Pain in Children (eBook)
XXI, 279 Seiten
Humana Press (Verlag)
978-1-59745-476-6 (ISBN)
Advances over the past two decades have enabled physicians to revolutionize the manner in which they can assess and manage children's pain. Thirty years ago it was thought that young children did not experience pain and therefore it was not necessary to treat it. Today professionals from a variety of disciplines have contributed data that have revolutionized medical perspectives. Technological advances now enable doctors to treat acute pain in fetuses, premature neonates, infants, toddlers, children, and adolescents with increasing precision and efficacy. Research highlighting the context of chronic pain has moved them away from a mind-body dichotomy and toward an integrated, holistic perspective that leads to substantial improvement in children's adaptive functioning as well as subjective discomfort.
This book covers these topics and is intended for anyone who provides medical care to children. Each chapter provides an overview of the problem, followed by a 'hands on' description of relevant assessment and intervention strategies. The role of the primary care practitioner is highlighted, both as a front-line resource as well as a consumer of specialized pediatric pain treatment services. Each chapter ends with a summary and specific bullet points highlighting the most central elements, making for quick and easy reference.
Advances over the past two decades have enabled physicians to revolutionize the manner in which they can assess and manage children's pain. Thirty years ago it was thought that young children did not experience pain and therefore it was not necessary to treat it. Today professionals from a variety of disciplines have contributed data that have revolutionized medical perspectives. Technological advances now enable doctors to treat acute pain in fetuses, premature neonates, infants, toddlers, children, and adolescents with increasing precision and efficacy. Research highlighting the context of chronic pain has moved them away from a mind-body dichotomy and toward an integrated, holistic perspective that leads to substantial improvement in children's adaptive functioning as well as subjective discomfort.This book covers these topics and is intended for anyone who provides medical care to children. Each chapter provides an overview of the problem, followed by a "e;hands on"e; description of relevant assessment and intervention strategies. The role of the primary care practitioner is highlighted, both as a front-line resource as well as a consumer of specialized pediatric pain treatment services. Each chapter ends with a summary and specific bullet points highlighting the most central elements, making for quick and easy reference.
Dedication 5
Foreword 7
Preface 11
Acknowledgements 13
Table of Contents 15
Contributors 19
Part I: General Considerations 23
Chapter 1 24
Pain and the Primary Pediatric Practitioner 24
Introduction 24
1. Managing Pain in Children: Your Ethical Obligation 26
2. Development of Pain Systems 26
3. Individual Differences in Pain Response 27
3.1. Genetics of Pain Response 27
3.2. Temperament 27
4. Consequences of Untreated Pain in the Young 28
Take-Home Points 28
References 28
Chapter 2 30
Developmental Issues in Understanding, Assessing, and Managing Pediatric Pain 30
Introduction 30
1. The Child in Pain 32
2. The Role of the Caregiver 32
3. Domains of Development 32
3.1. Physical Growth 33
3.2. Cognitive Capabilities 33
3.3. Emotional Processing 34
3.4. Behavioral Competence 35
3.5. Social Interaction 35
4. Stages of Development 36
4.1. Newborns 36
4.2. Infants 36
4.3. Toddlers 37
4.4. Preschoolers 37
4.5. Elementary School-Aged Children 38
4.6. Adolescence 38
Take-Home Points 39
References 39
