Pain in Infancy and Childhood

Editor(s): International Committee of Paediatricians. 57 / 2


Physiology of Pain in Infants and Children

Author(s): K.J.S. Anand

Newborn infants requiring surgical operations rarely were given the benefits of anaesthesia or postoperative analgesia until recently [1]. Lack of research on the physiology of pain during development promoted the myths that infants and children do not experience pain in the same way as adult patients and that the use of anaesthetic or analgesic drugs would expose them to the unnecessary risk of side effects and complications [2]. Randomized clinical trials investigating the use of potent anaesthesia/analgesia showed significant reductions in the physiologic responses and postoperative complications in those infants given adequate anaesthesia [1, 3, 4]. These data stimulated a greater scientific interest in the developing pathways and mechanisms that are associated with pain perception and deepened our understanding of the developmental biology of pain [5-9].

Measurement of Pain

Author(s): P.J. McGrath, G. Allen Finley

A child who has a fever will have his or her temperature taken. A child with suspected obesity will be weighed and measured. If a child has diabetes, blood sugars will be measured regularly. Increasingly in medicine, careful measurement is used to establish the presence of a problem, to gauge its severity and guide treatment. Pain is the exception. Often, pain is not measured, even when a child is suspected of being in pain. The failure to measure pain may hinder provision of the best care for children. If pain is not measured, it is easy to ignore it.

Pain management

Author(s): N.L. Schechter

The management of pain in children has undergone a revolution over the past 10-15 years [1, 2]. As previously noted in this issue, historically, pain was ignored or significantly undertreated in children for a variety of complex reasons. Over the past decade, however, attitudes that promoted undertreatment and practice patterns changed. Now, children's pain problems are at least considered and often adequately treated. Both pharmacologic and non-pharmacologie approaches will be described and strategies for specific pain problems outlined.

Attitudes, Beliefs and Ethics

Author(s): M. Levetown

Primum non nocere. First, do no harm. This dictum is a hallmark of medical practice. Yet it has been common practice to allow the more vulnerable patients, both children and impaired adults, to experience avoidable harm on a regular basis [1-4]. Harm occurs when the amount of hurt or suffering is greater than necessary to achieve the intended benefit [1]. The undertreatment of children's pain, particularly in the chronic pain syndrome and the non-postoperative procedural setting, is a persistent problem, occurring despite the well-documented safety, efficacy and improved patient out-comes that are related to proper pain management; this continued practice thus constitutes harm [5-7]. The exception to this generality is the postoperative setting. Strides have recently been made in paediatric postoperative pain management, and appropriately potent analgesics are now commonly, though not uniformly, ordered [7].