1
|
O'Keeffe M, Kamper SJ, Montgomery L, Williams A, Martiniuk A, Lucas B, Dario AB, Rathleff MS, Hestbaek L, Williams CM. Defining Growing Pains: A Scoping Review. Pediatrics 2022; 150:188581. [PMID: 35864176 DOI: 10.1542/peds.2021-052578] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/05/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Up to one third of children may be diagnosed with growing pains, but considerable uncertainty surrounds how to make this diagnosis. The objective of this study was to detail the definitions of growing pains in the medical literature. METHODS Scoping review with 8 electronic databases and 6 diagnostic classification systems searched from their inception to January 2021. The study selection included peer-reviewed articles or theses referring to "growing pain(s)" or "growth pain(s)" in relation to children or adolescents. Data extraction was performed independently by 2 reviewers. RESULTS We included 145 studies and 2 diagnostic systems (ICD-10 and SNOMED). Definition characteristics were grouped into 8 categories: pain location, age of onset, pain pattern, pain trajectory, pain types and risk factors, relationship to activity, severity and functional impact, and physical examination and investigations. There was extremely poor consensus between studies as to the basis for a diagnosis of growing pains. The most consistent component was lower limb pain, which was mentioned in 50% of sources. Pain in the evening or night (48%), episodic or recurrent course (42%), normal physical assessment (35%), and bilateral pain (31%) were the only other components to be mentioned in more than 30% of articles. Notably, more than 80% of studies made no reference to age of onset in their definition, and 93% did not refer to growth. Limitations of this study are that the included studies were not specifically designed to define growing pains. CONCLUSIONS There is no clarity in the medical research literature regarding what defines growing pain. Clinicians should be wary of relying on the diagnosis to direct treatment decisions.
Collapse
Affiliation(s)
- Mary O'Keeffe
- Institute for Musculoskeletal Health, Sydney Local Health District and The University of Sydney, Sydney, Australia
| | - Steven J Kamper
- Centre for Pain, Health and Lifestyle, New South Wales, Australia.,School of Health Sciences.,Nepean Blue Mountains Local Health District, Penrith, Australia
| | - Laura Montgomery
- Institute for Musculoskeletal Health, Sydney Local Health District and The University of Sydney, Sydney, Australia
| | - Amanda Williams
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, New South Wales, Australia
| | - Alexandra Martiniuk
- School of Public Health, Faculty of Medicine, and Health.,The George Institute for Global Health, Sydney Medical School, The University of Sydney, New South Wales, Australia.,Dalla Lana School of Public Health, The University of Toronto, Ontario, Canada
| | - Barbara Lucas
- Discipline of Paediatrics and Child Health, Sydney Medical School.,John Walsh Center for Rehabilitation Research, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.,Physiotherapy Department, Royal North Shore Hospital, St Leonards, Sydney, Australia
| | | | - Michael S Rathleff
- Center for General Practice at Aalborg University, Aalborg, Denmark.,Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark
| | - Lise Hestbaek
- Department of Sports Science and Clinical Biomechanics, Clinical Biomechanics, University of Southern Denmark, Campus vej 55, 5230, Odense, Denmark.,The Chiropractic Knowledge Hub, Odense, Denmark
| | - Christopher M Williams
- Centre for Pain, Health and Lifestyle, New South Wales, Australia.,Hunter New England Population Health Unit, Newcastle, Australia.,University of Newcastle, Callaghan, Australia
| |
Collapse
|
2
|
Willits AB, Grossi V, Glidden NC, Hyams JS, Young EE. Identification of a Pain-Specific Gene Expression Profile for Pediatric Recurrent Abdominal Pain. FRONTIERS IN PAIN RESEARCH 2022; 2:759634. [PMID: 35295473 PMCID: PMC8915586 DOI: 10.3389/fpain.2021.759634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 10/12/2021] [Indexed: 11/13/2022] Open
Abstract
