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Childhood Chronic Pain Position Statement from the American Pain Society Significance of the problem : Affects 15% to 20% of children (Goodman & McGrath, 1991). Creates significant emotional and social consequences. Financial costs, healthcare utilization and indirect costs are high Impact child’s overall health and may predispose for adult chronic pain (Campo et al., 1999; Walker, Garber, Van Slyke, & Greene, 1995).
Defining Pain Pain means an unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage. Acute pain signals a specific nociceptive event and is self-limited Chronic pain has been defined as pain that lasts longer than 3 (6) months and continues beyond the normal time expected for resolution of the problem or persists or recurs for other reasons.
Defining Pain Acute Pain Classification Somatic Pain: Result of activation of nociceptors (sensory receptors) sensitive to noxious stimuli in cutaneous or deep tissues. Experienced locally and described as constant, aching and gnawing. The most common type in cancer patients. Visceral Pain: Mediated by nociceptors. Described as deep, aching and colicky. Is poorly localized and often is referred to cutaneous sites, which may be tender. In cancer patients, results from stretching of viscera by tumor growth.
Managing Pain General Treatment Principles: Ask about pain regularly. Believe the patient's and family's reports of pain and what relieves it. Choose appropriate pain control options. Deliver interventions in a timely, logical, and coordinated fashion. Empower patients and their families.
Managing Pain Adjuvant Medication for Pain Corticosteroids Decadron Prednisone Most specific indication for brain metastasis and spinal cord compression. May add benefit for pain associated with inflammatory process. Side effects common: hunger and weight gain, stretch marks, muscle weakness
Managing Pain Adjuvant Medication for Pain Anticonvulsants Carbamazepime Gabapentin Neuropathic pain: May be helpful as antidepressant
Managing Pain Adjuvant Medication for Pain Antidepressants Amytriptyline Doxepin Trazadone Serotonin re-uptake inhibitors May be helpful as antidepressant Neuropathic pain of peripheral nerve injury
Managing Pain Adjuvant Medication for Pain Diphenhydramine Transdermal clonidine (0.1 to 0.2 mg/day)
Managing Pain Wisconsin Cancer Pain Initiative
Managing Pain Physical Pain Management Exercise regimen Cutaneous stimulation techniques: superficial heat and cold, massage, pressure or vibration Physical therapy: active and passive range-of-motion exercises to prevent joint contracture, muscle atrophy, cardiovascular deconditioning
Managing Pain Rehabilitation Treatment Modalities Physical Therapy Occupational Therapy Alternative Interventions: Acupuncture, reflexology, aroma therapy, music therapy, dance therapy, yoga, hypnosis, relaxation and imagery, distraction and reframing, psychotherapy, peer support group, spiritual, chiropractic, magnet therapy, bio-feedback, meditation, relaxation techniques
Managing Pain Nonpharmacologic Interventions: Invasive Procedures With rare exception, noninvasive treatments should precede invasive palliative approaches Palliative radiation therapy : treatment of symptomatic metastasis where tumor has caused pain, obstruction, or compression. Radiation should be administered in the fewest fractions possible to promote patient comfort during and after treatment. Neurolytic blockade of peripheral nerves should be reserved with rare exception for instances in which other therapies (palliative radiation, TENS, pharmacotherapy) are ineffective, poorly tolerated, or clinically inappropriate. Intraspinal medication (Ommya resevoir)