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- Herausgeber: John Wiley & Sons
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- Sprache: Englisch
Master paediatric pain management with precision
This practical guide equips nurses and healthcare professionals with evidence-based skills to effectively manage children's pain. Explore assessment techniques, pain relief strategies, and best practices for both hospital and community settings, with a focus on core knowledge, advanced insights, clinical scenarios, and practical tips.
The fully updated third edition includes an expanded procedural sedation section, enhanced coverage of capnography for respiratory monitoring, a new quality improvement sciences section, and additional online MCQs and self-assessment material.
Written by experienced authors, with contributions from global experts, Managing Pain in Children and Young People covers:
- Why pain prevention and treatment are crucial
- Pain's biopsychosocial nature and pharmacology of analgesic drugs
- Acute nociceptive, neuropathic, and visceral pain management
- Chronic headaches, post-surgical pain, neonatal pain, and procedural pain
- Paediatric palliative care and pain management in low-income countries
- Drug-free pain relief methods and ethical considerations
With a multidisciplinary focus, this essential resource is tailored for healthcare practitioners working with children and young people; including doctors, nurses, psychologists, and physiotherapists. This essential resource empowers you to provide the best possible care for young patients, helping them find comfort and relief in their journey towards healing.
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Veröffentlichungsjahr: 2024
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Table of Contents
Cover
Table of Contents
Title Page
Copyright Page
Dedication Page
Contributors
Foreword
Acknowledgements
1 Introduction
Multimodal Pain Management
References
2 Why Treating and Preventing Pain Matters
What is Pain?
Nociceptive Pain
Chronic Pain
What is Unique about Pain in Children and Young People?
The Historical Context of Children and Young People’s Pain
The Current Context of Children and Young People’s Pain
Consequences of Undermanaged Pain in Children and Young People
Ethical Imperative of Managing Pain in Children
Summary
Multiple Choice Questions
References
3 Anatomy and Physiology of Pain
What is Pain?
The Nervous System
Pain Mechanisms
Gate Control Theory of Pain
Neuromatrix Theory of Pain
Biopsychosical Theory of Pain
Central Sensitisation in Chronic Pain
Nociceptive Pain
Visceral Pain
Neuropathic Pain
Chronic Postsurgical Pain
Physiology of Pain in Children and Young People
Postnatal Development of Pain Processing
Summary
Multiple Choice Questions
Acknowledgements
References
4 Pain: A Biopsychosocial Phenomenon
Introduction
Nociception
Biological Factors
Psychological Factors
Social Factors
Summary
Multiple Choice Questions
References
5 Pharmacology of Analgesics
How Drugs Work
Routes of Drug Administration
Medication Challenges in Infants, Children and Young People
Selection of analgesics
Summary
Multiple Choice Questions
Acknowledgements
Useful Web Resources
References
6 Pain Assessment
Pain Measurement and Pain Assessment
Assessing Pain in Children and Young People
Pain Assessment Tools for Neonates
Pain Assessment in Ventilated CYP
Pain Assessment in CYP with Learning Disabilities
Ruling Out Delirium, Withdrawal and Other Non‐pain Pathologies when Assessing Pain
Choosing the Right Pain Assessment Tool
How Often Should Pain be Assessed?
Documentation
Summary
Acknowledgements
Multiple Choice Questions
References
7 Preventing and Treating Nociceptive Pain
What is Nociceptive Pain?
Causes of Nociceptive Pain in Children and Young People
Managing Nociceptive Pain
Pain Assessment
Pain Management in the Hospital Setting
Pharmacological Pain‐relieving Interventions
Analgesic Administration Techniques
Pain Problem‐solving: What to Do if the Pain Management Plan Is Not Working
Transition to Oral Analgesics from Specialist Analgesic Techniques
Pain Medications at Home
Psychological Pain‐relieving Interventions
Physical Pain‐relieving Interventions
Spirituality and Nociceptive Pain in Children and Young People
Summary
Acknowledgements
Key to Case Study
Multiple Choice Questions
References
8 The Prevention and Treatment of Neuropathic and Visceral Pain
Neuropathic Pain
Visceral Pain
Assessing Neuropathic and Visceral Pain
Treatments for Neuropathic and Visceral Pain
Summary
Key to Case Study
Multiple Choice Questions
Acknowledgements
References
9 Musculoskeletal Pain in Children and Young People
What is Musculoskeletal Pain?
Complex Regional Pain Syndrome and Chronic Widespread Pain
Diagnosing, Assessing and Treating Chronic Musculoskeletal Pain
Treatment of Chronic Musculoskeletal Pain
Treatment of Chronic Regional Pain Syndrome
Intensive Multidisciplinary Pain Programmes
Long‐term Outcomes in CYP with Chronic Musculoskeletal Pain
Summary
Key to Case Study
Multiple Choice Questions
Acknowledgement
References
10 Preventing and Treating Chronic Headache Disorders in Children and Young People
Definitions
Symptoms of Chronic Migraine
Symptoms of Chronic Tension‐type Headache
Comorbidities Associated with Chronic Headache Disorders
Impact of Headaches
Assessment of Pain in CYP with Headaches
Management of Chronic Headache Disorders
Outcomes for CYP who Experience Chronic Headaches and Chronic Migraines
Summary
Key to Case Study
Multiple Choice Questions
Acknowledgement
References
11 Chronic Postsurgical Pain in Children and Young People
Postsurgical Pain Trajectories and Impact
Management of Chronic Postsurgical Pain
Prevention of Chronic Postsurgical Pain
Summary
Key to Case Study
Multiple Choice Questions
Acknowledgements
References
12 Prevention and Management of Procedural Pain
Procedural Pain
Assessing Procedural Pain and Fear
Managing Procedural Pain
Summary
Key to Case Study
Multiple Choice Questions
Relevant Web Resources
References
13 Pain in the Neonate
Causes, Prevalence and Consequences of Neonatal Pain
Assessing Pain in the Neonate
Physical Pain‐relieving Interventions
Pharmacological Interventions for Neonatal Pain
Families and Pain Management
Summary
Key to Case Study
Multiple Choice Questions
Additional Online Resources
References
14 Palliative Care in Children and Young People
What is Paediatric Palliative Care?