Objectives: Functional Abdominal Pain (FAP) and Irritable Bowel Syndrome (IBS) are common recurrent abdominal pain diagnoses with the hallmark, lack of inflammation. To identify a biological signature for IBS/FAP in the colon, this study used genetic profiling to uncover gene expression changes associated with IBS/FAP and abdominal pain. Methods: Patients (8 to 17 years) newly diagnosed with IBS or FAP were enrolled in the study. At diagnostic colonoscopy, three rectal biopsies were collected, and gene expression analysis was performed using a Qiagen PCR Array. Relative fold difference in gene expression for 84 pain-associated genes was calculated using the 2-ΔΔ Cq method compared with pain-free controls. Factors affecting pain burden (Pain Burden Interview; PBI) were analyzed, including age, sex, rectal inflammation, and gene expression. Data were analyzed using multiple stepwise linear regression and 2-tailed t tests (P ≤ 0.05). Results: Of the 22 total patients in the study, 19 were diagnosed with either IBS-Constipation (frequency of 5.26%), IBS-Diarrhea (47.37%), IBS-Mixed (10.53%), or FAP (36.84%). IBS/FAP patients reported significantly higher pain burden at the time of diagnosis compared to pain-free controls (p < 0.001), as well as significantly higher abdominal pain (p = 0.01). Of the 84 genes, expression of GRIN1 (p = 0.02), MAPK3 (p = 0.04), P2X4 (p = 0.04), and PTGES3 (p = 0.02) were all significantly associated with PBI score. Discussion: Abdominal pain associated with IBS/FAP in pediatric patients may be linked to the expression of GRIN1, MAPK3, P2X4, and PTGES3, pointing to potential novel therapeutic targets for management of recurring abdominal pain.
Collapse
Affiliation(s)
- Adam B Willits
- Neuroscience Program, KU Medical Center, Kansas City, KS, United States
| | - Victoria Grossi
- Division of Digestive Diseases, Hepatology, and Nutrition, Connecticut Children's Medical Center, Hartford, CT, United States
| | - Nicole C Glidden
- Genetics and Genome Sciences, University of Connecticut School of Medicine, Farmington, CT, United States
| | - Jeffrey S Hyams
- Division of Digestive Diseases, Hepatology, and Nutrition, Connecticut Children's Medical Center, Hartford, CT, United States
| | - Erin E Young
- Neuroscience Program, KU Medical Center, Kansas City, KS, United States.,Genetics and Genome Sciences, University of Connecticut School of Medicine, Farmington, CT, United States.,Department of Anesthesiology, KU Medical Center, Kansas City, KS, United States
| |
Collapse
|
3
|
Choe R, Sim YF, Hong CHL, Mohideen S, Nadarajan R, Yap F, Shek LPC, Hsu CYS, Broekman BFP, Ferreira JN. Internalizing problems are associated with oral health-related quality of life in early childhood: Outcomes from an Asian multi-ethnic prospective birth cohort. PLoS One 2021; 16:e0256163. [PMID: 34383864 PMCID: PMC8360536 DOI: 10.1371/journal.pone.0256163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 07/30/2021] [Indexed: 11/18/2022] Open
Abstract
Oral health status ideally warrants for a holistic biopsychosocial approach to health and wellness. Little is known about the impact of behavioral problems on oral health-related quality of life (OHRQoL) in children due to the paucity of studies in early childhood, particularly in Asian multi-ethnic populations. This study evaluated the relationship between early child's socioemotional factors and OHRQoL, as well as its association with orofacial pain (OFP) and early childhood caries (ECC) in the Asian GUSTO birth cohort. Mother-child dyads were postnatally assessed at 3 time points. The Child Behavior Checklist (CBCL) was used to assess the child's socioemotional and behavioral problems at age 4-4.5 years together with other validated questionnaires to evaluate maternal anxiety and depression. ECC detection was performed at age 5, and OHRQoL (primary) and OFP (secondary) outcomes were assessed at age 6 from a total of 555 mother-child dyads. After a univariate regression analysis was performed to identify potential predictors and confounders, a multivariate regression model was run with predisposing factors (CBCL internalization and externalization problems, OFP, ECC) and adjusted for confounders (maternal psychosocial states, maternal education) to determine associations with OHRQoL. Results showed an association between CBCL internalization scores and poorer OHRQoL (RR = 1.03, p = 0.033, 95% CI 1.01 to 1.05), although the limited risk ratio may not have a practical applicability in psychosocially healthy children, alike the majority of those evaluated in this cohort. The average OHRQoL overall score among children with OFP was 2.39 times more than those without OFP (OR = 2.39, p < 0.001, 95% CI 2.00 to 2.86). Thus, in early childhood, OFP, and to lesser extent internalizing behaviors, may negatively impact OHRQoL. This study therefore highlights the complex relationship between OHRQoL and its predisposing socioemotional and somatic pain factors, and demands further investigations in clinically relevant populations.
