatr&#237;a es dif&#237;cil de estimar y seg&#250;n la evidencia cient&#237;fica actual&#44; podemos determinar que var&#237;a entre un 22&#37; &#40;dolor por procedimientos&#41; y un 77&#37; &#40;dolor en los pacientes de urgencias y en las plantas de hospitalizaci&#243;n&#41;&#59; con relaci&#243;n al dolor cr&#243;nico&#44; hasta un 30&#37; de los ni&#241;os pueden padecerlo en alg&#250;n momento de su vida&#46; Entre las barreras detectadas en el diagn&#243;stico de dolor se encuentran&#58; la dificultad para su valoraci&#243;n por falta de unidad en su registro&#44; existencia de diversas escalas de valoraci&#243;n &#40;seg&#250;n edad y tipo de dolor&#41; y por la ausencia de formaci&#243;n en manejo e interpretaci&#243;n de estas&#46; A esto se puede sumar&#44; en seg&#250;n qu&#233; &#225;mbitos sanitarios&#44; la elevada presi&#243;n asistencial y las dificultades de comunicaci&#243;n entre profesionales y entre estos con las familias&#46;</p><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Desde nuestro grupo de trabajo de la AEP deseamos manifestar nuestro claro posicionamiento en la recomendaci&#243;n de la valoraci&#243;n y registro del dolor de forma sistem&#225;tica en todos los ni&#241;os atendidos en el sistema sanitario&#44; considerando as&#237; el dolor como la quinta constante a determinar despu&#233;s de las constantes vitales&#46;</p></span>"
      ]
    ]
    "NotaPie" => array:1 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Leyva Carmona M&#44; Torres Luna R&#44; Ortiz San Rom&#225;n L&#44; Marsinyach Ros I&#44; Navarro Marchena L&#44; Mangudo Paredes AB&#44; et al&#46; Documento de posicionamiento del Grupo Espa&#241;ol para el Estudio del Dolor Pedi&#225;trico &#40;GEEDP&#41; de la Asociaci&#243;n Espa&#241;ola de Pediatr&#237;a sobre el registro del dolor como quinta constante&#46; An Pediatr &#40;Barc&#41;&#46; 2019&#59;91&#58;58&#46;</p>"
      ]
    ]
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        "etiqueta" => "Table 1"
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Type of pain based on&#58;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Duration</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Acute&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Chronic&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Cause</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Nociceptive&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Somatic visceral&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Neuropathic&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Mixed&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Course</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Continuous&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Intermittent&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Incident&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Irruptive&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Intensity</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Mild&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Moderate&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Intense&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
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        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Classification of pain&#46;</p>"
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      ]
      1 => array:8 [
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              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Percentage&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Author and bibliographic reference&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Pain in emergency care</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">30&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Grant PS<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">8</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">78&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Gaglani A&#44; Gross T<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">9</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Causes</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Musculoskeletal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="5" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">27&#37;&#8211;42&#37;</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Downing A&#44; Rudge G<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">10</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Headache&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Cooper C&#44; Dennison EM&#44; Leufkens HG&#44; Bishop N&#44; van Staa TP<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">11</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Ear pain&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Walker DM&#44; Teach SJ<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">12</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Painful swallowing&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Abdominal pain&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Procedural pain</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>At least one painful procedure during hospitalisation&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">78&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Baruch S Krauss&#44; Lorenzo Calligaris&#44; Steven M Green&#44; Egidio Barbi<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">15</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>No analgesia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">22&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Dowden S&#44; McCarthy M&#44; Chalkiadis G<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">17</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Pain in inpatients</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">77&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">EM Taylor&#44; K Boyer&#44; FA Campbell<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">21</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Postsurgical pain</span></td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#62;70&#37;</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Cai Y&#44; Lopata L&#44; Roh A<a class="elsevierStyleCrossRef" href="#bib0310"><span class="elsevierStyleSup">23</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Emons MI&#44; Petzke F&#44; Stamer UM<a class="elsevierStyleCrossRef" href="#bib0315"><span class="elsevierStyleSup">24</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Chronic pain</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">30&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Huguet A&#44; Mir&#243; J<a class="elsevierStyleCrossRef" href="#bib0320"><span class="elsevierStyleSup">25</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">King S&#44; Chambers CT&#44; Huguet A<a class="elsevierStyleCrossRef" href="#bib0325"><span class="elsevierStyleSup">26</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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        0 => array:2 [