Treating and Preventing Pain in Children and Young People with Advanced Incurable Cancer
Treating and Preventing Pain in Children and Young People with Severe Neurological Impairment
Ethical Considerations in Paediatric Palliative Care
Symptom Management to Optimise Comfort at the End of Life
Summary
Key to Case Study
Multiple Choice Questions
References
15 Treating and Preventing Pain in Children and Young People in Low‐ and Middle‐Income Countries
Managing Pain in CYP in LMICs
Challenges to Treating and Preventing Pain in CYP in LMICs
Overcoming Challenges to Treating and Preventing Pain in LMICs
Specific Issues in LMICs for the Treatment and Prevention of Pain in CYP
Summary
Key to Case Study
Multiple Choice Questions
Online Resources in English and French
References
16 Knowledge Implementation and Dissemination: Effectively Moving Forward
Implementation Science
Existing Gaps in Pain Practice
How Implementation Science Guides Us: Theories, Models and Frameworks
Knowledge Translation Strategies
Evaluating Knowledge Translation Strategies
Organising Knowledge Translation Strategies
The Way Forward
Summary
Multiple Choice Questions
References
Appendix 1: Drug Dosing Tables
List of Tables
References
Answers to Multiple Choice Questions
Index
End User License Agreement
List of Tables
Chapter 1
Table 1.1 Physical pain‐relieving interventions.
Table 1.2 Psychological pain‐relieving strategies.
Chapter 2
Table 2.1 Common types, and examples of, nociceptive pain.
Table 2.2 Classification of chronic pain disorders.
Table 2.3 Factors that make pain a distinct experience for children and you...
Table 2.4 Common types of nociceptive pain.
Table 2.5 Negative consequences of undermanaged nociceptive pain.
Table 2.6 Negative consequences of undermanaged chronic pain.
Chapter 3
Table 3.1 Key pain terminology.
Table 3.2 Key nervous system terminology.
Table 3.3 Conduction speed of nerve fibres.
Table 3.4 Neurotransmitters important in pain pathways.
Table 3.5 Factors influencing the experience of pain.
Table 3.6 Key differences in the physiology of pain in infants and children...
Chapter 4
Table 4.1 Definitions of main terms used throughout the chapter.
Table 4.2 How to adapt communication about pain in accordance with cognitiv...
Table 4.3 Questionnaires assessing pain‐related fears.
Chapter 5
Table 5.1 Pharmacology definitions.
Table 5.2 Pharmacokinetics definitions.
Table 5.3 Main routes of drug administration.
Table 5.4 Advantages and disadvantages of routes of analgesic administratio...
Table 5.5 Definitions of opioid terminology.
Chapter 6
Table 6.1 Pain history for CYP with nociceptive pain.
Table 6.2 Pain history questions for CYP with chronic pain and their parent...
Table 6.3 A sample of validated faces pain tools.
Table 6.4 A sample of validated multidimensional self‐report pain tools.
Table 6.5 Behavioural reactions to pain in newborn infants.
Table 6.6 A sample of validated behavioural tools.
Table 6.7 Physiological reactions to pain.
Table 6.8 A sample of validated multidimensional pain assessment tools for ...
Chapter 7
Table 7.1 Causes of nociceptive pain in CYP.
Table 7.2 Suggested observations for CYP receiving opioid infusion or patie...
Table 7.3 Suggested observations for CYP receiving regional anaesthesia.
Table 7.4 Complications related to insertion of epidural catheter.
Table 7.5 Drug‐related problems with regional anaesthesia (RA).
Table 7.6 Pain problem‐solving.
Table 7.7 Treatment of nociceptive pain at home.
Chapter 8
Table 8.1 Terms used to describe sensory changes that may be associated wit...
Table 8.2 Classification of neuropathic pain by level of lesion or disease ...
Table 8.3 Examples of central neuropathic pain.
Table 8.4 Peripheral neuropathic pain conditions in children and young peop...
Table 8.5 Examples of peripheral neuropathic pain.
Table 8.6 Classification of visceral pain.
Table 8.7 Causes of acute and chronic visceral pain in children and young p...
Table 8.8 Chronic secondary visceral pain conditions due to inflammation.
Table 8.9 Common patterns of neuropathic pain and sensory signs.
Table 8.10 Disease‐specific guidelines for pharmacological treatment.
Chapter 9
Table 9.1 Common types of chronic MSK pain in CYP.
Table 9.2 Common emotional and cognitive aspects of MSK pain.
Table 9.3 Budapest criteria for clinical diagnosis of CRPS.
Table 9.4 Considerations for taking history in the context of MSK pain.
Chapter 10
Table 10.1 Headache aetiologies.
Table 10.2 Brief overview of preventive medications for treating chronic he...
Chapter 11
Table 11.1 Pharmacological management of chronic postsurgical pain in CYP....
Chapter 12
Table 12.1 Recommended guidelines for the assessment of procedure‐related f...
Table 12.2 Questions to screen for high needle fear.
Table 12.3 Information needs of CYP.
Table 12.4 Statements for health professionals to use and avoid before, dur...
Table 12.5 Potential distractors by developmental stage.
Table 12.6 Onset of action of topical anaesthetics used for needle procedur...
Table 12.7 Overview of procedural sedation.
Table 12.8 Other sedative medications.
Table 12.9 Key intervention bundles for needle pain.
Chapter 13
Table 13.1 Indicators of neonatal pain.
Table 13.2 Pain assessment scales for acute procedural pain in term and pre...
Table 13.4 Pain assessment scales for prolonged pain in term and preterm in...
Chapter 14
Table 14.1 Categories of conditions eligible for PPC.
Table 14.2 Typologies of pain in oncology palliative care.
Table 14.3 Factors to consider during drug therapy using the WHO two‐step l...
Table 14.4 Adjuvant drugs commonly used in treatment of neuropathic pain in...
Table 14.5 Other modalities of treatment in complex situations.
Table 14.6 Factors influencing the perception and experience of pain.
Table 14.7 Psychological pain management techniques for CYP with advanced c...
Table 14.8 Nociceptive sources that cause acute pain.
Table 14.9 Pain syndromes from an impaired CNS that cause chronic pain.
Table 14.10 Examples of pain behaviours.
Table 14.11 Commonly used validated pain assessment tools.
Table 14.12 Pharmacological interventions for CYP with SNI.
Table 14.13 The neuro‐pain ladder.
Table 14.14 Barriers to the use of analgesic drugs in children with SNI....
Table 14.15 Management of common physical symptoms at the end of life.
Chapter 15
Table 15.1 Factors affecting opioid availability in African countries.
Table 15.2 Examples of ways to overcome barriers and challenges.
Table 15.3 List of widely available and relatively cheap adjuvant analgesic...
Table 15.4 Possible options for preventing procedural pain.
