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Pain management in the critically ill child
1Departments of Anesthesiology/Critical Care Medicine and Pediatrics, Johns Hopkins Hospital, Baltimore, MD 21287, USA.
Insights
Pediatric pain and procedural pain are often undertreated in children, particularly newborns and the critically ill. Adequate analgesia is crucial to prevent long-term changes in pain pathways and improve outcomes.
Area of Science:
- Pediatric medicine
- Pain management
- Neuroscience
Background:
- Children, especially newborns and critically ill, frequently experience inadequate pain treatment.
- Pain pathways are functional by 24 weeks gestation, making fetal and neonatal pain perception possible.
- Under-treatment of pain can lead to altered neural pathways and heightened pain sensitivity.
Purpose of the Study:
- To highlight the critical need for adequate analgesia in all children, including newborns and the critically ill.
- To address the consequences of undertreated pain on developing nervous systems.
- To identify barriers to effective pediatric pain management.
Main Methods:
- Literature review on pediatric pain perception and management.
- Analysis of factors contributing to undertreatment of pain in children.
- Discussion of the physiological and psychological impacts of unrelieved pain.
Main Results:
- Inadequate pain management is prevalent in pediatric populations.
- Untreated pain can cause neuroplastic changes, increasing future pain sensitivity.
- Children may deny pain to avoid further distressing procedures.
- Societal fears and misconceptions about analgesics contribute to undertreatment.
Conclusions:
- All children, regardless of age or critical condition, require analgesia for pain and procedures.
- Effective pain management is essential to prevent negative long-term consequences.
- Addressing societal fears and improving education on analgesics is necessary for better pediatric pain care.
Abstract:
Children frequently received no treatment, or inadequate treatment, for pain and for painful procedures. The newborn and critically ill children are especially vulnerable to no treatment or under-treatment. Nerve pathways essential for the transmission and perception of pain are present and functioning by 24 weeks of gestation. The failure to provide analgesia for pain results in rewiring the nerve pathways responsible for pain transmission in the dorsal horn of the spinal cord and results in increased pain perception for future painful results. Many children would withdraw or deny their pain in an attempt to avoid yet another terrifying and painful experiences, such as the intramuscular injections. Societal fears of opioid addiction and lack of advocacy are also causal factors in the under-treatment of pediatric pain. False beliefs about addictions and proper use of acetaminophen and other analgesics resulted in the failure to provide analgesia to children. All children even the newborn and critically ill require analgesia for pain and painful procedures. Unbelieved pain interferes with sleep, leads to fatigue and a sense of helplessness, and may result in increased morbidity or mortality.