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'Total Pain' in Children with Severe Neurological Impairment
Timothy A Warlow1, Richard D W Hain2
1All Wales Paediatric Palliative Care Managed Clinical Network, University Hospital of Wales, Heath Park, Cardiff CF14 4XW, UK. twarlow@doctors.org.uk.
Insights
Children with severe neurological impairment often struggle with pain management. Recent advances offer improved assessment and holistic
Area of Science:
- Pediatric Palliative Care
- Pain Management
- Neurology
Background:
- Children with palliative care needs, especially those with severe neurological impairment, face significant pain management challenges.
- Historically, behavioral responses in these children were misunderstood, leading to inadequate pain recognition and treatment.
- Advances in pain assessment and management have been made for this patient group.
Purpose of the Study:
- To summarize recent advances in pain assessment and management for children with severe neurological impairment.
- To apply the concept of 'Total Pain' using a holistic approach.
- To share experiences from a UK tertiary pediatric palliative care service.
Main Methods:
- Review of recent advances in pediatric pain management.
- Application of the 'Total Pain' model.
- Clinical experience from a tertiary pediatric palliative care service.
Main Results:
- Significant progress has been achieved in assessing and managing pain in children with severe neurological impairment.
- A holistic approach, considering 'Total Pain', enhances care.
- Multidisciplinary expertise is crucial.
Conclusions:
- Improved understanding and management strategies are now available for pain in children with severe neurological impairment.
- A holistic 'Total Pain' approach is recommended for comprehensive care.
- Continued advancements are vital in pediatric palliative care.
Abstract:
Many children with palliative care needs experience difficulty in managing pain. Perhaps none more so than those with severe neurological impairment. For many years; behaviours in these children were misunderstood. As a result; pain was poorly recognised and inadequately managed. Significant advances have been made in the assessment and management of pain in this challenging group of patients. We summarise these advances; drawing on our own experience working with infants; children and young adults with palliative care needs within a UK tertiary paediatric palliative care service. We expand on the recent understanding of 'Total Pain'; applying a holistic approach to pain assessment and management in children with severe neurological impairment.