Chapter 16
Table 16.1 Examples of contemporary IS research on childhood pain.
Table 16.2 Examples of parent‐focused KT tools.
Table 16.3 Evidence‐based educational strategies.
Table 16.4 Inter‐professional children’s pain educational training initiati...
Table 16.5 Implementation strategies from ERIC.
Appendix 1
Table A.1 Non opioid analgesia for neonates & infants 0–6 months of age (WH...
Table A.2 Opioid analgesics for neonates & infants (0–6 months) (WHO 2020)....
Table A.3 Non opioid analgesia for children and young people older than 6 m...
Table A.4 Opioid starting doses for children with acute pain older than 6 m...
Table A.5 Starting Doses for Patient (or Nurse)‐Controlled Analgesia (PCA) ...
Table A.6 Opioid antagonist doses (Kraemer 2009; Portenoy 2008; Miller 2011...
Table A.7 Adjuvant analgesia for infants, children and young people.
List of Illustrations
Chapter 1
Figure 1.1 Components of effective multimodal pain management.
Figure 1.2 WHO (2020) two‐step pain ladder.
Chapter 3
Figure 3.1 Synaptic events required for pain signalling in the spinal dorsal...
Figure 3.2 Schematic of ascending and descending pain pathways in the centra...
Chapter 4
Figure 4.1 Pain as a biopsychosocial phenomenon.
Chapter 6
Figure 6.1 Body map from the Standardized Universal Pain Evaluation for Pedi...
Figure 6.2 Faces Pain Scale–Revised.
Figure 6.3 Numerical rating scale (NRS).
Figure 6.4 Screenshot of Pain‐QuILT™.
Figure 6.5 Example of an algorithm for assessing pain in hospitalised childr...
Chapter 7
Figure 7.1 An algorithm outlining a five‐step approach to nociceptive pain m...
Figure 7.2 Distribution of dermatomes in CYP.
Figure 7.3 The Bromage scale to assess motor function in CYP.
Chapter 9
Figure 9.1 Classification of chronic primary pain.
Figure 9.2 Classification of chronic secondary MSK pain.
Figure 9.3 How to use the Beighton scoring system to measure joint hypermobi...
Chapter 13
Figure 13.1 Capillary blood collection during maternal–infant skin‐to‐skin c...
Figure 13.2 Facilitated tucking.
Chapter 15
Figure 15.1 The Conceptual Model for Palliative Care Development (WHO 2021 p...
Guide
Cover Page
Table of Contents
Title Page
Copyright Page
Dedication Page
Contributors
Foreword
Acknowledgements
Begin Reading
Appendix 1: Drug Dosing Tables
Answers to Multiple Choice Questions
Index
WILEY END USER LICENSE AGREEMENT
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Managing Pain in Children and Young People
A Clinical Guide
Third Edition
Edited by
Alison Twycross
Honorary Associate Professor, School of Nursing and Midwifery, University of Birmingham, UK; Editor‐in‐Chief, Evidence Based Nursing
Jennifer Stinson
Department of Anesthesia and Pain Medicine and Child Health Evaluative Sciences, Research Institute, The Hospital for Sick Children; and Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
William T. Zempsky
Professor of Pediatrics, University of Connecticut School of Medicine and Head of the Division of Pain and Palliative Medicine at Connecticut Children’s Medical Center, Storrs, Connecticut, USA
and
Abbie Jordan
Reader in the Department of Psychology and member of the Centre for Pain Research at the University of Bath, Bath, UK
This edition first published 2024© 2024 John Wiley & Sons Ltd
Edition HistoryBlackwell Publishing Ltd. (1e, 2009); John Wiley & Sons, Ltd. (2e, 2014)
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The right of Alison Twycross, Jennifer Stinson, William T. Zempsky, and Abbie Jordan to be identified as the authors of the editorial material in this work has been asserted in accordance with law.
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Library of Congress Cataloging‐in‐Publication DataNames: Twycross, Alison, editor. | Stinson, Jennifer, 1963– editor. | Zempsky, William T., editor. | Jordan, Abbie, editor.Title: Managing pain in children and young people : a clinical guide / edited by Alison Twycross, Jennifer Stinson, William Zempsky, Abbie Jordan.Other titles: Managing pain in children.Description: Third edition. | Hoboken, NJ : Wiley‐Blackwell, 2024. | Preceded by: Care planning in children : a clinical guide for nurses and healthcare professionals / edited by Alison Twycross, Stephanie Dowden, and Jennifer Stinson. 2nd edition. 2014. | Includes bibliographical references and index.Identifiers: LCCN 2023040793 (print) | LCCN 2023040794 (ebook) | ISBN 9781119645320 (paperback) | ISBN 9781119645689 (adobe pdf) | ISBN 9781119645672 (epub)Subjects: MESH: Pain Management | Child | AdolescentClassification: LCC RJ365 (print) | LCC RJ365 (ebook) | NLM WL 704.6 | DDC 616/.0472083–dc23/eng/20231031LC record available at https://lccn.loc.gov/2023040793LC ebook record available at https://lccn.loc.gov/2023040794
Cover Design: WileyCover Image: © ljubaphoto/Getty Images; Paul Burns/Getty Images; Caia Image/Getty Images
For Isabella, Joseph, Dexter, Io, Tallulah, Winston, Isodora, Zinnia and Elodie
For my daughters Hayley and Sara and my grandson Lowen
For Ava, Ophelia and Evangeline
For my OG pain colleagues Neil Schechter, Nancy Bright and Barbara Rzepski
Contributors
Julia AmblerUmduduzi – Hospice Care for Children, and Department of Paediatrics, Nelson Mandela Medical School, University of KwaZulu‐Natal, Durban, South Africa
Britney BenoitRankin School of Nursing, St Francis Xavier University, Antigonish, Nova Scotia, Canada
Krista BaergAssociate Professor General Pediatrics, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
Kathryn A. BirnieAssistant Professor, Departments of Anesthesiology, Perioperative and Pain Medicine and Community Health Sciences, University of Calgary; Associate Scientific Director, Solutions for Kids in Pain (SKIP); and Psychologist, Alberta Children’s Hospital, Calgary, Alberta, Canada
Line CaesDivision of Psychology, Faculty of Natural Sciences, University of Stirling, Stirling, UK
Marsha Campbell‐YeoSchool of Nursing and Departments of Pediatrics, Psychology and Neuroscience, Dalhousie University, and IWK Health, Halifax, Nova Scotia, Canada
Christine T. ChambersProfessor, Departments of Psychology and Neuroscience and Pediatrics, Dalhousie University, and Scientific Director, Solutions for Kids in Pain (SKIP), Halifax, Nova Scotia, Canada
Karen ChiuPhysiotherapist, Chronic Pain Program and Department of Rheumatology, The Hospital for Sick Children, Toronto, Ontario, Canada
Poh Heng ChongMedical Director, HCA Hospice Ltd, Singapore
Jacqui ClinchDepartment of Paediatric Rheumatology, Bristol Royal Children’s Hospital and Bath Centre for Pain Services, UK
Kaytlin ConstantinDepartment of Psychology, University of Guelph, Guelph, Ontario, Canada
Stephanie DowdenNursePrac Australia, Fremantle, Western Australia, Australia
Julia DowningChief Executive, International Children’s Palliative Care Network (ICPCN), Bristol, UK; and Honorary Professor in Palliative Care, Makerere University, Kampala, Uganda