Chapter 3 42
Measurement and Assessment of Pediatric Pain in Primary Care 42
1. Measurement of Pain: Why and How? 42
2. Pain Measurement in Primary Care Versus Specialized Settings 42
3. How Pain is Measured 42
4. Interpretation and Use of Pain Scores 43
5. Neonates, Infants, and Toddlers up to 2 Years 43
6. Preschool-Age Children (3 to 5 Years) 44
7. School-Age Children (6 to 12 Years) 44
8. Adolescents 45
9. Children with Developmental Disabilities 45
10. Children in Critical Care 45
11. Four Brief Case Examples 45
11.1. Self-Report Numerical Pain Scores in a Headache Diary 46
11.2. Self-Report Faces Pain Scores in Repeated Injections 46
11.3. Observation by Parents to Control Post-Tonsillectomy Pain at Home 46
11.4. Physician’s Use of a Global Numerical Rating Scale in a Busy Infant Ward 46
Take-Home Points 46
References 47
Chapter 4 50
Pain Management for Children with a Developmental Disability in a Primary Care Setting 50
Introduction 50
1. What is a Developmental Disability and Where is the Pain? 50
2. What Is an SNI and How Can it Lead to Painful Conditions? 51
3. Pain Expression in SNI 52
4. Pain Assessment 52
5. Investigation of Pain in a Child with an SNI 53
6. Pain Management 55
6.1. Analgesics 55
6.2. Drug Interactions 55
6.3. Drug Trials 56
6.4. Acute Pain 56
Take-Home Points 57
Recommended Reading Material 57
References 57
Chapter 5 60
Remote Management of Pediatric Pain 60
Introduction 60
1. Pediatrician to Patient and Family 61
1.1. Assessment at a Distance 61
1.2. Treatment at a Distance 62
1.3. Schools at a Distance 64
1.4. When to Refer to a Pain Service 64
2. Pediatric Pain Specialist Care to Patient and Family 65
2.1. Pediatric Pain Clinic Assessment at a Distance 65
2.2. Pediatric Pain Clinic Treatment at a Distance 65
2.3. Pediatric Pain Clinic and Schools at a Distance 66
2.4. Pediatric Pain Clinic and Distance Specific Treatments 66
3. Professional-to-Professional Consultation 67
4. Ethical/Legal Issues 69
5. Conclusion 69
Take-Home Points 69
References 69
Appendix A 71
Part II: Acute Pain Management 74
Chapter 6 76
Pain Management in the Primary Care Office 76
Introduction 76
1. Pains in Normal Growth and Development 77
1.1. Teething 77
1.2. Colic 77
1.3. Growing Pains 78
2. Pain Associated with Acute Infections 79
2.1. Otitis Media 79
2.2. Pharyngitis 80
2.3. Summary 80
3. Pain Associated with Minor Injuries 80
4. Creating a Pain-Friendly Office 81
4.1. Setting the Stage 81
4.2. Education 82
4.2.1. Parents and Children 82
4.2.2. Staff Education 82
4.3. Cultivating Relationships with Outside Providers 82
4.4. Office Environment 83
5. Summary 83
Take-Home Points 83
References 84
Chapter 7 86
Topical Anesthetics and Office-Based Procedures 86
Introduction 86
1. Needle Procedures: Immunizations, Venous Access, and Heel Lance 86
1.1. Prior to the Needle Procedure 87
1.1.1. Preparation 87
1.1.2. Site 87
1.1.3. Needle Type 87
1.1.4. Injectate Properties 88
1.2. During the Procedure 88
1.2.1. Parental Demeanor 88
1.2.2. Distraction 89
1.2.3. Topical Anesthetics 89
1.2.4. Complementary Analgesia for Infants 90
1.2.5. Physical Methods 90
1.2.6. Simultaneous Injection 90
2. Urinary Catheterization 90
3. Summary and Other Procedures 91
Take-Home Points 91
References 91
Chapter 8 94
Analgesic Medications for Acute Pain Management in Children 94
Introduction 94
1. Nonsteroidal Anti-Inflammatory Drugs 95
1.1. Nonspecific Cyclooxegenase Inhibitors 95
1.1.1. Acetylsalicylic Acid (Aspirin) 95
1.1.2. Acetaminophen 95
1.1.3. Ibuprofen 97
1.1.4. Naproxen 97
1.1.5. Etodolac 97
1.1.6. Ketorolac 97
1.2. COX-2 Inhibitors 97
2. Opioids 97
2.1. Agonists and Antagonists 98
2.2. Adverse Drug Reaction 98
2.3. Recommended Doses 98
2.4. Morphine 98
2.4.1. Fentanyl 99
2.4.2. Hydromorphone 100
2.4.3. Meperidine 100
2.4.4. Methadone 100
