Pediatric Pain Management

• Published in: Pediatric annals Vol. 40; no. 5; pp. 243 - 252
• Main Authors: Rosen, David A, Dower, Joshua
• Format: Journal Article
• Language: English
• Published: United States SLACK INCORPORATED 01.05.2011
• Subjects: Acetaminophen - administration & dosage; Acupuncture; Analgesics - administration & dosage; Analgesics - therapeutic use; Analgesics, Opioid - administration & dosage; Analgesics, Opioid - adverse effects; Analgesics, Opioid - therapeutic use; Anatomy; Anti-Inflammatory Agents, Non-Steroidal - therapeutic use; Anxiety; Behavior; Caregivers; Chemotherapy; Child; Children & youth; Family (Sociological Unit); Humans; Hypnotherapy; Music therapy; Narcotics; Neonates; Pain; Pain - drug therapy; Pain - physiopathology; Pain - prevention & control; Pain management; Pain Measurement; Quality of life; Scientific Research; Sleep; Stimuli
• ISSN: 0090-4481; 1938-2359
• DOI: 10.3928/00904481-20110412-05

When pain or painful stimuli are untreated or poorly treated, sensitization of the N-Methyl-D-aspartic acid (NMDA) receptor system can become activated, producing hyperexcitability of neurons, which leads to central nervous system (CNS) sensitization, activation of the wind-up phenomenon, initiation of pain memory, and opioid tolerance.10 In the CNS, glutamate is an excitatory amino acid believed to play a crucial role in the propagation of sensitization. Meta-analytic findings of these psychological interventions documented pain reduction immediately after treatment and follow-up in children with headaches, abdominal pain, and fibromyalgia.64 Cognitive behavioral therapy may be limited for many children due to lack of access to such services; this type of therapy can now be provided effectively through Internet-based telemedicine services.65 Acupuncture has been gaining appeal with effectiveness in chemotherapy situations, particularly as it relates to nausea and vomiting with chemotherapy, headache, pain, and agitation from bilateral myringotomy tube insertion, spinal fusion procedures, and management of reflex sympathetic dystrophy in children.66-68 Music has also found acceptance within the perioperative setting, reducing the morphine requirement of school-age children after same-day surgery.69 When music therapy was combined with acupuncture, there was no further pain reduction, although anxiety was reduced.70 Hypnotherapy is effective for the treatment of children with functional abdominal pain or irritable bowel syndrome compared with standard medical therapy.71,72 Utilizing combinations of non-pharmacologic techniques requires further study.