Mats ErikssonÖrebro University, School of Health Sciences, Örebro, Sweden
Paula ForgeronSchool of Nursing, Faculty of Health Sciences, University of Ottawa and Children’s Hospital of Eastern Ontario, Ottawa; and Research Institute and Department of Anesthesia, Dalhousie University, Halifax, Nova Scotia, Canada
Liesbet GoubertFaculty of Psychology and Educational Sciences, Department of Experimental‐Clinical and Health Psychology, Ghent University, Ghent, Belgium
Denise HarrisonProfessor, Department of Nursing, School of Health Sciences, Faculty of Medicine, Dentistry and Health Services, University of Melbourne, and Honorary Fellow, Murdoch Children’s Research Institute and Royal Children’s Hospital, Melbourne, Victoria, Australia; and Adjunct Professor, School of Nursing, Faculty of Health Sciences, University of Ottawa, Ontario, Canada
Jennifer HuntIndependent Palliative Care Consultant, Harare, Zimbabwe
Lindsay JibbChild Health Evaluative Sciences, Research Institute, The Hospital for Sick Children, and Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
Deepa KattailDepartment of Anesthesiology, McMaster University, Hamilton, Ontario, Canada
Sara KleinPhysiotherapist, Chronic Pain Program, Hospital for Sick Children, Toronto, Ontario, Canada
Charlie H.T. KwokHotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
Christina LiossiSchool of Psychology, University of Southampton, Southampton, and Pain Control Service, Great Ormond Street Hospital NHS Foundation Trust, London, UK
Hwee Hsiang LiowChild Life Therapist, Children’s Cancer Foundation, Singapore
Nicole E. MacKenzieDepartment of Psychology and Neuroscience, Dalhousie University, Halifax, Nova Scotia, Canada
C. Meghan McMurtryDepartment of Psychology, University of Guelph, Guelph; Pediatric Chronic Pain Program, McMaster Children’s Hospital, Hamilton; and Children’s Health Research Institute, Department of Paediatrics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
Giulia MesaroliPhysiotherapist, The Hospital for Sick Children, Toronto and PhD student in Clinical Epidemiology, The University of Toronto
Sueann PenroseChildren’s Pain Management Service, Royal Children’s Hospital, Melbourne, Victoria, Australia
Brittany N. RosenbloomChild Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
Cate SinclairVital Connections Allied Health, Albert Park, Victoria, Australia
Bonnie StevensProfessor Emeritus, Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, and Senior Scientist Emeritus, The Hospital for Sick Children, Toronto, Ontario, Canada
Jennifer StinsonDepartment of Anesthesia and Pain Medicine and Child Health Evaluative Sciences, Research Institute, The Hospital for Sick Children, and Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
Janice E. SumptonPharmacist Emeritus, London, Ontario, Canada
Naiyi SunDepartment of Anesthesia and Pain Medicine, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
Amelia SwiftReader in Health Professional Education, School of Nursing and Midwifery, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, UK
Anna TaddioLeslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
Tuan TrangHotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
Perri R. TutelmanDivision of Psychosocial Oncology, Department of Oncology, Cancer Care Alberta and University of Calgary Calgary, Alberta, Canada
Alison TwycrossHonorary Associate Professor, School of Nursing and Midwifery, University of Birmingham, UK; Editor‐in‐Chief, Evidence‐Based Nursing
Foreword
I have had the extreme pleasure of working with hospitalised children and young people for over three decades. In my early years as a paediatric nurse at the bedside, I was struck by the pain that children and young people endured as part of their diagnosis and treatment and how helpless healthcare professionals and family members felt in trying to comfort them. We did not know the impact of pain on these children and young people, but we did have an intuitive sense that it was harmful both physically and emotionally and needed to be prevented, reduced or eliminated.
I was fortunate to be part of a growing body of research focused on generating pain assessment measures and prevention and evaluating treatment strategies that were pharmacological, behavioural, physical and environmental. Yet there were still broad gaps remaining on how to prevent and treat pain in children and young people. In addressing these gaps, we needed a diverse set of skills from basic and clinical sciences and pain‐relieving strategies that integrated children, young people and families, healthcare professionals and organisational needs within the context of inter‐professional pain care. The voice of individuals with lived pain experiences was also needed, as was the exploration of the underlying mechanisms of pain and its treatment.
In addition, the dawning comprehension that even though we were generating evidence on effective pain prevention and treatment strategies, we did not always effectively disseminate or implement this new knowledge into practice. This lack of understanding of implementation and dissemination as critical components of implementation science is perhaps our greatest challenge and the one that needs the most attention moving forward.
This book serves to present and synthesise new knowledge, re‐igniting our commitment to solving the puzzle of pain in children and young people and to explore why treating and preventing pain matters. We will see what we have learned about the anatomy and physiology of pain and how this has influenced the clinical pain practices of assessment and treatment. There is a renewed focus on prevention, but where this is not possible, on the most up‐to‐date strategies on relieving acute nociceptive pain, procedural pain, neuropathic and visceral pain, chronic musculoskeletal pain, headaches and both acute and chronic postsurgical pain. As well, there is attention to special populations including neonates, children receiving palliative care, and children in low‐ and middle‐income countries. Finally, the challenges of implementation and dissemination of new knowledge are addressed in summarising the effective ways of moving forward.
We have an abundance of evidence that underlies effective prevention and treatment of pain in children and young people. However, the failure to effectively implement and disseminate this evidence results in the continued pain and suffering of children. We need to consider not only the effectiveness of the pain‐relieving intervention but the effectiveness of the implementation strategies across multiple populations and contexts. The new knowledge presented in this book will increase our awareness and knowledge of both pain prevention and treatment but also of how to best implement pain practice change that will improve child health outcomes.