2.4.5. Codeine 101
2.4.6. Oxycodone and Hydrocodone 101
2.4.7. Tramadol 101
2.4.8. Nalbuphine 102
2.4.9. Naloxone 102
3. Approaches to Opioid Use 102
3.1. Patient-Controlled Analgesia 103
3.2. Continuous Opioid Infusions 104
4. Nontraditional Analgesics 104
4.1. Antidepressants 104
4.2. Anticonvulsants 105
Take-Home Points 105
References 105
Chapter 9 108
Pain Management in the Emergency Department 108
Introduction 108
1. Advances in ED Pain Management 108
1.1. Procedural Sedation and Analgesia 108
1.2. Simple Procedural Pain Management 109
1.3. Acute Abdominal Pain 110
2. Nonpharmacologic Interventions 110
3. Pharmacologic Interventions 110
4. Preparing the Patient for an ED Visit 110
5. Pre-Hospital Pain Management 111
Take-Home Points 111
References 111
Chapter 10 114
Preparing Children for Invasive Procedures and Surgery 114
Introduction 114
1. Factors Associated with Pediatric Pain During Invasive Procedures 115
1.1. Nonmalleable Predictors of Children’s Pain and Distress 115
1.2. Malleable Predicators of Children’s Pain and Distress 115
2. Assessment of Pain, Distress, and Coping 116
3. Interventions for Acute Procedures 116
3.1. Pharmacologic Approaches 116
3.2. Psychological Interventions for Procedure-Related Pain 116
4. Interventions to Reduce Presurgical Anxiety 117
4.1. Midazolam 117
4.2. Parental Presence 118
4.3. Preparation Programs 118
5. When to Refer 119
5.1. For Further Information 119
Take-Home Points 119
References 119
Chapter 11 122
Pain Relief After Outpatient Surgery 122
Introduction 122
1. Regional Anesthesia for Outpatient Surgery 123
1.1. Caudal Anesthesia 123
1.1.1. Single Shot Caudals 123
1.2. Peripheral Nerve Blocks 124
1.2.1. Fascia Iliaca Block 124
1.2.2. Ilioinguinal/Iliohypogastric Nerve Blocks 124
1.2.3. Penile Blocks 125
1.3. Conclusions 125
2. Medication Management of Postoperative Pain 125
2.1. Acetaminophen 125
2.2. Nonsteroidal Anti-Inflammatory Drugs 126
2.3. Opioids 127
3. The Transition from Recovery Room to Home 128
Take-Home Points 128
References 129
Chapter 12 132
Regional Anesthesia 132
Introduction 132
1. Local Anesthetic Pharmacology 133
2. Regional Anesthetic Nerve Blocks and their Indications in Children 134
2.1. Head and Neck Blocks 134
2.1.1. Occipital Nerve Block 134
2.2. Upper Extremity Blocks 135
2.2.1. Interscalene Brachial Plexus Block 135
2.2.2. Infraclavicular Brachial Plexus Block 135
2.2.3. Axillary Brachial Plexus Block 136
2.2.4. Intravenous Regional (Bier) Block 136
2.3. Truncal Somatic and Visceral Blocks 136
2.3.1. Intercostal Nerve Block 136
2.3.2. Paravertebral Block 137
2.3.3. Rectus Sheath Nerve Block 137
2.3.4. Ilioinguinal and Iliohypogastric Nerve Block 137
2.3.5. Penile Block 138
2.3.6. Celiac Plexus Block 138
2.4. Lower Extremity Blocks 138
2.4.1. Lumbar Plexus Block 139
2.4.2. Femoral Nerve Block 139
2.4.3. Sciatic Nerve Block 139
2.4.4. Saphenous Nerve Block 139
2.4.5. Intravenous Regional (Bier) Block 140
2.5. Sympathetic Blocks 140
2.5.1. Stellate Ganglion Block 140
2.5.2. Lumbar Sympathetic Block 140
2.6. Neuraxial Nerve Blocks 141
2.6.1. Epidural Anesthesia (Thoracic, Lumbar) 141
2.6.1.1. Caudal (Sacral) Epidural Anesthesia 142
2.6.1.2. Intrathecal (Spinal) Anesthesia 142
Take-Home Points 143
References 143
Part III: Recurrent and Chronic Pain Management 144
Chapter 13 146
How to Talk to Parents about Recurrent and Chronic Pain 146
Case Illustration 146
Introduction 146
1. Significance of Recurrent and Chronic Pain 147
2. A Biopsychosocial Framework 147
2.1. Explaining the Biopsychosocial Framework to Children and Parents 148
3. Clinical Evaluation of Recurrent and Chronic Pain 148
3.1. Communicating about Psychological Contributors and Interventions 149
4. Engaging the Parent in Counseling by the Physician 149