Collapse
Affiliation(s)
- Ruth Choe
- Faculty of Dentistry, National University of Singapore, Singapore, Singapore
| | - Yu Fan Sim
- Faculty of Dentistry, National University of Singapore, Singapore, Singapore
| | | | - Sameema Mohideen
- Singapore Institute for Clinical Sciences, A*STAR, Singapore, Singapore
| | - Ranjani Nadarajan
- Singapore Institute for Clinical Sciences, A*STAR, Singapore, Singapore
| | - Fabian Yap
- Department of Paediatrics, KK Women’s and Children’s Hospital, Singapore, Singapore
| | - Lynette P.-C. Shek
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | | | - Birit F. P. Broekman
- Singapore Institute for Clinical Sciences, A*STAR, Singapore, Singapore
- OLVG and Amsterdam UMC, VU University, Amsterdam, The Netherlands
| | - Joao N. Ferreira
- Faculty of Dentistry, National University of Singapore, Singapore, Singapore
- Faculty of Dentistry, Exocrine Gland Biology and Regeneration Research Group, Department of Research Affairs, Chulalongkorn University, Bangkok, Thailand
- * E-mail:
| |
Collapse
|
4
|
|
5
|
Engel JM, Rapoff MA. Biofeedback-Assisted Relaxation Training for Adult and Pediatric Headache Disorders. ACTA ACUST UNITED AC 2016. [DOI: 10.1177/153944929001000504] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Headaches are one of the most common somatic complaints among adults and children. This study investigated the effects of thermal biofeedback-assisted relaxation training on adult and child tension, migraine, and mixed (migraine and tension) headache disorders. A multiple baseline design across three adult and four child participants was used and multiple outcomes were assessed including participants' records of headache duration and severity, medication intake, and downtime because of headaches. To corroborate participants' records of headache activity, family members independently recorded headache occurrences, and medication intake was corroborated by investigators' pill counts of headache medications. After treatment, reductions in headache duration and severity, downtime, and medication intake were noted for all participants, with four of seven participants headache-free at 1-year follow-up. The results are compared with previous studies and methodological issues are discussed, particularly the need to corroborate self-report measures in headache studies.
Collapse
|
6
|
|
7
|
Egger HL, Angold A. Common emotional and behavioral disorders in preschool children: presentation, nosology, and epidemiology. J Child Psychol Psychiatry 2006; 47:313-37. [PMID: 16492262 DOI: 10.1111/j.1469-7610.2006.01618.x] [Citation(s) in RCA: 803] [Impact Index Per Article: 44.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
We review recent research on the presentation, nosology and epidemiology of behavioral and emotional psychiatric disorders in preschool children (children ages 2 through 5 years old), focusing on the five most common groups of childhood psychiatric disorders: attention deficit hyperactivity disorders, oppositional defiant and conduct disorders, anxiety disorders, and depressive disorders. We review the various approaches to classifying behavioral and emotional dysregulation in preschoolers and determining the boundaries between normative variation and clinically significant presentations. While highlighting the limitations of the current DSM-IV diagnostic criteria for identifying preschool psychopathology and reviewing alternative diagnostic approaches, we also present evidence supporting the reliability and validity of developmentally appropriate criteria for diagnosing psychiatric disorders in children as young as two years old. Despite the relative lack of research on preschool psychopathology compared with studies of the epidemiology of psychiatric disorders in older children, the current evidence now shows quite convincingly that the rates of the common child psychiatric disorders and the patterns of comorbidity among them in preschoolers are similar to those seen in later childhood. We review the implications of these conclusions for research on the etiology, nosology, and development of early onset of psychiatric disorders, and for targeted treatment, early intervention and prevention with young children.