Bonnie Stevens, RN, PhD
Acknowledgements
This edition has taken much longer to write than planned, at least in part due to an ongoing global pandemic. There are several people without whom this book would not have been completed:
The authors, for delivering chapters despite the immense pressure the last few years has brought, and particularly those who stepped up at the last minute.
Abbie Jordan and William (Bill) Zempsky, for agreeing to join the editorial team due to other members stepping down.
My wonderful editorial assistant, Toni McIntosh.
MSc Health Psychology students Amy Parkinson, Holly Waring and Jenny Corser, all of whom supported development of some of the chapters.
Long Covid means I have had to take early retirement and so this will be the last edition of the book I am involved with. Given this, I would also like to thank Jennifer Stinson for being such a great writing partner over the years.
Alison Twycross
1Introduction
Alison Twycross
Honorary Associate Professor, School of Nursing and Midwifery, University of Birmingham, UK; Editor-in-Chief, Evidence-Based Nursing
Welcome to the third edition of Managing Pain in Children and Young People: A Clinical Guide. In this edition we have done things a little differently. Our aim remains to pull together current evidence for managing pain in children and young people (CYP) in an easily accessible format. However, we wanted the book to be seen as relevant to students and to members of interdisciplinary teams involved in managing children’s pain around the globe. To reflect this broader focus, the editorial line‐up now includes a medic (physician), a psychologist and two nurses. We have also extended the range of contributors, again drawing on international expertise across the multidisciplinary team. A new chapter has been added to ensure the book is applicable to those working in low‐ to middle‐income countries (Chapter 15).
The first few chapters set the scene for effective multimodal pain management by focusing on the following:
Why managing pain in children and young people is important.
The anatomy and physiology of pain.
Pain as a biopsychosocial phenomenon.
Pharmacology of analgesic drugs.
Pain assessment.
Given the new International Classification of Diseases (ICD)‐11 definition of chronic pain, we have decided to include three shorter chapters in this edition rather than one longer one. These chapters focus on the prevention and treatment of chronic postsurgical pain, musculoskeletal pain, and headaches.
Other chapters pull together the current evidence for the prevention and treatment of nociceptive pain, neuropathic and visceral pain, procedural pain, neonatal pain, and paediatric palliative care.
Despite the extensive research that has been carried out over the past 25 years, CYP still do not receive evidence‐based pain care. To address this issue, the final chapter covers how to effectively move forward with knowledge dissemination and implementation.
Multimodal Pain Management
Pain is a biopsychosocial phenomenon (see Chapter 4) and often has a spiritual element (Friedrichsdorf and Goubert 2020). Given this, the prevention and treatment of pain requires a multimodal approach (Figure 1.1). To make this explicit, one of the changes we have made to this edition is to integrate the evidence for physical and psychological pain‐relieving interventions into the chapters focusing on the prevention and treatment of pain. A brief description of physical and psychological pain‐relieving interventions is provided in Tables 1.1 and 1.2. Physical and psychological strategies used with neonates are outlined in Chapter 13.
Figure 1.1 Components of effective multimodal pain management.
World Health Organization Pain Ladder
An integral part of multimodal pain management is the use of analgesic drugs to prevent and treat pain. The World Health Organization (WHO) (2020) has devised a two‐step pain ladder to help guide decision‐making in this context (Figure 1.2). The 2020 WHO ladder takes into account the fact that codeine is no longer recommended for use in CYP (Box 1.1).
Table 1.1 Physical pain‐relieving interventions.
Active physical interventions
Activity pacing and energy conservation
Pacing involves reaching a balanced pattern of varied activity that is achievable on good and bad days without causing ‘crashes’ or increases in symptoms
The Royal College of Occupational Therapy provides useful advice about how to pace:
https://www.rcot.co.uk/conserving‐energy
Energy conservation is identified as a strategy for chronic pain management in the Canadian Pediatric Pain Management Standards (HSO
2023
)
Physiotherapy and daily exercise
Identified as a key strategy for chronic pain management by the Scottish Government (
2018
) and in the Canadian Pediatric Pain Management Standards (HSO
2023
)
Seen as a key component of managing chronic pain in CYP (Caes et al.
2018
; Harrison et al.
2019
)
Involves individualised exercise programmes aimed at increasing muscle strength and flexibility
Likely to be more effective when combined with psychological therapies, e.g. cognitive behavioural therapy, and goal setting (Caes et al.
2018
)
Relaxation
Identified as a strategy for acute and chronic pain management in the Canadian Pediatric Pain Management Standards (HSO
2023
)
The Scottish Government (
2018
) suggests relaxation is a low‐risk intervention that should be considered in the management of chronic pain in CYP
Yoga
Some evidence to support its use in chronic pain management (Harrison et al.
2019
)
Passive physical interventions
Acupuncture
Identified as a strategy for acute pain management in the Canadian Pediatric Pain Management Standards (HSO
2023
)
The Scottish Government (
2018
) recommends the use of acupuncture for CYP with back pain or headache
Ice and heat
Thermal applications identified as a strategy for chronic pain management in the Canadian Pediatric Pain Management Standards (HSO
2023
)
Massage
Identified as a strategy for chronic pain management in the Canadian Pediatric Pain Management Standards (HSO
2023
)
Transcutaneous electrical nerve stimulation (TENS)
Identified as a strategy for acute pain management in the Canadian Pediatric Pain Management Standards (HSO
2023
)
The Scottish Government (
2018
) suggests that TENS is a low‐risk intervention that should be considered in the management of chronic pain in CYP
Sensory and brain‐based strategies
Graded motor imagery and mirror therapy
The process of thinking and moving without actually moving
Has been shown to be particularly effective when moving the injured body part is too painful (Ramsey et al.
2017
)
Tactile stimulation or desensitisation
Desensitisation techniques help to restore normal sensitivity and include varied exercises to increase tolerance to the feel of different tactile and thermal sensations on the affected body part (Ayling Campos et al.
2011
)
The start of desensitisation can be difficult, as CYP experience increased discomfort during the application of sensory techniques (Ayling Campos et al.
2011
)
No evidence to support its use in practice
Table 1.2 Psychological pain‐relieving strategies.