          "identificador" => "bibs0015"
          "bibliografiaReferencia" => array:39 [
            0 => array:3 [
              "identificador" => "bib0200"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "El dolor de los ni&#241;os&#58; &#191;un gran desconocido o un gran olvidado&#63;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "F&#46; Reinoso-Barbero"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Rev Soc Esp Dolor"
                        "fecha" => "2000"
                        "volumen" => "7"
                        "paginaInicial" => "277"
                        "paginaFinal" => "278"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0205"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Part III&#58; Pain terms&#44; a current list with definitions and notes on usage&#44; classification of chronic pain&#44; iasp task force on taxonomy"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "H&#46; Merskey"
                            1 => "N&#46; Bogduk"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Libro" => array:4 [
                        "edicion" => "2nd ed&#46;"
                        "fecha" => "1994"
                        "editorial" => "Iasp Press"
                        "editorialLocalizacion" => "Seattle"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0210"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Updating the definition of pain"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "A&#46;C&#46; Williams"
                            1 => "K&#46;D&#46; Craig"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/j.pain.0000000000000613"
                      "Revista" => array:6 [
                        "tituloSerie" => "Pain"
                        "fecha" => "2016"
                        "volumen" => "157"
                        "paginaInicial" => "2420"
                        "paginaFinal" => "2423"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27200490"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0215"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "No brain&#44; no pain&#46; Pain is an emotion"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "S&#46; Macknik"
                            1 => "S&#46; Martinez-Conde"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1038/scientificamericanmind0716-1"
                      "Revista" => array:3 [
                        "tituloSerie" => "Sci Am Mind"
                        "fecha" => "2016"
                        "volumen" => "25"
                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "identificador" => "bib0220"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Randomised trial of fentanyl anaesthesia in preterm babies undergoing surgery&#58; effects on the stress response"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "K&#46;J&#46; Anand"
                            1 => "W&#46;G&#46; Sippell"
                            2 => "A&#46; Aynsley-Green"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Lancet"
                        "fecha" => "1987"
                        "volumen" => "1"
                        "paginaInicial" => "62"
                        "paginaFinal" => "66"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12849547"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0225"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "El dolor irruptor&#58; &#191;solo oncol&#243;gico&#63;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "V&#46; Ignacio"
                          ]
                        ]
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                    ]
                  ]
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                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Rev Soc Esp Dolor"
                        "fecha" => "2016"
                        "volumen" => "23"
                        "paginaInicial" => "3"
                        "paginaFinal" => "5"
                      ]
                    ]
                  ]
                ]
              ]
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              "identificador" => "bib0230"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Clinical implications of unmanaged needle-insertion pain and distress in children"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "R&#46;M&#46; Kennedy"
                            1 => "J&#46; Luhmann"
                            2 => "W&#46;T&#46; Zempsky"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Pediatrics"
                        "fecha" => "2008"
                        "volumen" => "122"
                        "paginaInicial" => "130"
                        "paginaFinal" => "133"
                      ]
                    ]
                  ]
                ]
              ]
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              "identificador" => "bib0235"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Analgesia delivery in the Emergency Departement"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "P&#46;S&#46; Grant"
                          ]
                        ]
                      ]
                    ]
                  ]
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                    0 => array:2 [
                      "doi" => "10.1016/j.ajem.2006.05.004"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Emerg Med"
                        "fecha" => "2006"
                        "volumen" => "24"
                        "paginaInicial" => "806"
                        "paginaFinal" => "809"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17098101"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib0240"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Pediatric pain management"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "A&#46; Gaglani"
                            1 => "T&#46; Gross"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.emc.2017.12.002"
                      "Revista" => array:6 [
                        "tituloSerie" => "Emerg Med Clin North Am"
                        "fecha" => "2018"
                        "volumen" => "36"
                        "paginaInicial" => "323"
                        "paginaFinal" => "334"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29622325"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib0245"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "A study of childhood attendance at emergency departments in the West Midlands region"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "A&#46; Downing"
                            1 => "G&#46; Rudge"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Emerg Med J"