5. Guidelines in Making Referrals 150
Take-Home Points 151
References 151
Chapter 14 154
Multidisciplinary Approaches to Chronic Pain 154
Introduction 154
1. Models of Care 155
1.1. Multidisciplinary Pain Center 156
1.2. Multidisciplinary Pain Clinic 156
1.3. Pain Clinic 156
1.4. Modality-Oriented Clinic 156
2. Multidisciplinary Centers for Children 156
3. Organization of the Multidisciplinary Evaluation 158
3.1. Initial Physical Exam 159
3.2. Initial Physical/Occupational Therapy Exam 159
3.3. The Feedback Session 159
3.4. The MPC and Primary Physicians 159
3.5. Treatment and Cost-Effectiveness of MPCs 160
4. Specific Disease Examples 160
4.1. Complex Regional Pain Syndrome (CRPS) Type I 160
4.2. Musculoskeletal Pain and Fibromyalgia 161
4.3. Headache 161
4.4. Abdominal and Pelvic Pain 162
5. Conclusion 162
Take-Home Points 162
References 162
Chapter 15 166
Psychological Interventions for Chronic Pain 166
Introduction 166
1. Biofeedback-Assisted Relaxation Training 167
2. Pain Coping Skills Training 168
3. Parental Guidance in Behavior Management Techniques 169
4. Family-Based Intervention 171
5. Consultation with School Personnel 171
6. Psychiatric Consultation 172
Take-Home Points 172
References 172
Chapter 16 174
Complementary and Alternative Approaches for Chronic Pain 174
Introduction 174
1. CAM Treatments for Children and Adolescents 175
1.1. Acupuncture 175
1.2. Hypnotherapy 177
1.3. Biofeedback 177
1.4. Therapeutic Yoga 178
1.5. Massage 178
1.6. Meditation 178
1.7. Other CAM Treatments 178
2. Guidelines for Clinicians and Parents 179
Take-Home Points 179
Recommended Reading 180
References 180
Part IV: Common Recurrent and Chronic Pain Problems in Primary Care 182
Chapter 17 184
Functional Abdominal Pain 184
Introduction 184
1. Definition of FAP 184
2. Prevalence 185
3. Etiology 185
4. Biopsychosocial Model 186
5. Prognosis 187
6. Assessment of FAP 187
7. Treatment 187
7.1. Pharmacological Therapy 187
7.2. Dietary Management 188
7.3. Psychological Interventions 188
7.4. Other Treatment Options 189
8. Conclusion 189
Take-Home Points 189
References 190
Chapter 18 194
Headaches 194
Introduction 194
1. Migraine 195
1.1. Migraine without Aura 195
1.2. Migraine with Aura 195
1.3. Complications of Migraine 196
1.4. Other Features Characteristic of Juvenile Migraines 196
2. Childhood Periodic Syndromes 196
3. Tension-Type Headache (TTH) 197
4. New Daily Persistent Headache (NDPH) 197
5. Referral to Secondary/Tertiary Care 198
6. Management 198
6.1. Management of Acute Migraine 199
6.2. Management of Chronic Migraines 200
6.3. Managing Chronic Daily Headaches 200
6.4. Biobehavioral Treatment 201
6.5. Dietary Modifications and Supplements 202
6.6. Physical Therapy 202
6.7. Acupressure and Acupuncture 202
Take-Home Points 202
Recommended Reading 203
References 203
Chapter 19 206
Evaluating and Managing Pediatric Musculoskeletal Pain in Primary Care 206
Introduction 206
1. Diagnostic Issues in Pediatric Musculoskeletal Pain 207
1.1. Overview 207
1.2. Important Considerations when Taking a History 208
1.3. Physical Exam 209
1.4. Laboratory Tests 209
1.5. Radiographs 211
2. Specific Musculoskeletal Pain Problems 212
2.1. Back Pain 212
2.2. Complex Regional Pain Syndrome 214
3. Follow-Up and Referral 215
3.1. When to Refer to a Pediatric Rheumatologist 215
3.2. When to Refer to a Pediatric Pain Clinic 217
3.3. Other Referrals 218
Take-Home Points 218
References 218
Chapter 20 222
Pain in Sickle Cell Disease 222
Introduction 222
1. Disease Pathophysiology 223
2. Clinical Characteristics of Vaso-Occlusive Pain 224
3. Other Pain Syndromes 225
3.1. Chest Pain 225
3.2. Headache 225
3.3. Abdominal Pain 225
3.4. Avascular Necrosis 226
4. Pain Treatment in the Home Setting 226
5. Pain Treatment in the ED 226
6. Pain Treatment in the Hospital Setting 227