Collapse
Affiliation(s)
- Helen Link Egger
- Center for Developmental Epidemiology, Department of Psychiatry and Behavioral Sciences at Duke University Medical Center, USA.
| | | |
Collapse
|
8
|
Weir EC, Burrow JG, Bell F. Existing methods of pain evaluation in children: an overview. ACTA ACUST UNITED AC 2000. [DOI: 10.12968/bjtr.2000.7.10.13843] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Evelyn C Weir
- Department of Podiatry and Radiography, Queen Margaret University College, Leith Campus, Edinburgh EH6 8HF,
| | - J Gordon Burrow
- Department of Physiotherapy, Podiatry and Radiography, Glasgow Caledonian University and
| | - Frank Bell
- Centre for Innovation in Healthcare Technology, Glasgow Caledonian University
| |
Collapse
|
9
|
Büttner W, Finke W. Analysis of behavioural and physiological parameters for the assessment of postoperative analgesic demand in newborns, infants and young children: a comprehensive report on seven consecutive studies. Paediatr Anaesth 2000; 10:303-18. [PMID: 10792748 DOI: 10.1046/j.1460-9592.2000.00530.x] [Citation(s) in RCA: 209] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Many different systems for the assessment of pain in newborns and infants have been tested for validity, rarely for reliability but never for sensitivity or specificity. We aimed to determine whether the assessment of an analgesic demand in the lower age group during the postoperative period is possible by observational methods only. In an repetitive and sequential prospective process for identifying observationable behaviour and measurable physiological parameters as indicators of a postoperative analgesic demand, 584 newborns, infants and young children were studied (7 prospective studies, 4238 observations). Twenty-six items were selected as suggested by current literature and for reasons of economy and practicability. The factor analyses resulted in a two-factorial solution with the behavioural items loading on one factor and the physiological parameters on the other (principal component analyses). The physiological parameters blood pressure, respiratory rate and heart rate were found to be unreliable and had no discriminant power to detect an analgesic demand during the postoperative period (discriminant analyses, ROC-curves). In newborns and infants, nine observational items were identified as equally selective, reliable, sensitive and specific to the assessment of postoperative analgesic demand, whereas in young children only five items could be identified (discriminant analyses, ROC-curves). For economic reasons, these five items (crying, facial expression, posture of the trunk, posture of the legs, motor restlessness) were chosen as the basis of an additional pain scale ranging from 0=no pain to 10=maximal (Children's and Infants' Postoperative Pain Scale, CHIPPS). Its internal consistency yielded values for Cronbachs' alpha with 0.92 for toddlers and 0.96 for infants. The coefficient for interrater reliability was 0.93. The scale was validated constructively by the intravenous administration of metamizol, tramadol, nalbuphine, piritramide and ketamine (repeated measures analysis of variance). The Toddler-Preschooler Postoperative Pain Scale and CHIPPS equally identified painfree situations or analgesic demand in 87.4%. In cases with definite pain, the score of CHIPPS was never below 4 points. Seventy-one toddlers gave verbal comments on their pain intensity: in 29 painfree situations the CHIPPS score was 3.0 and in 29 painful situations it was 5.7. The values for sensitivity and specificity of CHIPPS were calculated to be 0.92-0.96 and 0.74-0.95, respectively (discriminant analyses). We conclude that it is possible to determine postoperative analgesic demand in the low age group of children by using an observational system such as CHIPPS alone.
