News in childhood pain - Part 1

Persistent pain in childhood and medical illness can be challenging to manage. The chapter has been revised to give a brief overview of the approach to pain management in some childhood diseases. Better understanding of the etiology of pain mechanisms guide the management of pain. In addition, an understanding of the pathophysiology of the underlying processes and utilizing a stepwise assessment and treatment approach is important. Discussion around the multifaceted approach to childhood pain management incorporating the understanding of the role and place of analgesics in managing these medical illnesses is outline. In addition, appropriate medication or analgesia prescription and the role of nonpharmacological approaches has been considered in this revision.

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Developmental pharmacology of opioids

Oxford Textbook of Paediatric Pain ◽

10.1093/med/9780199642656.003.0044 ◽

2013 ◽

pp. 449-456

Author(s):

Gareth J. Hathway

Keyword(s):

Nervous System ◽

Gold Standard ◽

Early Life ◽

Endogenous Opioid ◽

Clinical Observations ◽

Central Nervous Systems ◽

Endogenous Opioid Systems ◽

Childhood Pain ◽

Opioid Systems

Recognition of the need for alternative analgesic regimens for managing neonatal and childhood pain has led to a rich literature concerning the ways in which early life pain differs from that at older ages. As in adults, opiates are often considered the gold standard analgesic class of drugs, of which morphine is the prototypical agent. There is a wealth of data detailing clinical observations, measurements, and interventions with regard to the use of opioids in treating pain in children. Studies in the early part of this century have highlighted that, in humans, age is an important factor that influences the morphine requirement of neonates following surgery; and dose requirements are influenced by both pharmacokinetic and pharmacodynamic factors. Laboratory studies have extended our understanding of changes within the peripheral and central nervous systems that underlie alterations in nociception in early life. This chapter will review what is currently known about the actions of opioids upon nociceptive and nociresponsive elements of the nervous system in early life, how they differ from adult responses, and ask whether manipulating endogenous opioid systems in early life may have consequences on neurodevelopment.

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Community Parents' Use of Non-Pharmacological Techniques for Childhood Pain Management

Children s Health Care ◽

10.1080/02739615.2012.643286 ◽

2012 ◽

Vol 41 (1) ◽

pp. 1-15 ◽

Cited By ~ 2

Author(s):

Ayala Y. Gorodzinsky ◽

Jessica M. Bernacki ◽

W. Hobart Davies ◽

Amy L. Drendel ◽

Steven J. Weisman

Keyword(s):

Pain Management ◽

Childhood Pain

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Cognitive styles and processes in paediatric pain

Oxford Textbook of Paediatric Pain ◽

10.1093/med/9780199642656.003.0010 ◽

2013 ◽

pp. 95-101 ◽

Cited By ~ 12

Author(s):

Liesbet Goubert ◽

Laura E. Simons

Keyword(s):

Chronic Pain ◽

Facial Pain ◽

Child Outcomes ◽

Cognitive Styles ◽

Child Disability ◽

Behavioural Responses ◽

Children And Parents ◽

Childhood Pain ◽

Protective Behaviours

Chronic pain is prevalent in children and adolescents. The current chapter outlines an interpersonal perspective on child pain, demonstrating the central role of child and parent pain-related cognitions in the development and maintenance of chronic pain in childhood. Pain takes place within a social context: children’s expressions of pain (e.g. facial pain displays) are observed and decoded by others (parents), eliciting emotional and behavioural responses. Parents’ responses may impact child outcomes in two ways, directly by imposing activity limitations/encouraging activity engagement or indirectly through observational learning. Although personality and temperamental factors may predispose children and parents to perceive pain as more or less threatening to deal with, the model presented in this chapter focuses on proximal pain-related cognitive processes and associated behaviours that contribute to pain-related disability in children. Recent evidence suggests that perceptions of pain as highly threatening (i.e. catastrophizing) may lead to fearful reactions to pain, activity avoidant behaviours, and more disability. In parents, catastrophizing thoughts about child pain are associated with higher levels of child disability, with recent evidence implicating parent protective behaviours as a mediating mechanism.

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