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The Assessment and Management of Chronic Pain in Children

  • Therapy In Practice
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Abstract

Chronic pain in children and adolescents is frequently misdiagnosed by caregivers. It is not treated until it results in the loss of routine ability and function. Chronic pain is often associated with underlying diseases commonly seen in childhood, including sickle cell disease, malignancy, rheumatologic disorders, inflammatory bowel disease, trauma, and states where there is no identifiable etiology. Chronic pain differs from acute pain in that it serves no useful function. Untreated or under-treated chronic pain will result in the unnecessary suffering of the patient, disruption of family routine, and cohesiveness and restriction of the child’s daily activities, thereby increasing long-term disability.

Accurate and repeated assessment of chronic pain is required for therapy to be effective. Assessment of chronic pain in children is difficult due to their developing cognitive abilities. The assessment of childhood pain varies with the child’s age, type of pain, situation, and prior painful experiences. Assessment tools such as the Varni-Thompson Pediatric Pain Questionnaire and the Visual Analog Scale are helpful for both the patient and physician in helping to identify situations that precipitate pain, to rate the level of pain and determine if therapy has been effective. Documentation of pain assessments and the effectiveness of interventions in the medical record should be included as a routine part of all patient records.

Most caregivers have extensive experience in the treatment of acute pain in children but are often not comfortable with the management of complicated and chronic pain states. The therapy for chronic pain in children is multifactorial. It can include agents from multiple classes of pharmacologic agents (nonsteroidal anti-inflammatory drugs, opioids, tricyclic antidepressants, and antineuroleptics) nonconventional therapies (acupuncture and pressure and aromatherapy), as well as herbal and homeopathic remedies.

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References

  1. Shapiro BS. Treatment of chronic pain in children and adolescents. Pediatr Ann 1995; 24(3): 148–56

    PubMed  CAS  Google Scholar 

  2. Campo JV, Di Lorenzo C, Chiappetta L, et al. Adult outcomes of pediatric recurrent abdominal pain: do they just grow out of it. Pediatrics 2001; 108(1): E1–7

    Article  PubMed  CAS  Google Scholar 

  3. Ball AJ, Ferguson S. Analgesia and analgesic drugs in paediatrics. Br J Hosp Med 1996; 55(9): 586–90

    PubMed  CAS  Google Scholar 

  4. Collins JJ, Byrnes ME, Dunkel IJ, et al. The measurement of symptoms in children with cancer. J Pain Symptom Manage 2000; 19(5): 363–77

    Article  PubMed  CAS  Google Scholar 

  5. Cassidy JT. Progress in diagnosing and understanding chronic pain syndromes in children. Curr Opin Rheumatol 1994; 6: 544–54

    Article  PubMed  CAS  Google Scholar 

  6. Franck LS, Greenberg CS, Stevens B. Pain assessment in infants and children. Pediatr Clin North Am 2000; 47(3): 487–512

    Article  PubMed  CAS  Google Scholar 

  7. Mahan KT, Strelecky DC. Recent concepts in understanding a child’s pain. J Am Podiatr Med Assoc 1991; 81(5): 231–42

    PubMed  CAS  Google Scholar 

  8. Garcia J, Altman RD. Chronic pain states: pathophysiology and medical therapy. Semin Arthritis Rheum 1997; 27(1): 1–16

    Article  PubMed  CAS  Google Scholar 

  9. Bonica JJ. Definition and taxonomy of pain. In: Bonica JJ, editor. The management of pain. 2nd ed. Philadelphia (PA): Lea & Febiger, 1990: 18–27

    Google Scholar 

  10. Markenson JA. Mechanisms of chronic pain. Am J Med 1996; 101Suppl. 1A: 6–18S

    Google Scholar 

  11. Wells WE. A review of chronic pain syndromes: etiology, transmission, and treatment. CRNA 1993; 4(4): 187–19

    PubMed  CAS  Google Scholar 

  12. Siddall PJ, Cousins MJ. Pain mechanisms and management: an update. Clin Exp Pharmacol Physiol 1995; 22: 679–88

    Article  PubMed  CAS  Google Scholar 

  13. Urban MO, Gebhart GF. Central mechanisms in pain. Med Clin North Am 1999; 83(3): 585–96

    Article  PubMed  CAS  Google Scholar 

  14. McGrath PA. Evaluating a child’s pain. J Pain Symptom Manage 1989; 4(4): 198–214

    Article  PubMed  CAS  Google Scholar 

  15. McGrath PJ. Report of the subcommittee on assessment and methodologic issues in the management of pain in childhood cancer. Pediatrics 1990; 86(5): 814–7

    PubMed  CAS  Google Scholar 

  16. Tyler DC, Tu A, Douthit J. Toward validation of pain measurement tools for children: a pilot study. Pain 1993; 52: 310–9

