Pain
Introduction
Pain is one of the most common symptoms in children with life limiting conditions. Pain is highly distressing and can affect the child's quality of life. It is therefore vital for physicians to be well trained in comprehensive pain management strategies.
The main goal of pediatric palliative care is improve the child’s quality of life and good pain management is an important part of this.
The key to effective pain control is obtaining a detailed assessment, developing a child specific treatment plan and frequently re- evaluating to determine efficacy(2).
Myths about pain in children
There have been many longstanding misconceptions about pain in children and it is only in the last decade or so that more research studies have been done which disprove these ideas. Some examples are(3):
- Infants can not feel pain because their nervous system is immature.
- Children do not feel as much pain as adults an active or sleeping child is not in pain.
- Children always tell the truth about pain.
- Children cannot describe or locate their pain.
The use of opioids in children creates an important socio-cultural impact on the families. Some concerns that parents have voiced regarding their reluctance to use opioids for pain control in children are(2):
- Fear of giving up.
- Opioids are too strong for children.
- Fear of side effects.
- Worry their child will become “addicted” to pain medications.
- Cultural or religious beliefs.
Also health care providers have expressed reluctance to the opioids use in children. Reasons cited included(2, 4, 5):
- Lack of sufficient education regarding managing pain.
- Misconceptions about frequency and severity of side effects, such as respiratory depression.
- Worries that opioids will shorten life expectancy.
- Concerns that escalating opioid doses will increase the likelihood of tolerance, and thus make pain control more difficult as the disease progresses.
Painting by Frida Khalo. She was afflicted by chronic pain after an accident which damaged her spine.