Collapse
Affiliation(s)
- W Büttner
- Clinic for Anaesthesiology and Surgical Intensive Care Medicine, Ruhr-University Bochum, Marienhospital Herne, Germany
| | | |
Collapse
|
10
|
Humphreys PA, Gevirtz RN. Treatment of recurrent abdominal pain: components analysis of four treatment protocols. J Pediatr Gastroenterol Nutr 2000; 31:47-51. [PMID: 10896070 DOI: 10.1097/00005176-200007000-00011] [Citation(s) in RCA: 133] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
BACKGROUND Recurrent abdominal pain (RAP) affects up to 34% of the world's population of children. Medical management has been limited, but behavioral strategies have been shown to be effective. In this study several components of published treatment protocols were adapted and/or improved and then compared using a pretest-posttest control group design. METHODS Sixty-four children and teenagers (mean age, 9.75 +/- 2.46 years) with diagnosed recurrent abdominal pain were randomly assigned to four groups: 1) fiber-only comparison group; 2) fiber and biofeedback-assisted cultivated low arousal; 3) fiber, biofeedback, and cognitive-behavioral interventions; and 4) fiber, biofeedback, cognitive-behavioral, and parental support. Participants were treated over 8 weeks in individual sessions. Biofeedback was supplied using small thermal devices. RESULTS All groups showed improvement in self-reported pain, even the fiber-only comparison group; however, the active treatment groups showed significantly more improvement before and after than the fiber-only comparison group (fiber only comparison group pain reduction at 79%; fiber and biofeedback at 100%; fiber, biofeedback, and cognitive-behavioral at 94%; fiber, biofeedback, cognitive-behavioral, and parental support at 93%). CONCLUSIONS This suggests that any of the active treatment protocols assessed in this investigation work better than established treatments that have been reported in the literature. Because the addition of cognitive and parental support components did not seem to increase treatment effectiveness, it is concluded that increased fiber with biofeedback-assisted cultivated low arousal was effective and efficient as a treatment modality.
Collapse
Affiliation(s)
- P A Humphreys
- Health Psychology/Behavioral Medicine, California School of Professional Psychology, San Diego, USA
| | | |
Collapse
|
11
|
Bandell-Hoekstra I, Abu-Saad HH, Passchier J, Knipschild P. Recurrent headache, coping, and quality of life in children: a review. Headache 2000; 40:357-70. [PMID: 10849029 DOI: 10.1046/j.1526-4610.2000.00054.x] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVES To clarify the concepts of coping with pain and quality of life (QoL) and to present a literature review of the strategies that children with recurrent headaches use to cope with their pain, the impact of recurrent headaches on children's QoL, and the influence of personal and situational variables on headache, coping, and QoL in children. METHODS The literature search encompassed published articles that were found by means of a CD-ROM search of MEDLINE (1966 to December 1998) and PsycLIT (1974 to December 1998) and the snowball method. RESULTS In pediatric headache research, only three studies have been found in which children report the use of various coping strategies, and only two studies considered QoL. Demographic factors and psychological variables such as depression, anger, and anxiety influence headache prevalence. The impact of headache-related variables such as headache type, severity, perceived cause, and prior experience on QoL has only been studied in adults. CONCLUSIONS More research on coping and QoL is needed in pediatric headache. The conceptual model that is presented in this article may serve as a guide.
Collapse
Affiliation(s)
- I Bandell-Hoekstra
- Department of Health Care Studies, Centre for Nursing Research, The Netherlands.; Department of General Practice, The Netherlands
| | | | | | | |
Collapse
|
12
|
Karwautz A, Wöber C, Lang T, Böck A, Wagner-Ennsgraber C, Vesely C, Kienbacher C, Wöber-Bingöl C. Psychosocial factors in children and adolescents with migraine and tension-type headache: a controlled study and review of the literature. Cephalalgia 1999; 19:32-43. [PMID: 10099858 DOI: 10.1111/j.1468-2982.1999.1901032.x] [Citation(s) in RCA: 106] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
We investigated 341 children and adolescents to evaluate the relevance of psychosocial factors in idiopathic headache. According to the criteria of the International Headache Society, 151 subjects had migraine and 94 had tension-type headache (TTH). Ninety-six subjects were headache-free controls. Psychosocial factors covered family and housing conditions, school problems, relations in the peer group, and several other items. We found that migraine patients did not differ from headache-free controls. Patients with TTH more often had divorced parents than the headache-free controls, and they had fewer peer relations than migraineurs and controls. In addition, migraine patients were significantly more often absent from school due to headache. All other psychosocial factors failed to discriminate between the three study groups. In conclusion, this controlled study in children and adolescents suggests that migraine is not related to family and housing conditions, school situation, or peer relations, whereas TTH is associated with a higher rate of divorced parents and fewer peer relations.