    Article  Google Scholar 

  17. Tobias JD. Weak analgesics and nonsteroidal anti-inflammatory agents in the management of children with acute pain. Pediatr Clin North Am 2000; 47(3): 527–43

    Article  PubMed  CAS  Google Scholar 

  18. Insel PA. Analgesic-antipyretic and anti-inflammatory agents and drugs employed in the treatment of gout. In: Hardman JG, Limbird LE, editors. Goodman & Gilman’s the pharmacological basis of therapeutics. 9th ed. New York: McGraw-Hill, 1996: 617–58

    Google Scholar 

  19. Keenan GF, Giannini EH, Athreya BH. Clinically significant gastropathy associated with anti-inflammatory drug use in children with rheumatoid arthritis. J Rheumatol 1995; 22: 1149–51

    PubMed  CAS  Google Scholar 

  20. Ilowite NT. Current treatment of juvenile rheumatoid arthritis. Pediatrics 2002; 109: 109–15

    Article  PubMed  Google Scholar 

  21. Bannwarth B. Risk-benefit assessment of opioids in chronic non-cancer pain. Drug Saf 1999; 21(4): 283–96

    Article  PubMed  CAS  Google Scholar 

  22. Darsey EH, Outlaw AC. Age-related considerations for the use of opioids in pediatric pain management. Pain Digest 1994; 4: 12–20

    Google Scholar 

  23. Grond S, Radbruch L, Lehmann KA. Clinical pharmacokinetics of transdermal opioids. Clin Phamacokinet 2000; 38(1): 59–89

    Article  CAS  Google Scholar 

  24. Bhatt-Mehta V, Rosen DA. Management of acute pain in children. Clin Pharm 1991; 10: 667–85

    PubMed  CAS  Google Scholar 

  25. Marshall BE, Longnecker DE. General anesthetics. In: Hardman JG, Limbird LE, editors. Goodman & Gilman’s the pharmacological basis of therapeutics. 9th ed. New York: McGraw-Hill, 1996: 307–30

    Google Scholar 

  26. Magni G. The use of antidepressants in the treatment of chronic pain. Drugs 1991; 42(5): 730–48

    Article  PubMed  CAS  Google Scholar 

  27. Baldessarini RJ. Drugs and the treatment of psychiatric disorders. In: Hardman JG, Limbird LE, editors. Goodman & Gilman’s the pharmacological basis of therapeutics. 9th ed. New York: McGraw-Hill, 1996: 431–59

    Google Scholar 

  28. Chambliss CR, Anand KJS. Pain management in the pediatric intensive care unit. Curr Opin Pediatr 1997; 9: 246–53

    Article  PubMed  CAS  Google Scholar 

  29. Mellick GA, Mellicy LB. Gabapentin: the management of reflex sympathetic dystrophy [letter]. J Pain Symptom Manage 1995; 10: 265–6

    Article  PubMed  CAS  Google Scholar 

  30. McGraw T, Kosek P. Erythromelalgia pain managed with gabapentin. Anesthesiology 1997; 86(4): 988–90

    Article  PubMed  CAS  Google Scholar 

  31. Ducharme J. Acute pain and pain control: state of the art annals of emergency medicine. Ann Emerg Med 2000; 35(6): 592–603

    Article  PubMed  CAS  Google Scholar 

  32. Neurontin® (gabapentin) capsules, tablets, oral solution [product information]. Morris Plains (NJ): Parke-Davis, a division of Warner-Lambert Co. Revised 2000 Oct

  33. Eisenberg DM, Davis TB, Ettner SL. Trends in alternative medicine use in the United States. JAMA 1998; 280: 1569–75

    Article  PubMed  CAS  Google Scholar 

  34. Spigelblatt L, Laine-Ammara GP, Pless IB, et al. The use of alternative medicine by children. Pediatrics 1994; 94 (6 Pt 1): 811–4

    PubMed  CAS  Google Scholar 

  35. Breuner CC, Barry PJ, Kemper KJ. Alternative medicine use in homeless youth. Arch Pediatr Adolesc Med 1998; 152: 1071–5

    PubMed  CAS  Google Scholar 

  36. Simpson N, Pearce A, Finlay F. The use of complementary medicine by children. Ambul Child Care 1998; 3(4): 351–6

    Google Scholar 

  37. Spigelblatt L. Alternative medicine: a pediatric conundrum. In: Coplin LG, editor. Talking to parents: best of the physicians guide to alternative medicine. Atlanta (GA): American Health Consultants, 2000: 13–9

    Google Scholar 

  38. Krauss HH, Godfrey C, Kirk J. Alternative health care: its use by individuals with physical disabilities. Arch Phys Med Rehabil 1998; 79: 1440–7

