101
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Jordan M, Keefer PM, Lee YLA, Meade K, Snaman JM, Wolfe J, Kamal A, Rosenberg A. Top Ten Tips Palliative Care Clinicians Should Know About Caring for Children. J Palliat Med 2018; 21:1783-1789. [PMID: 30289325 DOI: 10.1089/jpm.2018.0482] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Given the limited number of pediatric-specific palliative care programs, palliative care providers of all disciplines may be called on to care for infants, children, and adolescents with serious illness. This article provides a review of the unique components of pediatric palliative care, including key roles within an interdisciplinary team, pediatric developmental considerations, use of medical technology and complexities of symptom management in children with serious illness, hospice utilization, as well as pointers for discussions with families regarding a patient's quality of life and goals of care.
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Affiliation(s)
- Megan Jordan
- 1 Duke Palliative Care, Departments of Medicine and Pediatrics, Duke University, Durham, North Carolina
| | - Patricia M Keefer
- 2 Pediatric Palliative Care Program, Department of Pediatrics and Communicable Diseases, C.S. Mott Children's Hospital, Ann Arbor, Michigan
- 3 Department of Internal Medicine, Michigan Medicine, Ann Arbor, Michigan
| | - Yu-Lin Amy Lee
- 4 Duke Internal Medicine-Pediatrics Primary Care, Departments of Medicine and Pediatrics, Duke University, Durham, North Carolina
| | - Kristin Meade
- 5 Duke Palliative Care, Department of Medicine, Duke University, Durham, North Carolina
| | - Jennifer M Snaman
- 6 Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Joanne Wolfe
- 6 Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts
- 7 Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts
- 8 Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Arif Kamal
- 9 Duke Cancer Institute, Duke Fuqua School of Business, Durham, North Carolina
| | - Abby Rosenberg
- 10 Division of Hematology/Oncology, Department of Pediatrics, Seattle Children's Research Institute, Center for Clinical and Translational Research, University of Washington, Seattle, Washington
- 11 Division of Bioethics and Palliative Care, Department of Pediatrics, University of Washington, Seattle, Washington
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102
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Affiliation(s)
- Julie M Hauer
- Division of General Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
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103
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Bogetz JF, Hauer J. Certainty of Decisions: A Process-Based Model for Decision Making for Children With Severe Neurological Impairment. Clin Pediatr (Phila) 2018; 57:1227-1231. [PMID: 29113499 DOI: 10.1177/0009922817740668] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Jori F Bogetz
- 1 University of California, San Francisco, CA, USA.,2 UCSF Benioff Children's Hospital, San Francisco, CA, USA
| | - Julie Hauer
- 3 Harvard School of Medicine, Boston, MA, USA.,4 Seven Hills Pediatric Center, Groton, MA, USA
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104
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Blackman JA, Svensson CI, Marchand S. Pathophysiology of chronic pain in cerebral palsy: implications for pharmacological treatment and research. Dev Med Child Neurol 2018; 60:861-865. [PMID: 29882358 DOI: 10.1111/dmcn.13930] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/17/2018] [Indexed: 12/23/2022]
Abstract
UNLABELLED The high prevalence of chronic pain in individuals with cerebral palsy (CP) across the lifespan has been well documented, as has its negative impact on quality of life. However, without an understanding of the underlying (possibly unique) pathophysiology of pain in CP, identification of more effective management options, such as innovative and individualized pharmacological approaches to non-opioid pain treatment, will be significantly hindered. We review, briefly, what is known about chronic pain in CP and present what we need to know with respect to the neurobiology of pain and new developments in pain treatment research that might be applied to CP. WHAT THIS PAPER ADDS Pain conditions in cerebral palsy have differing mechanisms and will not respond to the same treatments. Novel analgesics under development include inhibitors of ion channels, nerve growth factor, and calcitonin gene-related peptide.
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Affiliation(s)
| | | | - Serge Marchand
- Université de Sherbrooke, Sherbrooke, QC, Canada.,Fonds de Recherche du Québec - Santé, Montreal, QC, Canada
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105
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CE: Original Research: Pain in Nonverbal Children with Medical Complexity: A Two-Year Retrospective Study. Am J Nurs 2018; 118:28-37. [DOI: 10.1097/01.naj.0000544137.55887.5a] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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106
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Morrison F, Fairhurst J, Fairhurst C. Case series: Use of Glyceryl Trinitrate patches to improve peripheral circulation in children with severe neurodisability. Eur J Paediatr Neurol 2018; 22:451-456. [PMID: 29317214 DOI: 10.1016/j.ejpn.2017.12.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Revised: 10/16/2017] [Accepted: 12/23/2017] [Indexed: 10/18/2022]
Abstract
AIM Evaluation of topical Glyceryl trinitrate as a therapeutic option to improve peripheral circulation in 16 children with severe complex neurodisability, poor capillary return and signs of vascular insufficiency, including discomfort. METHODS If insufficient improvement in capillary return was obtained using conservative measures, a 5 mg GTN patch was placed each day on the front of the tibia of each leg. Children were reviewed clinically for up to 12 months of treatment. Distal limb comfort was measured using a Likert scale, either patient or carer reported. Standardised capillary refill time was assessed at each clinical review. RESULTS Use of the patches led to improved capillary refill time and parent/patient reported comfort in all children. Healing of skin ulcers in lower limbs after application of the patch was also noted. There was universal parent/patient satisfaction with use of the patch. One child with Aicardi Goutieres syndrome had a skin reaction with prolonged use and minor adverse effects were reported in 4 others but this did not result in discontinuation of treatment. SUMMARY GTN patches were relatively well tolerated in this group of children. We suggest that use of GTN patches be considered for children with severe neurodisability and poor peripheral circulation causing discomfort. GTN patches may also have a role in healing of persistent skin ulcers for these children.
