Expert guidance on treating pain in children through #CPCDialog

Last week ICPCN held an informative #CPCdialog tweetchat on the important topic of ‘Pain in Children’. Tweetchat guests were paediatric pain experts Dr Christine Chambers and Dr Allen Finley, both from Dalhousie University. An important array of topics and resources were shared during the hour long session. What follows are some of the questions posed to the experts and a summary of their responses with links to the resources they mentioned.

Why is pain management so important?
Dr Chambers pointed out that poorly managed pain leads to longer hospitalization and unnecessary suffering; it can also lead to pain sensitization and changes in brain development. She said, “My view is that if there is something more that can be done to help a child we should do it!” Dr Finley also commented that failure to prevent pain early in life can have long term consequences for the child.

In low resources settings with procedural pain challenges with getting EMLA and applying in time for it work, are there any other recommended alternatives?
A YouTube video on cost effective ways to treat needle pain was recommended. Other non-pharmacological techniques are very effective but also proper use of infiltrated lidocaine with a small needle was recommended by Dr Finley.

What are the barriers to proper pain management?
The experts expressed that the sad reality is that pain isn’t made the priority it should be in healthcare. Many healthcare providers often complain about a lack of knowledge and a lack of time, and changing these providers’ practices is one of the biggest challenges. Many healthcare professionals and patients are also just not aware that there is more that can be done for pain. ‘Why children’s pain gets short shrift‘ by Andre’ Pickard and New York Times blog, ‘Why aren’t we managing children’s pain’ are great articles which discuss some of these barriers.

How many people are using hypnosis or the magic glove for minor procedural pain?
Distraction and hypnosis have a strong evidence for procedure pain management, but are not often used. Dr Finley pointed out that it is important to identify pain mechanisms and not just assume that everything responds to morphine when dealing with drug treatment. An interesting study on the ‘Systematic review and meta-analysis of distraction and hypnosis for needle-related pain and distress in children and adolescents,’ was shared.

Regarding the use of pain scales, which are the most effective?
The Faces Pain Scale Revised is one of the best pain scales. The following #itdoesnthavetohurt blog post also shares more important information regarding pain scales.

How can we raise awareness and bring attention to the problem of pain in children?
Dr Chambers said, “We’ve been trying to raise awareness about children’s pain and proven pain control using social media #itdoesnthavetohurt. We need to reach parents with evidence-based information that can help their children. The problem of poorly managed pain needs to be addressed at all levels.” The role of parents was also discussed, particularly that they need to be empowered to demand better pain control, as families can often be too passive.

How can we ensure children and families receive proper pain management?
Dr Chambers highlighted the need for system wide solutions such as those offered by ChildKind International. Emphasis was also made on the need for proper education of health professionals. The following paediatric pain courses were mention:

In closing Dr Finley pointed out the importance of us collectively raising awareness of pain in children, he said, “Pain isn’t ‘owned’ by any individual disease speciality or group, thus no one takes responsibility.”

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