7. Closing Thoughts 227
Take-Home Points 227
References 228
Chapter 21 230
Chronic Pelvic Pain 230
Introduction 230
1. Evaluation 230
1.1. History 230
1.2. Physical Exam 230
1.3. Testing 231
2. Primary Dysmenorrhea 231
3. Endometriosis 231
4. Irritable Bowel Syndrome 232
5. Musculoskeletal Pain 233
6. Interstitial Cystitis 233
7. Pediatric Pain Center: A Multidisciplinary Approach 234
7.1. Pharmacologic Therapies 234
7.1.1. Antidepressants 234
7.1.2. Anticonvulsants 235
7.1.3. Tramadol 235
7.2. Cognitive-Behavioral Therapy 235
7.3. Physical Therapy 236
7.4. Complementary and Alternative Medicines (CAM) 236
Take-Home Points 236
References 236
Chapter 22 240
Palliative Care for the Pediatrician 240
Introduction 240
1. Epidemiology 240
2. Definition of Palliative Care 241
2.1. Essential Elements of Pediatric Palliative Care 241
3. Identifying Children Who Might Benefit from Palliative Care 241
4. The Role of the Primary Care Physician 242
4.1. Communication 242
4.2. Coordination of Care 243
4.3. Respite Care 243
5. End-of-Life Issues 243
5.1. Grief and Bereavement 243
5.2. Complicated Grief 244
6. Pain and Symptom Management 245
6.1. Pain 246
6.1.1. Initiating Therapy 246
6.1.2. Neonates 246
6.2. Opioid Side Effects 247
6.2.1. Idiosyncratic Reactions 247
6.2.2. Opioid Rotation 247
6.3. Progressing Pain 248
6.3.1. Intractable Pain 248
6.3.2. Total Analgesia 248
6.4. Dyspnea 248
6.5. Nausea and Vomiting 249
6.6. Seizures 249
Take-Home Points 249
References 249
Part V: Special Topics 252
Chapter 23 254
Labeling of Pediatric Pain Medications 254
Introduction 254
1. Important Lessons from Pediatric Studies 256
1.1. Pharmacokinetics 256
1.2. Efficacy 256
1.3. Safety 257
2. Regulatory Highlights 257
3. FDA-Approved Labeling 257
4. Special Topics: DEA Regulations 259
5. Pediatric Labeling for Drugs Commonly Used For Analgesia or Anesthesia as of December 2006 260
5.1. Acute Pain 260
5.1.1. Acetaminophen, Aspirin, and Nonsteroidal Agents 260
5.1.2. Opioids 273
5.1.3. Epidurals 273
5.1.4. Local Anesthesia 274
5.1.5. Topical Anesthesia 274
5.2. Chronic Pain 274
5.3. Headaches 274
5.4. Muscle Relaxants 274
6. Gaps in Labeling 275
Take-Home Points 275
Resources 276
References 276
Chapter 24 278
Pediatrician as Advocate 278
Introduction 278
1. Barriers to Pain Advocacy in Primary Care 279
2. Physician as Advocate 280
3. The Importance of the Message 280
4. Developing Your Message 281
5. Story Telling 281
6. Goal and a Plan of Action: Advocating for Kids’ Pain Outside of the Exam Room 283
Take-Home Points 284
References 284
Chapter 25 286
Conclusion: What to Do When There is Nothing to Do 286
Introduction 286
1. There is Always Something to Offer 286
2. There is Always Something to Do (at Least by the Patient) 287
3. FDA Approval and Medication Use 287
4. Looking Ahead 289
5. "Good Luck" 289
Final Take-Home Points 290
Index 292
| Erscheint lt. Verlag | 11.9.2008 |
|---|---|
| Vorwort | Charles Berde |
| Zusatzinfo | XXI, 279 p. 10 illus. |
| Verlagsort | Totowa |
| Sprache | englisch |
| Themenwelt | Medizin / Pharmazie ► Allgemeines / Lexika |
| Medizin / Pharmazie ► Medizinische Fachgebiete ► Allgemeinmedizin | |
| Medizin / Pharmazie ► Medizinische Fachgebiete ► Anästhesie | |
| Medizin / Pharmazie ► Medizinische Fachgebiete ► Innere Medizin | |
| Medizin / Pharmazie ► Medizinische Fachgebiete ► Neurologie | |
| Medizin / Pharmazie ► Medizinische Fachgebiete ► Pädiatrie | |
| Medizin / Pharmazie ► Medizinische Fachgebiete ► Schmerztherapie | |
| Schlagworte | Care • chronic pain • Management • Pain • pain management • Primary Care • Surgery • Treatment |
| ISBN-10 | 1-59745-476-1 / 1597454761 |
| ISBN-13 | 978-1-59745-476-6 / 9781597454766 |
| Haben Sie eine Frage zum Produkt? |
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