    Article  PubMed  CAS  Google Scholar 

  39. NIH Consensus Conference. Acupuncture. JAMA 1998; 280: 1518–24

    Google Scholar 

  40. Kemper KJ, Sarah R, Silver-Highfield E, et al. On pins and needles: pediatric pain patients’ experience with acupuncture. Pediatrics 2000; 105: 941–7

    PubMed  CAS  Google Scholar 

  41. Bille B. Migraine in school children. Acta Pediatr Scand 1962; 51Suppl. 136: 1–151

    Google Scholar 

  42. Sillanpaa M. Changes in the prevalence of migraine and other headaches during the first seven school years. Headache 1983; 23: 15–9

    Article  PubMed  CAS  Google Scholar 

  43. Pintov S, Lahat E, Alstein M, et al. Acupuncture and the opioid system: implications in the management of migraine. Pediatr Neurol 1997; 17: 129–33

    Article  PubMed  CAS  Google Scholar 

  44. Behrman RE, Kleigman RM, Arvin AM, editors. Nelson textbook of pediatrics. 15th ed. Philadelphia (PA): WB Saunders, 1996

    Google Scholar 

  45. Field T, Hernandez-Reif M, Seligman S, et al. Juvenile rheumatoid arthritis: benefits from massage. J Pediatr Psychol 1997; 22: 607–17

    Article  PubMed  CAS  Google Scholar 

  46. Styles JL. The use of aromatherapy in hospitalized children with HIV. Complement Ther Nurs Midwifery 1987; 3(1): 16–20

    Article  Google Scholar 

  47. Weizman Z, Alkrinawi S, Goldfarb D, et al. Efficacy of herbal tea preparation in infant colic. J Pediatr 1993; 122: 650–2

    Article  PubMed  CAS  Google Scholar 

  48. Fugh-Berman A. Alternative medicine: what works? Philadelphia (PA): Williams and Wilkins, 1997

    Google Scholar 

  49. McCarthy GM, McCarthy DJ. Effect of topical capsaicin in the therapy of painful osteoarthritis of the hands. J Rheumatol 1992; 19: 604–7

    PubMed  CAS  Google Scholar 

  50. Capsaicin Study Group. Treatment of painful diabetic neuropathy with topical capsaicin. Arch Intern Med 1991; 151: 2225–9

    Article  Google Scholar 

  51. Watson CPN, Evan RJ, Vatt VR. Post-herpetic neuralgia and topical capsaicin. Pain 1988; 33: 333–40

    Article  PubMed  CAS  Google Scholar 

  52. Berstein JE, Korman NJ, Bickers DR, et al. Topical capsaicin treatment of chronic post-herpetic neuralgia. J Dermatol 1989; 21: 265–70

    Google Scholar 

  53. Gately CA, Miers M, Mansel RE, et al. Drug treatments for mastalgia: 17 years experience in the Cardiff mastalgia clinic. J Royal Soc Med 1992; 85: 12–5

    Google Scholar 

  54. Belch JJF, Ansell D, Madhok R, et al. Effects of altering dietary essential fatty acids on requirements for non-steroidal anti-inflammatory drugs in patients with rheumatoid arthritis. Ann Rheum Dis 1988; 47: 96–104

    Article  PubMed  CAS  Google Scholar 

  55. Murphy JJ, Hepinstall S, Mitchell JRA. Randomized double-blind, placebo-controlled trial of feverfew in migraine prevention. Lancet 1988; II: 189–92

    Article  Google Scholar 

Download references

Acknowledgments

The authors sincerely acknowledge the helpful comments from James D. Fortenberry, MD, Jana A. Stockwell, MD, Toni Petrillo, MD and Atul Vats, MD, and thank Kelley Durbin for help with manuscript preparation.

No sources of funding were used to assist in the preparation of this manuscript. The authors have no conflicts of interest that are directly relevant to the content of this manuscript.

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Authors and Affiliations

  1. Critical Care Medicine and Pediatric Transport, Children’s Healthcare of Atlanta at Egleston Children’s Hospital, Atlanta, Georgia, USA

    C. Robert Chambliss

  2. Division of Critical Care Medicine, Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA

    Judith Heggen

  3. Pharmacy Department, Children’s Healthcare of Atlanta, Atlanta, Georgia, USA

    David N. Copelan

  4. Division of Pediatric Critical Care, Nemours Children’s Clinic, Arnold Palmer Children’s Hospital, Orlando, Florida, USA

    Robert Pettignano

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  1. C. Robert Chambliss
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  2. Judith Heggen
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  3. David N. Copelan
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  4. Robert Pettignano
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Chambliss, C.R., Heggen, J., Copelan, D.N. et al. The Assessment and Management of Chronic Pain in Children. Pediatr-Drugs 4, 737–746 (2002). https://doi.org/10.2165/00128072-200204110-00005

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