Children & Pain: Overview of Pediatric Pain
Author: Thomas C. Weiss : Contact: Disabled World
Synopsis and Key Points:
Information regarding pediatric pain, one of the most under-diagnosed, misunderstood and under-treated medical issues in children.
Pain is one of the most under-diagnosed, misunderstood and under-treated medical issues, especially in children. One of the most challenging roles of healthcare professionals serving children is to appropriately assess and treat the pain they experience. New regulations perceive pain as the fifth vital sign and require caregivers to regularly assess and address pain. Pain is a personal experience, a number of different terms are used to describe different sensations. Assessment of pain in children is linked to their level of development. Children who are the same age vary greatly in their tolerance and perception of pain.
Pain is defined as a feeling triggered in the nervous system. Pain can be sharp or dull. It may come and go, or it may be constant. Pain is mediated by specific nerve fibers that carry the pain impulses to the brain where their conscious appreciation may be modified by many factors. Pain can be helpful in diagnosing a problem. Without pain, you might seriously hurt yourself without knowing it, or you might not realize you have a medical problem that needs treatment. Once you take care of the problem, pain usually goes away. However, sometimes pain goes on for weeks, months or even years. This is called chronic pain. Sometimes chronic pain is due to an ongoing cause, such as cancer or arthritis.
Every child will experience pain at some point, whether it is from common bumps and bruises, or because of more chronic conditions such as gastrointestinal issues, headaches, or diabetes. As many as 40% of children and teenagers complain of pain that happens at least one time per week. Chronic pain affects at least 15-20% of children. Chronic pain is more prevalent in women than men; girls also report more pain than boys.
Pediatric pain stems from a large range of chronic conditions, oftentimes bone pain, bone pain or joint pain, abdominal pain or headaches, which require pain management. Yet the medical community has not placed the same emphasis on pain management for children as it has for adults or seniors.
- Every year, 1.5 million children have surgery and a number of them receive inadequate pain relief.
- In 20% of children, the pain becomes chronic.
- Out of children between the ages of 5-17, 20% experience headaches.
- Greater than one-third of children complain about abdominal pain lasting two weeks or more.
- Juvenile arthritis, which causes inflammation and aches of a child's joints, affects almost 250,000 children younger than age 16.
If left unaddressed, chronic pain may affect children in ways that will follow them around throughout their entire lives. Children may develop emotional and psychological scars from their pain and taint future choices about their lives and health. Untreated pain in childhood may also lead to chronic pain in both adulthood and old age.
Pain is really a physical and emotional experience perceived and processed by the brain. Pain is a real health issue. Every child has different perceptions of pain and the meaning of pain is different from child to child. The goal of treatment is to decrease the intensity of pain while making the child feel better. For pain that is acute, this goal is often not treated with success.
Chronic pain, or pain lasting for at least a three month period of time or more, has a different effect on the child's nervous system and must be treated differently. Maybe one of the hardest challenges for medical professionals is pain management in children. It is at times necessary to inflict pain during immunizations, procedures and other treatments. In the past, there was a fair lack of accountability where providing pain relief is concerned.
Culture has changed, as evidenced by the new Joint Commission on Accreditation of Healthcare Organizations (JCAHO) regulations which regard pain as the fifth vital sign and require caregivers to assess and address pain on a regular basis. Pain; however, is still one of the most misunderstood, under-diagnosed and under-treated medical issues for children. Pediatric pain is under-treated and neglected for a number of reasons:
- Adults and children react differently to pain
- Doctors focus on the source instead of the symptom
- Some doctors do not understand pediatric pain management
- Many doctors become so focused on determining what is causing a child's pain they fail to perform pain management
Signs of Pain in Children
Certain behaviors can alert a parent or caregiver to a child's pain. The behaviors can be present even if the child is unable to properly express the pain they are experiencing. Behaviors parents and caregivers should watch for include:
- Decreased physical activity
- Avoiding contact with other children
- Changes in sleep pattern or appetite
- Favoring one leg or arm over the other
- Irritability, crankiness or unruly behavior
- Non-verbal expressions of pain such as wincing, gasping or frowning
- Physical cues like flushed skin, dull eyes, sweating or rapid breathing
One way to help children in regards to pain is to go over words describing pain so they can use the words that best show what they feel such as, 'itchy,' 'sore,' 'aching,' or, 'burning.' Do not rely on only verbal input from a child; ask your child to point to their body and show where they hurt and how the pain travels through them.
Pain sensation is a product of a number of interacting neural systems. Pain transmission may also be modulated by descending pathways that constitute the, 'analgesia,' system. Neonates have the same number of pain nerve endings per millimeter of skin as adults. They are present in a fetus from the second trimester. The central nervous system tracts that sub-serve pain are entirely myelinated by 30 weeks in intra-uterine life. Cortical interconnections with the thalamus, tracts that play a role in higher perception of pain, are complete by 24 weeks. The descending inhibitory controllers of pain; though, are deficient in the neonate controllers of pain. What this leads to is the likelihood that neonates, pre-term neonates in particular, might be more sensitive to pain than older children or adults.
Pain helps us to avoid physical harm, but unrelieved pain might be inherently harmful, both psychologically and physiologically. Failure to intervene early in a child's pain may lead to impairment in functioning as well as disruption in families. Unaddressed pain increases fear and anxiety which; in turn, increases perception of pain. Again; if pain is not addressed and treated early, it may vastly impact a child's quality of life by interfering with:
- School attendance
- Academic performance
- Participation in sports and other extracurricular activities
In addition, if unrelieved childhood pain may enhance a child's vulnerability to pain later on in life. Early experiences such as pain are associated with several alterations in the adult brain in many animal models. Repeated exposure to pain can cause altered pain sensitivity, stress disorders, anxiety, Attention Deficit Disorder, hyperactivity, impaired social skills, as well as patterns of self-destructive behavior.
It is vital that healthcare providers start to recognize pediatric pain so appropriate strategies may be devised to target and reduce children's distress and pain-related disability. Unaddressed pain may also result in notable financial stress for family members who not only have to pay for healthcare costs, but who might also have to miss work in order to care for a child who is ill. Inadequate prevention and relief of pain in children is still widespread. A number of obstacles exist to providing appropriate pain management in children and teenagers.
- 1: High-frequency Electrical Stimulation to Spinal Cord Eases Chronic Pain : Case Western Reserve University (2015/12/04)
- 2: Dry Eye and Chronic Pain Syndrome : University of Miami Miller School of Medicine (2016/01/08)
- 3: Adenosine: A Switch to Turn Off Pain : Saint Louis University (2014/11/29)
- 4: Spinal Cord Stimulation Reduces Chronic Pain Emotional Aspect : Ohio State University Wexner Medical Center (2016/03/22)
- 5: Caffeine Can Help Reduce Joint and Other Pain : Disabled World (2014/06/17)
- 6: Complex Regional Pain Syndrome (CRPS) Study Insights : University of Bath (2017/07/10)
- 7: Pain: A Multi-layered Gradual Event : Max-Planck-Gesellschaft (2016/03/25)
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