Page 267 Guide to Pain Management in Low-Resource Settings

Chapter 34

Pain Management in Children

Dilip Pawar and Lars Garten

Th is chapter will cover the diffi culties in treating pain in quantitatively compared to adults. Th e pain response is
children and provide you with an overview of pharma- more intense at the beginning, but wears off much ear-
cological and nonpharmacological interventions for ef- lier than in adults. Hence, no single formula is going to
fective pain control in acute pain (injury/trauma-related work for everyone, and customized pain relief measures
and postoperative pain) and chronic pain (cancer and are required.
HIV-related pain) in children. Parental understanding and support is helpful be-
cause of their emotional attachment. As children may
Do children feel pain? not ask for analgesia as adults can or do, an eff ort has
to be made to anticipate pain, especially in infants and
Until recently, many believed that children do not feel children who cannot express themselves verbally.
pain, a belief based on lack of understanding, and on Most of the general principles of analgesia can be
fear of using narcotics with potential respiratory depres- applied to children, but there are some signifi cant physi-
sion and addiction in children, rather than on any sci- ological diff erences between adults and children that
entifi c rationale. Today it is well known that the sensory can cause problems, especially in neonates and small in-
nervous system and pain pathways develop around mid- fants. Just look at the case reports and imagine you have
gestation, with connections and function maturing over to deal with these clinical situations.
the fi rst 3 months after birth.
Th ere is no evidence to support the view that pain is Case reports
less intense in neonates and young children due to their
developing nervous system. However, pain is subjec- You are in a small rural hospital with limited drugs.
tive, and the pain response is individual and is modifi ed Consider the following real-life cases. How might you
through social learning and experience. Early pain expe- manage them?
rience plays an important role in shaping an individual’s
Case report 1 (“acute trauma”)
later pain response by alternation in the stress-axis and
antinociceptive circuitry. Ahmed, a 3-year-old boy, with acute burns over a large
part (more than 20%) of his body, has been admitted.
Aren’t children just “little adults”? He is in severe pain. How will you manage analgesia in
this child?
Th e pediatric age group is heterogeneous, ranging from Th e boy suff ers from severe post-traumatic pain,
the newborn to the adolescent. Children’s pain percep- so he needs fast analgesia. Use morphine as an intra-
tion and responses are diff erent both qualitatively and venous (i.v.) bolus (if not possible, substitute enteral
Guide to Pain Management in Low-Resource Settings, edited by Andreas Kopf and Nilesh B. Patel. IASP, Seattle, © 2010. No responsibility is assumed by IASP 255
for any injury and/or damage to persons or property as a matter of product liability, negligence, or from any use of any methods, products, instruction, or
ideas contained in the material herein. Because of the rapid advances in the medical sciences, the publisher recommends that there should be independent
verifi cation of diagnoses and drug dosages. Th e mention of specifi c pharmaceutical products and any medical procedure does not imply endorsement or
recommendation by the editors, authors, or IASP in favor of other medical products or procedures that are not covered in the text.