Strategy
Description
Acceptance and commitment therapy (ACT)
A type of psychotherapy that promotes acceptance to deal with negative thoughts, feelings, symptoms or circumstances
ACT also encourages increased commitment to healthy constructive activities that uphold CYP’s values or goals
More information is available at Glashofer (
2022
)
Biofeedback
The Institute for Chronic Pain (
2017
) describes biofeedback as:
Enabling individuals to learn how to change physiological activity for the purposes of improving health and performance
Using precise instruments to measure physiological activity, e.g. brainwaves, heart function, breathing, muscle activity and skin temperature
Using this feedback to support the desired physiological changes
Over time, these changes endure without continued use of an instrument (Schwartz and Andrasik
2016
)
More information about biofeedback can be found in this video:
https://www.facebook.com/watch/?v=638866001271911&extid=NS‐UNK‐UNK‐UNK‐IOS_GK0T‐GK1C&ref=sharing
Cognitive behavioural therapy (CBT)
MIND (
2022
) describes CBT as a type of talking therapy that teaches coping skills for dealing with different problems (pain, mood, etc.)
CBT is not a single type of treatment; rather it is a class of multi‐component therapies based in the cognitive behavioural theoretical model (Palsson and Ballou
2020
)
CBT focuses on how your thoughts, beliefs and attitudes affect your feelings and actions
Can be delivered face to face or online (Fisher et al.
2019
)
More information about CBT can be seen in this video:
https://www.youtube.com/watch?v=9c_Bv_FBE‐c
Distraction
Great Ormond Street Hospital (
2020
) define distraction as: An approach that helps a child or young person cope with an invasive procedure or if they are facing a difficult experience in the hospital. It can also be helpful if a child is in pain or discomfort.
More information is available on their website:
https://www.gosh.nhs.uk/conditions‐and‐treatments/procedures‐and‐treatments/distraction/
Nowadays digital distraction is often used, e.g. virtual reality or video games (Gates et al.
2020
)
Exposure‐based therapies
A type of CBT
Based on the concept that avoidance behaviours can exacerbate symptoms
Through exposure CYP are encouraged to face sensations and situations that cause them pain or make them fearful, therefore alleviating their distress (Person and Keefer
2021
)
Hypnotherapy
Relies on a special mental state (hypnosis) induced with the help of verbal guidance from the therapist to facilitate receptivity to therapeutic suggestions
While the patient is in a receptive state, the therapist uses
deepening techniques
and then delivers post‐hypnotic suggestions that help facilitate changes in emotions, thoughts and physical symptoms (Palsson and Ballou
2020
)
Mindfulness
Involves focusing on bringing attention to the present moment (Harrison et al.
2019
)
Psychotherapy (counselling)
Psychotherapy can help someone in pain to:
Express their feelings and process them in a safe and supportive relationship
Gain deeper insight into the issues they face
Talk about things in a confidential environment that they might not feel able to discuss with anyone else
Find better ways to cope with feelings and fears
Change the way they think and behave to improve their mental and emotional well‐being
Improve relationships in their life, including with themselves
Make sense of any clinical diagnoses they have been given by understanding what has happened to them
Heal from trauma
For more information, see
https://www.psychotherapy.org.uk/seeking‐therapy/what‐is‐psychotherapy/
Sleep hygiene strategies
Many young people with chronic pain report disturbed sleep (Badawy et al.
2019
)
Sleep hygiene is an important component of managing chronic pain
More information can be found on the following two websites:
https://www.gosh.nhs.uk/conditions‐and‐treatments/procedures‐and‐treatments/sleep‐hygiene‐children/
https://www.sleepfoundation.org/sleep‐hygiene
Figure 1.2 WHO (2020) two‐step pain ladder.
BOX 1.1 CODEINE IS NO LONGER RECOMMENDED FOR USE IN CHILDREN AND YOUNG PEOPLE
Following a series of fatalities involving the ultra‐rapid metabolism of codeine in children with obstructive sleep apnoea after undergoing adenotonsillectomy (Kelly et al.
2012
), the Medicines and Healthcare products Regulatory Agency (MHRA) (
2013
) recommended that codeine should no longer be used for pain relief in children younger than 12 years.
Codeine should also be avoided in all CYP under the age of 18 years with obstructive sleep apnoea undergoing tonsillectomy or adenoidectomy (MHRA
2013
).
Physical Pain‐relieving Interventions
Physical pain‐relieving interventions are an integral part of managing CYP pain (Figure 1.1) and particularly useful when managing chronic pain. They are defined as:
Interventions intended to help the body function physically (Health Standards Organization [HSO] 2023, p. XVI).
However, there is very little evidence of their effectiveness (Caes et al. 2018; Birnie et al. 2020). Despite this, WHO (2020) recommends the use of physical therapies either alone or in combination with other treatments for CYP with chronic pain. The commonly used physical interventions used in CYP are outlined in Table 1.1.
Psychological Pain‐relieving Interventions
Psychological pain‐relieving interventions are an important part of preventing and treating pain (Figure 1.1) and have been described as:
Interventions to harness the connection between mind and body by addressing thoughts (cognition), emotions and behaviours/actions to help the child and their family directly or indirectly influence the experience of pain (HSO 2023, p. XVI).
While these techniques are widely used in practice, the results of several systematic reviews all conclude that there is minimal and low‐quality evidence to support their use (Birnie et al. 2018; Caes et al. 2018; Fisher et al. 2018, 2019). Evidence suggests that these interventions can be delivered online or face‐to‐face (Fisher 2019; WHO 2020). Some of the psychological strategies used with CYP are defined in Table 1.2.
References
Ayling Campos, A., Amaria, K., Campbell, F. and McGrath, P.A. (2011) Clinical impact and evidence base for physiotherapy in treating childhood chronic pain.
Physiotherapy Canada
63(1), 21–33.
Badawy, S.M., Law, E.F. and Palermo, T.M. (2019) The interrelationship between sleep and chronic pain in adolescents.
Current Opinion in Physiology
11, 25–28.
Birnie, K.A., Noel, M., Chambers, C.T., Uman, L.S. and Parker, J.A. (2018) Psychological interventions for needle‐related procedural pain and distress in children and adolescents.
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Canadian Journal of Pain
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Caes, L., Fisher, E., Clinch, J. and Eccleston, C. (2018) Current evidence‐based interdisciplinary treatment options for pediatric musculoskeletal pain.
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Pediatrics
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Glashofer, D.R. (2022) What is acceptance and commitment therapy (ACT)? Available at
https://www.verywellmind.com/acceptance‐commitment‐therapy‐gad‐1393175
(accessed 15 December 2022).
