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Published on: January 11, 2016
Pain in children with significant neurological impairment
T F Oberlander1, M E O'Donnell, C J Montgomery
1Division of Developmental Pediatrics, Sunny Hill Health Centre for Children, University of British Columbia, Vancouver, Canada. timothyo@interchange.ubc.ca
Insights
Children with neurological impairments may experience pain differently due to altered systems. Understanding their unique pain communication is key for effective pain management strategies.
Area of Science:
- Pediatric neurology
- Pain medicine
- Neuroscience
Background:
- Children with neurological impairments present complex pain experiences.
- Neurological conditions like cerebral palsy can alter pain perception and communication.
- Evidence suggests pain is not blunted but uniquely experienced.
Purpose of the Study:
- To explore the multifaceted nature of pain in children with neurological impairments.
- To understand how neurological, communication, and environmental factors influence pain.
- To guide effective pain management strategies in this population.
Main Methods:
- Review of existing literature on pain in pediatric neurological conditions.
- Analysis of the interplay between pain systems and motor, sensory, and autonomic functions.
- Consideration of communication disabilities and psychosocial factors.
Main Results:
- Neurological impairment uniquely impacts pain perception and expression.
- Communication barriers and environmental factors significantly alter the pain experience.
- Establishing baseline behaviors and consistent monitoring are crucial for assessment.
Conclusions:
- Pain management requires addressing underlying causes and employing multimodal approaches.
- Pharmacological strategies include the analgesic ladder, opioids, and antispasticity medications.
- Effective pain control can be achieved with regional analgesia and appropriate monitoring.
Abstract:
The pain experience in the child with a significant neurological impairment is complex and confusing, and it raises many questions about the very nature of pain itself. Early work in this field suggests that the pain experience may be blunted. The neurological impairment associated with conditions such as cerebral palsy may alter the neurological system and hence the ability to comprehend and communicate pain; there is no evidence to date that this reflects true pain insensitivity or indifference. From recent work, the emerging body of evidence supports a relationship between the pain system and the motor, sensory, and autonomic systems and demonstrates how alterations to these systems may have a profound and unique impact on the pain experience. Beyond the altered neurological substrate, communication disabilities and social/environmental factors also seem to alter the pain experience. Establishing a clear pain history, including baseline information of child-specific patterns of behaviors and ongoing comparative use of this information over time, can provide clinically meaningful measures. Pain management should be directed at the underlying sources of pain and should include the analgesic ladder for everyday pain, opioids for acute/procedural pain (+/- benzodiazepine adjuvants), and antispasticity medications for high tone. With appropriate monitoring, demand and regional analgesic techniques can provide effective and safe postoperative pain control. The lack of basic and clinical knowledge in this field, however, adds another challenge to the clinician.