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Affiliation(s)
- Frances Morrison
- Department of Paediatric Neurosciences, Evelina London Children's Hospital, Guys and Saint Thomas' NHS Foundation Trust, Lambeth Palace Road, London, SE1 7EH, UK
| | | | - Charlie Fairhurst
- Department of Paediatric Neurosciences, Evelina London Children's Hospital, Guys and Saint Thomas' NHS Foundation Trust, Lambeth Palace Road, London, SE1 7EH, UK.
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107
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Warlow TA, Hain RDW. 'Total Pain' in Children with Severe Neurological Impairment. CHILDREN-BASEL 2018; 5:children5010013. [PMID: 29346304 PMCID: PMC5789295 DOI: 10.3390/children5010013] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Revised: 01/11/2018] [Accepted: 01/12/2018] [Indexed: 12/17/2022]
Abstract
Many children with palliative care needs experience difficulty in managing pain. Perhaps none more so than those with severe neurological impairment. For many years; behaviours in these children were misunderstood. As a result; pain was poorly recognised and inadequately managed. Significant advances have been made in the assessment and management of pain in this challenging group of patients. We summarise these advances; drawing on our own experience working with infants; children and young adults with palliative care needs within a UK tertiary paediatric palliative care service. We expand on the recent understanding of 'Total Pain'; applying a holistic approach to pain assessment and management in children with severe neurological impairment.
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Affiliation(s)
- Timothy A Warlow
- All Wales Paediatric Palliative Care Managed Clinical Network, University Hospital of Wales, Heath Park, Cardiff CF14 4XW, UK.
| | - Richard D W Hain
- All Wales Paediatric Palliative Care Managed Clinical Network, University Hospital of Wales, Heath Park, Cardiff CF14 4XW, UK.
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108
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Neuropathic Pain as Potential Source of Feed-induced Dystonia in Children With Severe Central Nervous System Disorders. J Pediatr Gastroenterol Nutr 2018; 66:e25. [PMID: 28902091 DOI: 10.1097/mpg.0000000000001739] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
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109
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Palat G, Vallath N, Chary S, Broderick A. When to Use Methadone for pain: A Case-Based Approach. Indian J Palliat Care 2018; 24:S15-S20. [PMID: 29497250 PMCID: PMC5806301 DOI: 10.4103/ijpc.ijpc_182_17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
The case studies are written in this article to illustrate how methadone might be used for pain in the Indian context. These cases might be used for discussion in a multidisciplinary team, or for individual study. It is important to understand that pain requires a multidisciplinary approach as opioids will assist only with physical, i.e. neuropathic and nociceptive pain, but not emotional, spiritual, or relational pain or the pain of immobility. The social determinants of pain were included to demonstrate how emotional, relational, and psychological dimensions of pain amplify the physical aspects of pain. The case studies follow a practical step-wise approach to pain while undergoing cancer treatment, pain toward the end-of-life and needing longer acting opioid. Methadone in children, and methadone in conditions of opioid toxicity or where there is a need for absorption in the proximal intestine cases are included.
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Affiliation(s)
- Gayatri Palat
- Department of Pain and Palliative Medicine, MNJ Institute of Oncology, Hyderabad, Telangana, India
| | - Nandini Vallath
- Trivandrum Institute for Palliative Sciences, Trivandrum, Kerala, India
| | - Srini Chary
- Division of Palliative Medicine, Department of Oncology, University of Calgary, Calgary, Alberta, Canada
| | - Ann Broderick
- Department of Hospice and Palliative Care, Veterans Administration Medical Center, Iowa City, Iowa, USA
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110
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Hauer J. Feeding Intolerance in Children with Severe Impairment of the Central Nervous System: Strategies for Treatment and Prevention. CHILDREN-BASEL 2017; 5:children5010001. [PMID: 29271904 PMCID: PMC5789283 DOI: 10.3390/children5010001] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Revised: 12/21/2017] [Accepted: 12/21/2017] [Indexed: 12/21/2022]
Abstract
Children with severe impairment of the central nervous system (CNS) experience gastrointestinal (GI) symptoms at a high rate and severity, including retching, vomiting, GI tract pain, and feeding intolerance. Commonly recognized sources of symptoms include constipation and gastroesophageal reflux disease. There is growing awareness of sources due to the impaired nervous system, including visceral hyperalgesia due to sensitization of sensory neurons in the enteric nervous system and central neuropathic pain due to alterations in the thalamus. Challenging the management of these symptoms is the lack of tests to confirm alterations in the nervous system as a cause of symptom generation, requiring empirical trials directed at such sources. It is also common to have multiple reasons for the observed symptoms, further challenging management. Recurrent emesis and GI tract pain can often be improved, though in some not completely eliminated. In some, this can progress to intractable feeding intolerance. This comprehensive review provides an evidence-based approach to care, a framework for recurrent symptoms, and language strategies when symptoms remain intractable to available interventions. This summary is intended to balance optimal management with a sensitive palliative care approach to persistent GI symptoms in children with severe impairment of the CNS.
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Affiliation(s)
- Julie Hauer
- Boston Children's Hospital, Division of General Pediatrics, Harvard School of Medicine, 300 Longwood Ave, Boston, MA 02115, USA.
- Seven Hills Pediatric Center, 22 Hillside, Groton, MA 01450, USA.
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