                        "fecha" => "2006"
                        "volumen" => "23"
                        "paginaInicial" => "391"
                        "paginaFinal" => "393"
                      ]
                    ]
                  ]
                ]
              ]
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              "identificador" => "bib0250"
              "etiqueta" => "11"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Epidemiology of childhood fractures in Britain&#58; a study using the general practice research database"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "C&#46; Cooper"
                            1 => "E&#46;M&#46; Dennison"
                            2 => "H&#46;G&#46; Leufkens"
                            3 => "N&#46; Bishop"
                            4 => "T&#46;P&#46; van Staa"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1359/JBMR.040902"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Bone Miner Res"
                        "fecha" => "2004"
                        "volumen" => "19"
                        "paginaInicial" => "1976"
                        "paginaFinal" => "1981"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15537440"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            11 => array:3 [
              "identificador" => "bib0255"
              "etiqueta" => "12"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Emergency department treatment of primary headaches in children and adolescents"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "D&#46;M&#46; Walker"
                            1 => "S&#46;J&#46; Teach"
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                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/MOP.0b013e3282ff6308"
                      "Revista" => array:6 [
                        "tituloSerie" => "Curr Opin Pediatr"
                        "fecha" => "2008"
                        "volumen" => "20"
                        "paginaInicial" => "248"
                        "paginaFinal" => "254"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18475091"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            12 => array:3 [
              "identificador" => "bib0260"
              "etiqueta" => "13"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Out-of-hospital emergency medicine in pediatric patients&#58; prevalence and management of pain"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "M&#46; Galinski"
                            1 => "N&#46; Picco"
                            2 => "B&#46; Hennequin"
                            3 => "V&#46; Raphael"
                            4 => "A&#46; Ayachi"
                            5 => "A&#46; Beruben"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.ajem.2010.06.031"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Emerg Med"
                        "fecha" => "2011"
                        "volumen" => "29"
                        "paginaInicial" => "1062"
                        "paginaFinal" => "1066"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20685056"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            13 => array:3 [
              "identificador" => "bib0265"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The neurobiologic basis of pediatric pain"
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                            0 => "B&#46;S&#46; Krauss"
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                            3 => "E&#46; Barbi"
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                        "paginaInicial" => "83"
                        "paginaFinal" => "92"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26095580"
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                      "titulo" => "Epidemiology and management of painful procedures in children in Canadian hospitals"
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                            0 => "B&#46; Stevens"
                            1 => "L&#46;K&#46; Abbott"
                            2 => "J&#46; Yamada"
                            3 => "D&#46; Harrison"
                            4 => "J&#46; Stinson"
                            5 => "A&#46; Taddio"
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                    ]
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                      "Revista" => array:5 [
                        "tituloSerie" => "Canadian Med Assoc J"
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                        "paginaInicial" => "E403"
                        "paginaFinal" => "E410"
                      ]
                    ]
                  ]
                ]
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                    0 => array:2 [
                      "titulo" => "Achieving organizational change in pediatric pain management"
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                          "autores" => array:3 [
                            0 => "S&#46; Dowden"
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                            2 => "G&#46; Chalkiadis"
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                    ]
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                        "volumen" => "13"
                        "paginaInicial" => "321"
                        "paginaFinal" => "326"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18719714"
                            "web" => "Medline"
                          ]
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                  ]
                ]
              ]
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "The prevalence of pain in hospitalized patients and resolution over six months"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "F&#46;V&#46; Abbott"
                            1 => "K&#46; Gray-Donald"
                            2 => "M&#46;J&#46; Sewitch"
                            3 => "C&#46;C&#46; Johnston"
                            4 => "L&#46; Edgar"
                            5 => "M&#46;E&#46; Jeans"
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                    0 => array:1 [
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                        "tituloSerie" => "Pain"
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                        "paginaInicial" => "15"
                        "paginaFinal" => "28"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/1513602"
                            "web" => "Medline"
                          ]
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                      ]
                    ]
                  ]
                ]
              ]
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "A survey of pain in hospitalized patients aged 4&#8211;14 years"
