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Psychologische Schmerzdiagnostik bei Kindern

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Zusammenfassung

Die Intensität von Schmerzen kann nicht direkt gemessen, sondern nur indirekt beschrieben werden, was die Erfassung umso schwieriger macht, je jünger die Patienten sind. Bis vor wenigen Jahren hat man wegen fehlender offensichtlicher Schmerzäußerungen angenommen, dass Neugeborene, Säuglinge und Kleinkinder weniger Schmerzen als Erwachsene empfinden würden. Dies hat sich jedoch als ein Irrtum herausgestellt, der umso gravierender wird, je mehr über Prozesse der Schmerzsensibilisierung und den Aufbau eines Schmerzgedächtnisses bekannt wird. Es werden einige Besonderheiten der Schmerzempfindung bei Früh-, Neugeborenen und Kleinkindern vorgestellt und psychologische Messverfahren zur Schmerzdiagnostik beschrieben. Diese gliedern sich in Skalen zur Fremdbeobachtung bei Kleinkindern und Methoden zur Selbsteinschätzung bei älteren Kindern. Insbesondere die Verfahren zur Fremdbeobachtung, aber auch die Selbstbeurteilungsskalen haben sich als objektiv, reliabel, valide und damit als zur standardisierten Schmerzdiagnostik geeignet erwiesen.

Abstract

Pain in premature infants, neonates, and young children impairs their development to a great extent and may lead to long-lasting pain memories and undertreatment of pain. Up to 15 years ago, the opinion prevailed that babies—especially neonates—could not feel pain generally because they could not report their pain sensations to adults and were not able to verbalize their feelings. In the past decade, standardized scales have been developed to assess pain in children. While in neonates and children up to 2 years standardized scales were developed for observation of their reactions, for children 3 years and older self-report scales are used to assess pain sensations. The text describes a variety of standardized pain assessment scales which fulfil the requirements of reliability and validity.

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Literatur

  1. Ambuel B, Hamlett KW, Marx CM, Blumer JL (1992) Assessing distress in pediatric intensive care environments: the COMFORT scale. J Pediatr Psychol 17: 95–109

    CAS  PubMed  Google Scholar 

  2. Anand KJ (2000) Pain, plasticity, and premature birth: a prescription for permanent suffering? Nat Med 6: 971–973

    Article  CAS  PubMed  Google Scholar 

  3. Ballantyne M, Stevens B, McAllister M, Dionne K, Jack A (1999) Validation of the premature infant pain profile in the clinical setting. Clin J Pain 15: 297–303

    Article  CAS  PubMed  Google Scholar 

  4. Beyer JE, McGrath PJ, Berde CB (1990) Discordance between self-report and behavioral pain measures in children aged 3–7 years after surgery. J Pain Symptom Manage 5: 350–356

    CAS  PubMed  Google Scholar 

  5. Bieri D, Reeve RA, Champion GD, Addicoat L, Ziegler JB (1990) The faces pain scale for the self-assessment of the severity of pain experienced by children: development, initial validation, and preliminary investigation for ratio scale properties. Pain 41: 139–150

    Article  CAS  PubMed  Google Scholar 

  6. Birbaumer N (1986) Schmerz. In: Miltner W, Birbaumer N, Gerber WD (Hrsg) Verhaltensmedizin. Springer, Berlin Heidelberg New York

  7. Bremerich DH, Neidhart G, Roth B, Kessler P, Behne M (2001) Postoperative Schmerztherapie im Kindesalter. Anaesthesist 50: 102–112

    Article  CAS  PubMed  Google Scholar 

  8. Büttner W, Breitkopf L, Finke W, Schwanitz M (1990) Critical aspects of an outside evaluation of postoperative pain in infants. A placebo-controlled double-blind study of the question of the reliability and validity of the measurement system. Anaesthesist 39: 151–157

