Managing Pain in Children and Young People

Alison Twycross is Former Deputy Dean and Professor of Children's Nursing; Honorary Associate Professor, School of Nursing and Midwifery, University of Birmingham, UK.

Jennifer Stinson is Mary Jo Haddad Nursing Chair in Child Health; Nurse Practitioner, Chronic Pain Program; The Hospital for Sick Children, Toronto, Canada, and Professor, Faculty of Nursing, University of Toronto, Canada.

William T. Zempsky, MD, MPH is the Francine L. and Robert B. Goldfarb-William T. Zempsky, MD Endowed Chair for Pain and Palliative Medicine, Vice Chair for Academic Affairs and Research at Connecticut Children's Medical Center, as well as Professor of Pediatrics at University of Connecticut School of Medicine, USA.

Abbie Jordan is a Reader in the Department of Psychology and member of the Centre for Pain Research at the University of Bath, UK.

Contributors xx

Foreword xxiii

Acknowledgements xxiv

1 Introduction 1
Alison Twycross

Multimodal Pain Management 1

References 6

2 Why Treating and Preventing Pain Matters 8
Nicole E MacKenzie, Perri R Tutelman, Christine T Chambers, and Kathryn A Birnie

What is Pain? 8

Nociceptive Pain 9

Chronic Pain 9

What is Unique about Pain in Children and Young People? 10

The Historical Context of Children and Young People’s Pain 10

The Current Context of Children and Young People’s Pain 12

Consequences of Undermanaged Pain in Children and Young People 14

Ethical Imperative of Managing Pain in Children 14

Summary 16

Multiple Choice Questions 16

References 17

3 Anatomy and Physiology of Pain 21
Charlie H.T Kwok and Tuan Trang

What is Pain? 21

The Nervous System 21

Pain Mechanisms 21

Gate Control Theory of Pain 27

Neuromatrix Theory of Pain 27

Biopsychosical Theory of Pain 28

Central Sensitisation in Chronic Pain 29

Nociceptive Pain 30

Visceral Pain 30

Neuropathic Pain 31

Chronic Postsurgical Pain 31

Physiology of Pain in Children and Young People 31

Postnatal Development of Pain Processing 32

Summary 34

Multiple Choice Questions 34

Acknowledgements 35

References 35

4 Pain: A Biopsychosocial Phenomenon 37
Line Caes, Paula Forgeron, and Liesbet Goubert

Introduction 37

Nociception 37

Biological Factors 38

Psychological Factors 41

Social Factors 43

Summary 45

Multiple Choice Questions 45

References 46

5 Pharmacology of Analgesics 50
Janice E Sumpton

How Drugs Work 50

Routes of Drug Administration 53

Medication Challenges in Infants, Children and Young People 53

Selection of analgesics 55

Summary 67

Multiple Choice Questions 67

Acknowledgements 68

Useful Web Resources 68

References 68

6 Pain Assessment 73
Lindsay Jibb and Jennifer Stinson

Pain Measurement and Pain Assessment 73

Assessing Pain in Children and Young People 73

Pain Assessment Tools for Neonates 84

Pain Assessment in Ventilated CYP 85

Pain Assessment in CYP with Learning Disabilities 85

Ruling Out Delirium, Withdrawal and Other Non-pain Pathologies when Assessing Pain 86