Collapse
Affiliation(s)
- A Karwautz
- Department of Neuropsychiatry of Childhood and Adolescence, University of Vienna, Austria
| | | | | | | | | | | | | | | |
Collapse
|
13
|
Zeltzer LK, Bush JP, Chen E, Riveral A. A psychobiologic approach to pediatric pain: Part 1. History, physiology, and assessment strategies. CURRENT PROBLEMS IN PEDIATRICS 1997; 27:225-53. [PMID: 9377897 DOI: 10.1016/s0045-9380(97)80025-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- L K Zeltzer
- University of California, Los Angeles School of Medicine, 90095-1752, USA
| | | | | | | |
Collapse
|
14
|
Rodgers C, Levin L, Robeson M, Kunkel EJ. Pain and disability in families of chronic noncancer pain patients. PSYCHOSOMATICS 1996; 37:476-80. [PMID: 8824128 DOI: 10.1016/s0033-3182(96)71536-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The authors conducted a cross-sectional study to determine the prevalence of chronic noncancer pain or disability in first-degree relatives of patients who had sustained a physically traumatic injury with resultant chronic pain. A control group of general internal medicine patients was also interviewed about existence in their family of chronic pain or of disability, either pain-related or related to nonpainful chronic illness. None of the control patients were themselves experiencing acute or chronic pain. There was no statistically significant difference between the two groups in the prevalence of chronic pain or disability in family members. The study's findings suggest that chronic noncancer pain patients should not be viewed as a uniform group with regard to learned behaviors and/or familial aggregation.
Collapse
Affiliation(s)
- C Rodgers
- Department of Psychiatry and Human Behavior, Jefferson Medical College, Philadelphia, PA 19107-5004, USA
| | | | | | | |
Collapse
|
15
|
Williams HA. The silent ones: a review of sampling issues and biases pertinent to the area of pediatric oncology procedural pain. J Pediatr Oncol Nurs 1996; 13:31-9. [PMID: 8904464 DOI: 10.1177/104345429601300107] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Pain related to procedures for pediatric oncology patients is a salient topic. Although these procedures can cause much distress, this area has been neglected in research. Previous research has suffered from serious sampling problems, such as using small, nonrepresentative, biased samples. In addition, little is known about the influence of sociocultural factors on the phenomena of pain in children. This article presents the results of a review of the past 10 years of pertinent literature, argues that sociocultural influences on pain need to be studied, and offers suggestions for improving sampling designs.
Collapse
Affiliation(s)
- H A Williams
- Department of Anthropology, University of Florida, Gainesville, USA
| |
Collapse
|
16
|
|
17
|
Wangemann BU. [Specific aspects of perioperative pain relief in children.]. Schmerz 1994; 8:82-94. [PMID: 18415441 DOI: 10.1007/bf02530413] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/1993] [Accepted: 10/03/1993] [Indexed: 11/29/2022]
Abstract
Pain relief in children during the perioperative period can be provided by means of peripherally or centrally acting analgesics or of regional anaesthetic techniques. Narcotics or regional blockde are indicated when peripherally acting analgesics prove inadequate to abolish pain. Side effects of narcotics must be taken into account: opioids must not be administered unless continuous safety monitoring of the child's respiration is assured. If narcotics fail to relieve pain, regional anaesthesia may be indicated. All advantages and drawbacks of the various techniques that might be appropriate must be considered: the technique involving the least risk and side effects is the anaesthetic technique with a broad margin of safety when applied by an anaesthesiologist who has experience with paediatric regional blocks include topical anaesthesia, local infiltration, peripheral nerve blocks (e.g. nervi dorsalis penis, plexus axillaris) and caudal epidural blockade. Caution must be exercised whenever narcotics are administered systemically or epidurally; side effects must not be underestimated, even under conditions of intensive care observation. The provision of effective pain relief is a rewarding task-and particularly in little children.
