Managing Pain in Children and Young People

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