1
Introduction

Alison Twycross

Honorary Associate Professor, School of Nursing and Midwifery, University of Birmingham, UK; Editor-in-Chief, Evidence-Based Nursing

Welcome to the third edition of Managing Pain in Children and Young People: A Clinical Guide. In this edition we have done things a little differently. Our aim remains to pull together current evidence for managing pain in children and young people (CYP) in an easily accessible format. However, we wanted the book to be seen as relevant to students and to members of interdisciplinary teams involved in managing children’s pain around the globe. To reflect this broader focus, the editorial line‐up now includes a medic (physician), a psychologist and two nurses. We have also extended the range of contributors, again drawing on international expertise across the multidisciplinary team. A new chapter has been added to ensure the book is applicable to those working in low‐ to middle‐income countries (Chapter 15).

The first few chapters set the scene for effective multimodal pain management by focusing on the following:

• Why managing pain in children and young people is important.
• The anatomy and physiology of pain.
• Pain as a biopsychosocial phenomenon.
• Pharmacology of analgesic drugs.
• Pain assessment.

Given the new International Classification of Diseases (ICD)‐11 definition of chronic pain, we have decided to include three shorter chapters in this edition rather than one longer one. These chapters focus on the prevention and treatment of chronic postsurgical pain, musculoskeletal pain, and headaches.

Other chapters pull together the current evidence for the prevention and treatment of nociceptive pain, neuropathic and visceral pain, procedural pain, neonatal pain, and paediatric palliative care.

Despite the extensive research that has been carried out over the past 25 years, CYP still do not receive evidence‐based pain care. To address this issue, the final chapter covers how to effectively move forward with knowledge dissemination and implementation.

Multimodal Pain Management

Pain is a biopsychosocial phenomenon (see Chapter 4) and often has a spiritual element (Friedrichsdorf and Goubert 2020). Given this, the prevention and treatment of pain requires a multimodal approach (Figure 1.1). To make this explicit, one of the changes we have made to this edition is to integrate the evidence for physical and psychological pain‐relieving interventions into the chapters focusing on the prevention and treatment of pain. A brief description of physical and psychological pain‐relieving interventions is provided in Tables 1.1 and 1.2. Physical and psychological strategies used with neonates are outlined in Chapter 13.

Figure 1.1 Components of effective multimodal pain management.

World Health Organization Pain Ladder

An integral part of multimodal pain management is the use of analgesic drugs to prevent and treat pain. The World Health Organization (WHO) (2020) has devised a two‐step pain ladder to help guide decision‐making in this context (Figure 1.2). The 2020 WHO ladder takes into account the fact that codeine is no longer recommended for use in CYP (Box 1.1).

Table 1.1 Physical pain‐relieving interventions.

Table 1.2 Psychological pain‐relieving strategies.