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                            0 => "C&#46;C&#46; Johnston"
                            1 => "F&#46;V&#46; Abbott"
                            2 => "K&#46; Gray-Donald"
                            3 => "M&#46;E&#46; Jeans"
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                      ]
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                        "tituloSerie" => "Clin J Pain"
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                        "paginaInicial" => "154"
                        "paginaFinal" => "163"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/1633379"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
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                    0 => array:2 [
                      "titulo" => "The hidden error of mismanaged pain&#58; a systems approach"
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                          "autores" => array:3 [
                            0 => "J&#46;A&#46; McNeill"
                            1 => "G&#46;D&#46; Sherwood"
                            2 => "P&#46;L&#46; Starck"
                          ]
                        ]
                      ]
                    ]
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                      "Revista" => array:5 [
                        "tituloSerie" => "J Pain Symptom Manag"
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                        "volumen" => "28"
                        "paginaInicial" => "47"
                        "paginaFinal" => "58"
                      ]
                    ]
                  ]
                ]
              ]
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Pain in hospitalized children&#58; a prospective cross-sectional survey of pain prevalence&#44; intensity&#44; assessment and management in a Canadian pediatric teaching hospital"
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                        0 => array:2 [
                          "etal" => false
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                            2 => "F&#46;A&#46; Campbell"
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                    ]
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                        "paginaInicial" => "25"
                        "paginaFinal" => "32"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18301813"
                            "web" => "Medline"
                          ]
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                      ]
                    ]
                  ]
                ]
              ]
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Pain after surgery in children&#58; clinical recommendations"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "S&#46;M&#46; Walker"
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                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Curr Opin Anaesthesiol"
                        "fecha" => "2015"
                        "volumen" => "28"
                        "paginaInicial" => "570"
                        "paginaFinal" => "576"
                      ]
                    ]
                  ]
                ]
              ]
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              "identificador" => "bib0310"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Factors influencing postoperative pain following discharge in pediatric ambulatory surgery patients"
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                          "etal" => true
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                            2 => "A&#46; Roh"
                            3 => "M&#46; Huang"
                            4 => "M&#46;A&#46; Monteleone"
                            5 => "S&#46; Wang"
                          ]
                        ]
                      ]
                    ]
                  ]
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                    0 => array:2 [
                      "doi" => "10.1016/j.jclinane.2017.03.033"
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                        "tituloSerie" => "J Clin Anesth"
                        "fecha" => "2017"
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                        "paginaFinal" => "104"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28494878"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "identificador" => "bib0315"
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              "referencia" => array:1 [
                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Current practice of acute pain management in children&#8212;a national follow-up survey in Germany"
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                            2 => "U&#46;M&#46; Stamer"
                            3 => "W&#46; Mei&#223;ner"
                            4 => "R&#46; Koschwitz"
                            5 => "J&#46; Erlenwein"
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                      ]
                    ]
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                    0 => array:2 [
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                        "tituloSerie" => "Paediatr Anaesth"
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                        "paginaInicial" => "883"
                        "paginaFinal" => "890"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27461766"
                            "web" => "Medline"
                          ]
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                ]
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "The severity of chronic pediatric pain&#58; an epidemiological study"
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                    ]
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                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
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                        "paginaInicial" => "226"
                        "paginaFinal" => "236"
                      ]
                    ]
                  ]
                ]
              ]
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "The epidemiology of chronic pain in children and adolescents revisited&#58; a systematic review"
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                            2 => "A&#46; Huguet"
                            3 => "R&#46;C&#46; MacNevin"
                            4 => "P&#46;J&#46; McGrath"
                            5 => "L&#46; Parker"
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                    0 => array:2 [
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                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22078064"