Collapse
Affiliation(s)
- B U Wangemann
- Klinik für Anästhesiologie der Johannes Gutenberg-Universität, Langenbeckstraße 1, D-55131, Mainz
| |
Collapse
|
18
|
|
19
|
Aldridge D. Music therapy research 1: A review of the medical research literature within a general context of music therapy research. ARTS IN PSYCHOTHERAPY 1993. [DOI: 10.1016/0197-4556(93)90029-2] [Citation(s) in RCA: 25] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
20
|
Dalens B. [Acute pain in children and its treatment]. ANNALES FRANCAISES D'ANESTHESIE ET DE REANIMATION 1991; 10:38-61. [PMID: 1672584 DOI: 10.1016/s0750-7658(05)80270-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Pain in paediatrics has long been underestimated. The numerous scientific studies carried out during the last decade show that its existence can no longer be doubted: in fact, pain already exists during the neonatal period, and probably throughout the last trimester of gestation as well. Pain pathways mature during the embryonic period and peripheral receptors develop between the 7th and 20th week. A-delta and C fibers, as well as spinal roots and nerves, are completely differentiated before the end of the second month. The development of specific neurotransmitters and thalamic and cortical dendritic branching occurs later on; it is well enough developed to allow perception of painful stimuli (slow or protopathic component) from the beginning of the foetal period onwards. The discriminative rapid component develops in parallel to myelinisation, and the psycho-affective component, which requires a long and complex learning process, will not be fully operative until the end of puberty. Assessing pain, already a difficult task in the adult, is all the more so in children because of lesser verbal communicative capabilities, difficulty in handling abstract concepts, lack of experience of painful stimuli to make comparisons, and ignorance of their body image. In the very young child, diagnosing pain relies on suggestive circumstances, and an altered behaviour, knowing that no one symptom in pathognomonic. As the child grows up, methods for self-assessment of pain become usable, such as coloured scales and simplified verbal scales. However, behavioural tests remain the mainstay until the prepubertal period. The treatment of acute pain requires a reasoned approach which takes into account the state of the child, that of the aetiological investigations, the likely course of the lesions, as well as the patient's analgesic requirements. Therapeutic means do not differ from those for adult patients; however, the differences of distribution of body water, the small possibilities of linking with plasma proteins, and limited conjugation with glucuronate must be taken into account, especially during the first months of life. Local and regional anaesthetic block techniques are of great interest in elective and emergency surgery, as well as in trauma: they can provide complete pain relief, mostly without having any effect on the patient's physiological state (haemodynamics and consciousness). Peripherally acting analgesic agents, which are well supported on the whole, as well as co-analgesics, have a great part to play, although there are less drugs available than for adults. The most useful ones are paracetamol, followed by the salicylates, propionic acid derivatives and non steroid anti-inflammatory drugs.(ABSTRACT TRUNCATED AT 400 WORDS)
Collapse
Affiliation(s)
- B Dalens
- Département d'Anesthésie-Réanimation, Pavillon Gosselin, Hôtel-Dieu, Clermont-Ferrand
| |
Collapse
|
21
|
|
22
|
Abstract
Much recent attention has focused on the development and refinement of pain measures, as well as on the use of more effective pain control methods for infants, children, and adolescents. This article reviews the primary categories of pediatric pain measures, with a specific focus on the selection of the most appropriate behavioral, physiologic, or subjective method for assessing a child's pain. The optimum pain measure depends on the age and cognitive level of a child, the type of pain experienced, and the situation in which the pain occurs. While no single measure is adequate for all children for all types of acute, recurrent, and chronic pain, it is possible to choose practical, valid, and reliable methods for evaluating any child's pain experience.