Great Ormond Street Hospital (2020) Distraction. Available at
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(accessed 16 May 2023).
Harrison, L.E., Pate, J.W., Richardson, P.A., Ickmans, K., Wicksell, R.K. and Simons, L.E. (2019) Best‐evidence for the rehabilitation of chronic pain. Part 1: pediatric pain.
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Pediatric Pain Management
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Management of Chronic Pain in Children and Young People. A National Clinical Guideline
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Guidelines for the Management of Chronic Pain in Children
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2Why Treating and Preventing Pain Matters
Nicole E. MacKenzie, Perri R. Tutelman, Christine T. Chambers, and Kathryn A. Birnie
Pain is a universal experience for children and young people (CYP). Undermanaged and preventable pain can have significant short‐ and long‐term consequences for CYP and their families. This chapter provides an introduction to pain in CYP, including an overview of the definition, types and prevalence of pain experienced by children from infancy to adolescence. Factors that make pain in CYP unique, such as developmental changes and family involvement, are reviewed. The history of CYP pain and its development as a discipline is discussed. An overview of the biological, psychological and social sequelae of undermanaged acute and chronic pain in CYP is provided. Finally, the ethical imperative of managing pain in CYP is discussed.
What is Pain?
From everyday aches to medical procedures, illnesses and injuries, pain is a sensation experienced by all CYP from a young age. Despite the ubiquitous experience of pain, its subjective and individualised nature makes it difficult to define. The most widely accepted definition of pain is that of the International Association for the Study of Pain (IASP). Initially adopted in 1979, the definition was revised for the first time in 2020 to align with research and theoretical advancements in the field. According to the IASP, pain is broadly defined as (Raja et al. 2020):
An unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage.
By definition, pain is more than a bodily sensation; it is a multidimensional experience that is inextricably linked to one’s psychological and social functioning and context (see Chapter 4 for further information on the biopsychosocial model of pain). The IASP definition is accompanied by six supplemental notes that highlight key features of pain (Box 2.1), several of which have direct implications for the understanding of pain in CYP; e.g., pain as a concept learned throughout one’s life experiences, and the importance of behavioural pain assessment for young children or others who cannot communicate verbally (Craig and MacKenzie 2021). This definition must therefore be actively integrated into the pain care and management of CYP (Jordan et al. 2021).
BOX 2.1 ACCOMPANYING NOTES FOR THE REVISED IASP DEFINITION OF PAIN
Pain is always a personal experience that is influenced to varying degrees by biological, psychological and social factors.
Pain and nociception are different phenomena. Pain cannot be inferred solely from activity in sensory neurons.
Through their life experiences, individuals learn the concept of pain.
A person’s report of an experience as pain should be respected.
Although pain generally serves an adaptive role, it may have adverse effects on function and social and psychological well‐being.
Verbal description is only one of several behaviours to express pain; inability to communicate does not negate the possibility that a human or a non‐human animal experiences pain.
Taken from Raja et al. (2020).
Nociceptive Pain
At its most fundamental level, pain serves a critical evolutionary purpose. Pain is a sensation associated with the body’s protection system; it is a warning sign of bodily threat and serves as an alert to take action to avoid harm. Nociceptive (acute) pain refers to the often sudden, time‐limited pain experienced in response to noxious stimuli that motivates behaviours to avoid tissue injury (Kent et al. 2017). CYP experience various types of nociceptive pain; some of the most common are described in Table 2.1.
The prevention and treatment of nociceptive pain is described in more detail in Chapter 7. When nociceptive pain persists for an extended period of time (i.e. beyond three months; Treede et al. 2015), it no longer serves a protective role, at which time it is considered chronic.
Table 2.1 Common types, and examples of, nociceptive pain.
Sources: Eccleston et al. (2021); Stevens and Zempsky (2021).
Procedural pain (see
Chapter 12
)
Pain due to vaccination, venepuncture or lumbar puncture
Postoperative pain (see
Chapter 7
)
Pain after surgery
Pain due to injuries
Pain from a playground or sports‐related injury
Visceral pain (see
Chapter 8
)
Appendicitis
Acute exacerbations of chronic conditions (see
Chapters 8
–
11
)
Sickle cell vaso‐occlusive crises, juvenile idiopathic arthritis flares
Chronic Pain
With the 2019 release of the 11th revision of the International Classification of Diseases (ICD‐11), chronic pain was systematically defined and classified for the first time. According to the ICD‐11, chronic pain is pain that persists or recurs for longer than three months (Treede et al. 2015). The cut‐off of three months or longer was selected by the ICD‐11 taskforce to allow for a clear and measurable definition and to align with temporal cut‐offs of other chronic conditions (Finnerup et al. 2018).
Much like nociceptive pain, there are various types of chronic pain that are grouped based on aetiology and pathophysiology. In the ICD‐11, chronic pain disorders are classified into two overarching categories with several subcategories (Table 2.2).
However, several chronic pain conditions in CYP have established diagnostic criteria that deviate from the ICD‐11 definition of chronic pain. For instance, according to the Rome IV criteria for CYP functional abdominal pain disorders, symptoms are only required to be present for a duration of two months or longer for diagnosis (Hyams et al. 2016). A degree of flexibility and prudent clinical judgement is therefore necessary in clinical practice when it comes to the diagnosis and treatment of CYP with chronic pain (see Chapters 9–11).
Table 2.2 Classification of chronic pain disorders.
Sources: Nicholas et al. (2019); Treede et al. (2019).
Category
Definition
Main subcategories
Chronic primary pain
Chronic pain in one or more locations associated with significant emotional distress and/or functional impairment that is not accounted for by another chronic pain condition. Importantly, chronic primary pain conditions are considered health conditions in and of themselves
Chronic widespread pain (e.g. fibromyalgia)
Complex regional pain syndrome
Chronic primary headache or orofacial pain (e.g. chronic migraine)
Chronic primary visceral pain (e.g. irritable bowel syndrome)
Chronic primary musculoskeletal pain (e.g. chronic primary low back pain)
Chronic secondary pain
Chronic pain linked to other diseases as the underlying cause
Chronic cancer‐related pain (e.g. pain during or after cancer due to the disease or its treatments)
Chronic postsurgical (e.g. after thoracotomy) or post‐traumatic (e.g. after burn injury) pain
Chronic neuropathic pain (e.g. pain due to diabetic neuropathy)
Chronic secondary headache or orofacial pain (e.g. chronic headache due to seizures)
Chronic secondary visceral pain (e.g. pain due to inflammatory bowel disease)
Chronic secondary musculoskeletal pain (e.g. pain due to joint inflammation from juvenile idiopathic arthritis)
What is Unique about Pain in Children and Young People?