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                ]
              ]
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              "identificador" => "bib0330"
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              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Guideline for the management of pain in children"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "Clinical Effectiveness Committee"
                          ]
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                    0 => array:1 [
                      "Libro" => array:2 [
                        "fecha" => "2010"
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                  ]
                ]
              ]
            ]
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Pediatric and emergency medicine residents&#8217; attitudes and practices for analgesia and sedation during lumbar puncture in pediatric patients"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "V&#46;R&#46; Breakey"
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                            2 => "R&#46;D&#46; Goldman"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1542/peds.2006-3527"
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                        "tituloSerie" => "Pediatrics"
                        "fecha" => "2007"
                        "volumen" => "119"
                        "paginaInicial" => "631"
                        "paginaFinal" => "636"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17332220"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
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            28 => array:3 [
              "identificador" => "bib0340"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Nurses&#8217; views about the barriers and facilitators to effective management of pediatric pain"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "A&#46; Twycross"
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                    ]
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                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Pain Manag Nurs"
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                        "paginaInicial" => "64"
                        "paginaFinal" => "72"
                      ]
                    ]
                  ]
                ]
              ]
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Problems and barriers in ensuring effective acute and post-operative pain management&#8212;an international perspective"
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                        0 => array:2 [
                          "etal" => false
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                        ]
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                    ]
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                    0 => array:2 [
                      "doi" => "10.17219/acem/26394"
                      "Revista" => array:6 [
                        "tituloSerie" => "Adv Clin Exp Med"
                        "fecha" => "2015"
                        "volumen" => "24"
                        "paginaInicial" => "905"
                        "paginaFinal" => "910"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26768644"
                            "web" => "Medline"
                          ]
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                    ]
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                ]
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              "identificador" => "bib0350"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Missed opportunities&#58; a case study of barriers to the delivery of palliative care on neonatal intensive care units"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "M&#46; Martin"
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                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Int J Palliat Nurs"
                        "fecha" => "2013"
                        "volumen" => "19"
                        "paginaInicial" => "251"
                        "paginaFinal" => "256"
                      ]
                    ]
                  ]
                ]
              ]
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            31 => array:3 [
              "identificador" => "bib0355"
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Pain in children &#40;part I&#41;&#58; history&#44; pathophysiology&#44; assessment and implications"
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                        0 => array:2 [
                          "etal" => false
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                            0 => "M&#46;C&#46; Casado"
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                    0 => array:1 [
                      "Revista" => array:3 [
                        "tituloSerie" => "Medwave"
                        "fecha" => "2004"
                        "volumen" => "4"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            32 => array:3 [
              "identificador" => "bib0360"
              "etiqueta" => "33"
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Pain relief&#58; a universal human right"
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                        0 => array:2 [
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                            0 => "M&#46;J&#46; Cousins"
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                        ]
                      ]
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                    0 => array:2 [
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                        "paginaInicial" => "1"
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                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15494176"
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                    ]
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                ]
              ]
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                    0 => array:2 [
                      "titulo" => "Science is not enough&#58; the modern history of pediatric pain"
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                          0 => array:2 [
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                          ]
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                ]
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                    0 => array:2 [
                      "titulo" => "Implementing the new pain managements standards"
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                        0 => array:2 [
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