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Transformative action required to improve pain management in kids

Lancet Child and Adolescent Health
Reuters Health - 23/10/2020 - Several transformative goals need to be pursued simultaneously to improve the management of pediatric pain, which is commonly unrecognized and undertreated.

"We all want kids to grow up healthy and with the ability to pursue their passions," Dr. Christopher Eccleston of the Center for Pain Research at the University of Bath, in the U.K., told Reuters Health by email. "And doctors and nurses and parents all want to spare children from pain and suffering that can get in the way. Pain awareness and management should start at the beginning and carry on throughout childhood. Don't wait until it is too late."

Dr. Eccleston and colleagues on a Lancet Child and Adolescent Health Commission offer four goals aimed at improving the lives of children and adolescents with pain and their families. Their report, along with several linked articles, appears in The Lancet Child and Adolescent Health.

First, the commission says, make pain matter. Investment in a strong research base, including social science, can improve our understanding of the social and cultural context of pain so that we can better address it.

Second, make pain understood. This, too, requires greater investment in pain research, including the entire biopsychosocial model, basic science, and classification.

Third, make pain more visible. Not only should pain be assessed in every child, but also a greater focus should be placed on assessing outcomes that are important to patients than on those of interest to researchers and clinicians.

Fourth, reduce pain through a multimodal approach that includes psychological, pharmacological and physical interventions. Innovation in new ways to personalize individual treatments can also support this goal.

These four goals must be addressed simultaneously, not sequentially, the commission says.

"The standard of care for children in pain today is no care," Dr. Eccleston said. "At the current rate of innovation, it will take 1,000 years to have a comparable treatment model as exists for adults. We need to totally re-think the pain treatment center and create sustainable new solutions."

"There is very good evidence that we can make a difference in kids' lives," he said. "We need to (create) new solutions and get our knowledge into practice."

Two related commentaries address specific aspects of pediatric pain management. In the first, Dr. Baba Psalm Duniya Inusa of Guy's and St. Thomas' NHS Foundation Trust, in London, and colleagues describe the racial inequalities in access to care for young people living with pain due to sickle-cell disease.

"Health-care providers need to listen, respect, and trust individuals with sickle cell disease who might have different cultures and traditional beliefs," they write. "The development of standardized treatment protocols and comprehensive training programs, which include prevention of complications and management of acute and persistent pain, as well as the improvement of professional attitudes and cultural competency for hematologists, primary care and emergency care workers, and other health-care providers, is warranted."

The second commentary, by Dr. Mary Suma Cardoso of Selayang Hospital, in Batu Caves, Malaysia, and colleagues, focuses on pediatric pain management in low- and middle-income countries (LMICs).

"Pain management in children is very much neglected, especially in LMICs, and we can do much better, and our children deserve better," Dr. Cardoso told Reuters Health by email.

"A lot of changes can be implemented without the need for large amounts of resources - what it takes is awareness and change in attitude and prioritization," she said. "Simple steps can be taken and easily implemented, e.g., to reduce the pain from immunization in children, we just need to allow the mother to cuddle the child and use distraction (e.g., play, blowing bubbles, singing)."

"Children's complaints of pain should not be ignored," Dr. Cardoso concluded. "There are long-term consequences of unrelieved pain in infants and children."

Two "reflection" essays related to this report describe the school experience for young people living with chronic pain and the value of artwork as an outlet for pediatric pain.

Emma Snow, from Alberta, Canada, explains, "Living with chronic pain really destroys every factor of your life. I lost a social life, sleep habits were horrible, I couldn't focus in school."

But after completing an 11-week program focusing on cognitive behavioral self-management, "I have a social life; I travel. I just love life right now," she writes.

By Will Boggs MD

SOURCE: https://bit.ly/2FR72pV, https://bit.ly/3mah8Sb, https://bit.ly/3oirpO8, https://bit.ly/3kpitUH and https://bit.ly/3ogDVO5 Lancet Child and Adolescent Health, online October 13, 2020.

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