CYP have unique biological, psychological and social factors that influence their experience of pain. For instance, there are clear anatomical and physiological differences between CYP and adults that are relevant to how pain is managed pharmacologically in CYP (see Chapter 5). However, there are numerous other considerations that make pain a distinct experience for CYP. These are outlined in Table 2.3.
The Historical Context of Children and Young People’s Pain
Today, CYP’s pain management is considered a fundamental human right (Brennan et al. 2019). However, it was not always this way. As recently as 35 years ago, it was widely believed that children, particularly infants, were not neurologically mature enough to feel pain (Unruh and McGrath 2013). This thinking was questioned in the early 1980s when Anand and colleagues began a series of clinical trials comparing the outcomes of premature infants who received standard surgical pain care (i.e. no pain management) with premature infants who received anaesthesia. These trials found that infants did, in fact experience pain and infants who did not receive anesthesia experienced poorer outcomes than those who did (e.g. Anand et al. 1987; Anand & Hickey 1992).
Table 2.3 Factors that make pain a distinct experience for children and young people.
The concept of pain develops throughout childhood
CYP’s understanding of pain develops as they mature cognitively and as their experience with pain (e.g. vaccinations, injuries, illnesses) grows in terms of contextual experiences (Jaaniste et al.
2016
)
CYP’s cognitive and social development may influence how pain is remembered later in life (Noel et al.
2015
)
The ongoing development of CYP’s understanding of pain highlights the importance of taking a developmental approach to pain assessment and treatment across childhood
The challenge of self‐report
Self‐report is considered optimal for pain assessment given the subjective nature of pain (see
Chapter 6
)
The ability for a CYP to reliably self‐report on their pain begins at age three years in a limited capacity. More advanced skills (e.g. ability to provide visual analogue and numerical ratings) emerges around age six or seven years in typically developing children (Birnie et al.
2019a
)
The role of parents
Parental behaviours that attend to the pain (e.g. reassurance, empathy, protectiveness) contribute to worsened pain (Neville et al.
2020
)
Behaviours that direct attention away from pain (e.g. distraction, coping strategies) are associated with the ability to regulate distress related to pain (Russell and Park
2018
)
Degree of family cohesion, distress and social environment may also impact CYP’s perceptions of pain and subsequent responses (Meints and Edwards
2018
)
The lifelong impact of pain in childhood
CYP are uniquely at risk for long‐term effects of pain given the early stage of the developing somatosensory and central nervous systems (Walker
2019
)
Nociceptive pain in early life has documented effects on sensory thresholds, pain sensitisation and neurodevelopment observed into adulthood (Vinall et al.
2014
; Walker et al.
2019
)
Upwards of 19% of CYP with chronic pain continue to report chronic pain in adulthood (Larsson et al.
2018
), which can influence mental health and vocational prospects later in life (Groenewald et al.
2019
; Murray et al.
2020
)
Meaningful change in CYP’s surgical pain practices were achieved only after a mother, Jill Lawson, brought lived experience of this research into the public eye (Rovner 1986). In 1985, Jill’s prematurely born son, Jeffrey Lawson, underwent major surgery at Children’s National Hospital (Washington, DC) soon after birth, and in line with standard care at the time received no anaesthesia. Jill spoke out about Jeffrey’s experience, and her advocacy efforts, coupled with Dr Anand’s landmark research, drew public attention to the issue of pain management in children and catalysed the development of the field of paediatric pain management.
In 1987, the American Academy of Pediatrics and American Society of Anesthesiologists released a joint statement recognising infants’ sense of pain and proclaiming that it was no longer ethical to perform surgery on preterm babies without anaesthesia (American Academy of Pediatrics 1987; American Society of Anesthesiologists 1987). The history of CYP pain provides important context to the advancement of the discipline, which required a combination of both science and parental advocacy (McGrath 2011). As was true with Jill Lawson’s early efforts, public awareness and changes to policy remain necessary to continue to move the field forward.
The Current Context of Children and Young People’s Pain
While progress has been made in paediatric pain management, CYP continue to experience pain in a variety of circumstances. In 2021, the Lancet Child and Adolescent Health Commission released a report on the state of pain in childhood, identifying that the global recognition, assessment and treatment of children’s pain lag behind the wealth of available research evidence on effective pain management practices in adults (Eccleston et al. 2021). The Commission proposed four transformative goals that researchers, clinicians, policy‐makers and funders must collaboratively address to move the field of CYP’s pain management forward in partnership with CYP and their families (Box 2.2).
The Commission also highlighted the importance of understanding what is most important to patients, both in clinical assessment and in research priorities. In a recent Priority Setting Partnership, young people with chronic pain, family members and health professionals identified patient‐oriented research priorities, which included topics such as the relative efficacy of physical, psychological and pharmacological treatments, chronic pain care delivery, access and coordination, academic and vocational support, and clinician training (Birnie et al. 2019a). However, a review of the published literature on paediatric chronic pain found that most of these patient‐oriented priorities had little to no available evidence, suggesting a gap between what has been researched and what is important to patients (Birnie et al. 2020).
BOX 2.2 TRANSFORMATIVE GOALS TO MOVE CYP PAIN MANAGEMENT FORWARD
To make CYP’s pain:
matter
(e.g. to clinicians, policy‐makers, healthcare executives)
understood
(e.g. further knowledge generation of the biopsychosocial aspects of pain in childhood is needed)
visible
(e.g. implementation of regular, validated pain assessment practices for all children)
better
(e.g. more research on pharmacological, psychological and personalised treatment approaches).
Source: Lancet Commission (Eccleston et al. 2021).
There is a critical need for new research to inform best practice in dissemination and implementation of pain management (Chambers 2018), and creative approaches to knowledge mobilisation that address the needs of patients, health professionals, policy‐makers and other groups. Examples of such initiatives include the Solutions for Kids in Pain (SKIP) network (kidsinpain.ca), whose mission is to improve CYP’s pain management through coordination and collaboration (SKIP 2021). The importance of knowledge translation in pain has been recognised by IASP, naming 2022 the Global Year for Translating Pain Knowledge to Practice, providing researchers and clinicians with resources to support knowledge translation of pain research (https://www.iasp‐pain.org/advocacy/global‐year/translating‐pain‐knowledge‐to‐practice/). See also Chapter 16 for more information about knowledge implementation and dissemination.