    PubMed  Google Scholar 

  9. Denecke H, Kröner-Herwig B (2000) Kopfscherz-Therapie mit Kindern und Jugendlichen. Ein Trainingsprogramm. Hogrefe, Göttingen

  10. Dickenson AH (1997) Plasticity: implications for opioid and other pharmacological interventions in specific pain states. Behav Brain Sci 20: 392–403

    Article  CAS  PubMed  Google Scholar 

  11. Fitzgerald M, Jennings E (1999) The postnatal development of spinal sensory processing. Proc Natl Acad Sci USA 96: 7719–7722

    Article  CAS  PubMed  Google Scholar 

  12. Fitzgerald M, Beggs S (2001) The neurobiology of pain: developmental aspects. Neuroscientist 7: 246–257

    CAS  PubMed  Google Scholar 

  13. Fuller BF, Conner DA (1995) The effect of pain on infant behaviors. Clin Nurs Res 4: 253–273

    CAS  PubMed  Google Scholar 

  14. Hasenbring M (1999) Prozesse der Chronifizierung von Schmerzen. In: Basler HG, Franz C, Kröner-Herwig B, Rehfisch HP, Seemann H (Hrsg) Psychologische Schmerztherapie. Springer, Berlin Heidelberg New York, S 161–176

  15. Henkel W, Zernikow B (2002) Tagebuch. Deutsche Krebsstiftung (Hrsg)http://www.kinderkrebsstiftung.de

  16. Johnston CC, Strada ME (1986) Acute pain response in infants: a multidimensional description. Pain 24: 373–382

    Article  CAS  PubMed  Google Scholar 

  17. Karling M, Renstrom M, Ljungman G (2002) Acute and postoperative pain in children: a Swedish nationwide survey. Acta Paediatr 91: 660–666

    Article  CAS  PubMed  Google Scholar 

  18. Keck JF, Gerkensmeyer JE, Joyce BA, Schade JG (1996) Reliability and validity of the faces and word descriptor scales to measure procedural pain. J Pediatr Nurs 11: 368–374

    CAS  PubMed  Google Scholar 

  19. Kerns RD, Turk DC, Rudy TE (1985) The West Haven Multidimensional Pain Inventory (WHYMPI). Pain 23: 245–256

    Article  Google Scholar 

  20. Krechel SW, Bildner J (1995) CRIES: a new neonatal postoperative pain measurement score: initial testing of validity and reliability. Paediatr Anaesth 5: 53–61

    CAS  PubMed  Google Scholar 

  21. Kuttner L (1989) Management of young children’s acute pain and anxiety during invasive medical procedures. Pediatrician 16: 39–44

    CAS  PubMed  Google Scholar 

  22. Lafreniere L, Laureau E, Vanasse M, Forest L, Ptito M (1990) Maturation of short latency somatosensory evoked potentials by median nerve stimulation: a cross-sectional study in a large group of children. Electroencephalogr Clin Neurophysiol 41: 236–242

    CAS  Google Scholar 

  23. Larsson BA (1999) Pain management in neonates. Acta Paediatr 88: 1301–1310

    Article  CAS  PubMed  Google Scholar 

  24. Lawrence J, Alcock D, McGrath P, Kay J, MacMurray SB, Dulberg C (1993) The development of a tool to assess neonatal pain. Neonatal Network 12: 59–66

    CAS  Google Scholar 

  25. Marsh DF, Hatch DJ, Fitzgerald M (1997) Opioid systems and the newborn. Br J Anaesth 79: 787–795

    CAS  PubMed  Google Scholar 

  26. McGrath PA (1987) An assessment of children’s pain: a review of behavioural, physiological and direct scaling techniques. Pain 31: 147–176