Collapse
|
23
|
Abstract
After having been virtually completely forgotten since the Second World War, paediatric regional anaesthesia has been undergoing a renewal in the last decade. This renewed interest in old techniques is due to several converging factors: a better knowledge of the pharmacology of local anaesthetic agents in the child, the availability of equipment adapted for children, the remarkable haemodynamic stability of the very young child during an epidural block, as well as the need to treat pain not just in the operative period. The child is not, or rather, is not only a small adult. Embryological development is not finished at birth. The incompletely myelinized nervous system as well as the incomplete skeletal ossification will influence local anaesthetic pharmacodynamics and the choice of anaesthetic technique and anatomical landmarks. Aponeurotic sheaths are only poorly attached to anatomical structures, especially nerves. This, together with the fact that epidural fat in the young child is very fluid, explains why some techniques are very efficient, but also why the volumes of required anaesthetic solution are proportionately much more important than in adults. The general pharmacology of local anaesthetic drugs is very close to adults. However, the very important regional blood flow rates, the different body water distribution, the immature neurovegetative system, the weak activity of some enzymes, and the relatively greater importance of the liver and brain by weight explain the differences found in pharmacokinetics, which are differences in degree and not in nature. The choice of the appropriate local anaesthetic agent depends on these factors. In France, the chosen drug will almost exclusively be an amide, mostly lignocaine and bupivacaine. The psychological immaturity of children makes any assessment of pain quite difficult. Moreover, body image has not yet been completely acquired in most cases, so reducing the possibility of conceptualization. The usefulness of techniques requiring an active patient participation, in particular the search for paraesthesia, is therefore rather reduced. Light general anaesthesia and peripheral nerve stimulators (for nerve blocks) are essential, and desirable at least, if not wished by most patients. Caudal anaesthesia is an important technique in the child. It is easy to perform, efficient, with small risk. Its ideal indication is surgery below the umbilicus in the infant and young child. Lumbar epidural anaesthesia requires greater experience as well as proper equipment, especially in the very young child. Peripheral nerve blocks are less used than in adults.(ABSTRACT TRUNCATED AT 400 WORDS)
Collapse
Affiliation(s)
- B Dalens
- Département d'Anesthésie-Réanimation, Pavillon Gosselin, Hôtel-Dieu, Clermont-Ferrand
| |
Collapse
|
24
|
Rapoff MA, Page-Goertz S. Pain in children. ISSUES IN COMPREHENSIVE PEDIATRIC NURSING 1988; 11:iii-iv. [PMID: 3198429 DOI: 10.3109/01460868809038006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
|
25
|
McGrath PA. An assessment of children's pain: a review of behavioral, physiological and direct scaling techniques. Pain 1987; 31:147-176. [PMID: 3324017 DOI: 10.1016/0304-3959(87)90033-9] [Citation(s) in RCA: 155] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Research on the assessment and management of pain in infants and children has increased dramatically, with the consequence that a wide variety of behavioral, physiological, and psychological methods are now available for measuring pediatric pain. Although the criteria for a pain measure for children are identical to those required for any measuring instrument, special problems exist in pediatric pain measurement because the influence of developmental factors, previous pain experience, and parental attitudes on children's perceptions and expressions of pain is not known. This article reviews the recent advances in the measurement of pain in children, with special emphasis on the methods that satisfy the criteria for reliability and validity, the methods that can be used to assess multiple dimensions of pain, and the methods that may be appropriate for assessing all types of acute, recurrent, and chronic pediatric pain.
Collapse
Affiliation(s)
- Patricia Anne McGrath
- Department of Paediatrics, Faculty of Medicine, University of Western Ontario, London, Ont.Canada
| |
Collapse
|
26
|
Beyer JE, Levin CR. Issues and Advances in Pain Control in Children. Nurs Clin North Am 1987. [DOI: 10.1016/s0029-6465(22)01317-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
|
27
|
Lavigne JV, Schulein MJ, Hahn YS. Psychological aspects of painful medical conditions in children. I. Developmental aspects and assessment. Pain 1986; 27:133-146. [PMID: 3540810 DOI: 10.1016/0304-3959(86)90206-x] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
The assessment and development of pain in children is reviewed in the first part of a two-part series. Assessment of pain in children has relied on self-report measures that have included visual analogue procedures using concrete stimuli for ratings. Behavioral assessment procedures are more sophisticated, but research on behavioral assessment of pediatric pain has begun to emergy only recently. There has been very little research on the developmental aspects of pain tolerance and pain threshold in children. There are preliminary indications that children's thoughts and attitudes about pain may change with age in a manner that contributes to more intense feelings of pain in adolescence than childhood. Children undergoing painful medical procedures show declining emotional outbursts with age and increasing signs of self-control and muscular rigidity. Possibilities for integrating the study of the developmental aspects of pain with social learning theory, cognitive developmental theory, and the psychology of physical symptom perception are discussed.
Collapse
Affiliation(s)
- John V Lavigne
- Department of Child Psychiatry, Children's Memorial Hospital, and Northwestern University Medical School, Chicago, IL 60614 U.S.A. Department of Neurosurgery, Children's Memorial Hospital, and Northwestern University Medical School, Chicago, IL 60614 U.S.A
| | | | | |
Collapse
|