Choosing the Right Pain Assessment Tool 87

How Often Should Pain be Assessed? 89

Documentation 89

Summary 89

Acknowledgements 89

Multiple Choice Questions 90

References 90

7 Preventing and Treating Nociceptive Pain 94
Sueann Penrose and Cate Sinclair

What is Nociceptive Pain? 94

Causes of Nociceptive Pain in Children and Young People 94

Managing Nociceptive Pain 96

Pain Assessment 96

Pain Management in the Hospital Setting 97

Pharmacological Pain-relieving Interventions 97

Analgesic Administration Techniques 104

Pain Problem-solving: What to Do if the Pain Management Plan Is Not Working 115

Transition to Oral Analgesics from Specialist Analgesic Techniques 115

Pain Medications at Home 115

Psychological Pain-relieving Interventions 117

Physical Pain-relieving Interventions 118

Spirituality and Nociceptive Pain in Children and Young People 118

Summary 118

Acknowledgements 119

Key to Case Study 119

Multiple Choice Questions 121

References 121

8 The Prevention and Treatment of Neuropathic and Visceral Pain 126
Krista Baerg and Giulia Mesaroli

Neuropathic Pain 126

Visceral Pain 129

Assessing Neuropathic and Visceral Pain 132

Treatments for Neuropathic and Visceral Pain 137

Summary 140

Key to Case Study 141

Multiple Choice Questions 142

Acknowledgements 142

References 143

9 Musculoskeletal Pain in Children and Young People 147
Sara Klein, Karen Chiu, Jacqui Clinch, and Christina Liossi

What is Musculoskeletal Pain? 147

Complex Regional Pain Syndrome and Chronic Widespread Pain 152

Diagnosing, Assessing and Treating Chronic Musculoskeletal Pain 153

Treatment of Chronic Musculoskeletal Pain 156

Treatment of Chronic Regional Pain Syndrome 160

Intensive Multidisciplinary Pain Programmes 161

Long-term Outcomes in CYP with Chronic Musculoskeletal Pain 162

Summary 162

Key to Case Study 163

Multiple Choice Questions 164

Acknowledgement 165

References 165

10 Preventing and Treating Chronic Headache Disorders in Children and Young People 170
Naiyi Sun, Christina Liossi, and Jacqui Clinch

Definitions 170

Symptoms of Chronic Migraine 171

Symptoms of Chronic Tension-type Headache 171

Comorbidities Associated with Chronic Headache Disorders 171

Impact of Headaches 172

Assessment of Pain in CYP with Headaches 172

Management of Chronic Headache Disorders 173

Outcomes for CYP who Experience Chronic Headaches and Chronic Migraines 177

Summary 177

Key to Case Study 178

Multiple Choice Questions 178

Acknowledgement 179

References 179

11 Chronic Postsurgical Pain in Children and Young People 182
Christina Liossi, Jacqui Clinch, and Brittany N Rosenbloom

Postsurgical Pain Trajectories and Impact 183

Management of Chronic Postsurgical Pain 183

Prevention of Chronic Postsurgical Pain 188

Summary 188

Key to Case Study 189

Multiple Choice Questions 189

Acknowledgements 190

References 190

12 Prevention and Management of Procedural Pain 194
Kaytlin Constantin, Anna Taddio, Deepa Kattail, and C Meghan McMurtry

Procedural Pain 194

Assessing Procedural Pain and Fear 195

Managing Procedural Pain 198

Pharmacological Interventions 204

Summary 212

Key to Case Study 213

Multiple Choice Questions 216

Relevant Web Resources 216

References 217

13 Pain in the Neonate 220
Marsha Campbell-Yeo, Mats Eriksson, and Britney Benoit

Causes, Prevalence and Consequences of Neonatal Pain 220

Assessing Pain in the Neonate 221

Physical Pain-relieving Interventions 226

Pharmacological Interventions for Neonatal Pain 228

Families and Pain Management 230

Summary 231

Key to Case Study 231

Multiple Choice Questions 232

Additional Online Resources 233

References 233

14 Palliative Care in Children and Young People 241
Poh Heng Chong and Hwee Hsiang Liow

What is Paediatric Palliative Care? 241

Treating and Preventing Pain in Children and Young People with Advanced Incurable Cancer 244

Treating and Preventing Pain in Children and Young People with Severe Neurological Impairment 251

Ethical Considerations in Paediatric Palliative Care 260

Symptom Management to Optimise Comfort at the End of Life 261

Summary 262

Key to Case Study 263

Multiple Choice Questions 263

References 264

15 Treating and Preventing Pain in Children and Young People in Low-and Middle-Income Countries 270
Julia Downing, Julia Ambler, and Jennifer Hunt

Managing Pain in CYP in LMICs 270

Challenges to Treating and Preventing Pain in CYP in LMICs 271

Overcoming Challenges to Treating and Preventing Pain in LMICs 276

Specific Issues in LMICs for the Treatment and Prevention of Pain in CYP 278

Summary 283

Key to Case Study 284

Multiple Choice Questions 286

Online Resources in English and French 287

References 288

16 Knowledge Implementation and Dissemination: Effectively Moving Forward 291
Bonnie Stevens, Amelia Swift, and Denise Harrison

Implementation Science 291

Existing Gaps in Pain Practice 292

How Implementation Science Guides Us: Theories, Models and Frameworks 292

Knowledge Translation Strategies 294

Evaluating Knowledge Translation Strategies 294

Evaluating Social Media 297

Organising Knowledge Translation Strategies 301

The Way Forward 302

Summary 303

Multiple Choice Questions 303

References 304

Appendix 1: Drug Dosing Tables 308

Answers to Multiple Choice Questions 318

Index 319