    Article  CAS  PubMed  Google Scholar 

  27. McGrath PJ, McAlpine L (1993) Psychologic perspectives of pediatric pain. J Pediatr 122: S2–S8

    CAS  PubMed  Google Scholar 

  28. McVey C (1998) Pain in the very preterm baby: „suffer little children?“. Pediatr Rehabil 2: 47–55

    CAS  PubMed  Google Scholar 

  29. Mitchell P (1999) Understanding a young child’s pain. Lancet 354: 1708

    CAS  PubMed  Google Scholar 

  30. Niederberger U, Kropp P, Gerber WD (1997) Methoden der Kopfschmerzforschung. In: Strauss B, Bengel J (Hrsg) Forschungsmethoden in der Medizinischen Psychologie. Hogrefe, Göttingen, S 257–270

  31. Piaget J (1969) Das Erwachen der Intelligenz beim Kinde. Klett, Stuttgart

  32. Pothmann R, Plump U, Maibach G, Frankenberg S von, Besken E, Kröner-Herwig B (1991) Migränetagebuch für Kinder. Arcis, München

  33. Pothmann R, Frankenberg S von, Müller B, Sartory G, Hellmeier W (1994) Epidemiology of headache in children and adolescents: evidence of high prevalence of migraine among girls under ten. Int J Behav Med 1: 76–89

    Google Scholar 

  34. Rahman W, Dashwood MR, Fitzgerald M, Aynsley-Green A, Dickenson AH (1998) Postnatal development of multiple opioid receptors in the spinal cord and development of spinal morphine analgesia. Brain Res Dev Brain Res 15: 239–254

    Google Scholar 

  35. Scholz OB (1994) Schmerzmessung und Schmerzdiagnostik—Methoden, Analysen, Ergebnisse am Beispiel rheumatischer Erkrankungen. Karger, Basel

  36. Stevens B, Johnston C, Petryshen P, Taddio A (1996) Premature Infant Pain Profile: development and initial validation. Clin J Pain 12: 12–22

    Article  Google Scholar 

  37. Taddio A (2001) Pain management for neonatal circumcision. Paediatr Drugs 3: 101–111

    CAS  PubMed  Google Scholar 

  38. Tesler MD, Savefra MC, Holzemer WL, Wilkie DJ, Ward JA, Paul SM (1991) The word-graphic rating scale as a measure of children’s and adolescents‘ pain intensity. Res Nurs Health 14: 361–371

    CAS  PubMed  Google Scholar 

  39. Thurber CA, Martin-Herz SP, Patterson DR (2000) Psychological principles of burn wound pain in children. I: Theoretical framework. J Burn Care Rehabil 21: 376–387

    Article  CAS  PubMed  Google Scholar 

  40. Van Dijk M, Boer JB de, Koot HM, Tibboel D, Passchier J, Duivenvoorden HJ (2000) The reliability and validity of the COMFORT scale as a postoperative pain instrument in 0 to 3-year-old infants. Pain 84: 367–377

    Article  PubMed  Google Scholar 

  41. Westerling D (1999) Postoperative recovery evaluated with a new, tactile scale (TaS) in children undergoing ophthalmic surgery. Pain 83: 297–301

    Article  CAS  PubMed  Google Scholar 

  42. Wilson GA, Doyle E (1996) Validation of three pediatric pain scores for use by parents. Anaesthesia 51: 1005–1007

    CAS  PubMed  Google Scholar 

  43. Wong DL, Baker CM (1988) Pain in children: comparison of assessment scales. Pediatr Nurs 14: 9–17

    CAS  PubMed  Google Scholar 

  44. Zernikow B (2001) (Hrsg) Schmerztherapie bei Kindern. Springer, Berlin Heidelberg New York

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„Psychologische Schmerzdiagnostik bei Kindern“ ist bereits in leicht modifizierter Form in Monatsschrift Kinderheilkunde 10/2003 erschienen.

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Kropp, P. Psychologische Schmerzdiagnostik bei Kindern. Schmerz 18, 61–74 (2004). https://doi.org/10.1007/s00482-003-0266-2

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