Pain treatment and prevention in pediatric palliative care

2021 ◽  
pp. 292-311
Author(s):  
Stefan J. Friedrichsdorf
Keyword(s):  
Chronic Pain ◽  
Palliative Care ◽  
Visceral Pain ◽  
Pain Treatment ◽  
Symptom Control ◽  
Pediatric Palliative Care ◽  
Serious Illness ◽  
Psychological Therapies ◽  
Total Pain ◽  
The Usa

Annually, at least 21 million children could benefit from pediatric palliative care (PPC) and 8 million would need specialized PPC services. In the USA alone, more than 40,000 children aged 0–19 years die annually; 55% of them are infants younger than 1 year of age. Pain is common, under-recognized, and under-treated, especially in children with progressive neurodegenerative and chromosomal conditions with central nervous system impairment. Unrelieved pain is also common in children with advanced serious illness during the end-of-life period, and, when treated, the therapy is commonly ineffective. Treating pain in children with serious illness is not profoundly different than advanced pain management for children with complex acute conditions or diseases such as major trauma, burns, cancer, or those with sickle cell disease in vaso-occlusive crisis. It is important to appreciate that children with serious illness are more likely to simultaneously suffer from acute pain, neuropathic pain, visceral pain, total pain, and chronic pain. As such, multimodal analgesic (i.e., multiple agents, interventions, rehabilitation, psychological modalities, and integrative (“nonpharmacologic,” e.g., behavioral, physiological, and psychological) therapies that act synergistically for more effective pediatric pain and symptom control with fewer side effects than a single analgesic or modality must be employed. Opioids, such as morphine, fentanyl, hydromorphone, oxycodone, and methadone, remain the mainstay medications to effectively treat pain in children with serious illness. However, medications alone are often insufficient for optimal pain control. In fact, the paradigm shift away from “medications only” toward offering “multimodal analgesia” to children with serious illness experiencing pain, including addressing chronic pain/primary pain disorders and total pain has become a “game changer” in advancing PPC to ensure that patients can live as long as possible, as well as possible.

scholarly journals Delivering Pediatric Palliative Care: From Denial, Palliphobia, Pallilalia to Palliactive

Children ◽  
2018 ◽  
Vol 5 (9) ◽  
pp. 120 ◽  
Author(s):  
Stefan Friedrichsdorf ◽  
Eduardo Bruera
Keyword(s):  
Palliative Care ◽  
Care Service ◽  
Symptom Control ◽  
Palliative Care Service ◽  
The United States ◽  
Pediatric Palliative Care ◽  
Emotional Impact ◽  
Optimal Care ◽  
Comfort Care ◽  
Serious Illness

Among the over 21 million children with life-limiting conditions worldwide that would benefit annually from a pediatric palliative care (PPC) approach, more than eight million would need specialized PPC services. In the United States alone, more than 42,000 children die every year, half of them infants younger than one year. Advanced interdisciplinary pediatric palliative care for children with serious illnesses is now an expected standard of pediatric medicine. Unfortunately, in many institutions there remain significant barriers to achieving optimal care related to lack of formal education, reimbursement issues, the emotional impact of caring for a dying child, and most importantly, the lack of interdisciplinary PPC teams with sufficient staffing and funding. Data reveals the majority of distressing symptoms in children with serious illness (such as pain, dyspnea and nausea/vomiting) were not addressed during their end-of-life period, and when treated, therapy was commonly ineffective. Whenever possible, treatment should focus on continued efforts to control the underlying illness. At the same time, children and their families should have access to interdisciplinary care aimed at promoting optimal physical, psychological and spiritual wellbeing. Persistent myths and misconceptions have led to inadequate symptom control in children with life-limiting diseases. Pediatric Palliative Care advocates the provision of comfort care, pain, and symptom management concurrently with disease-directed treatments. Families no longer have to opt for one over the other. They can pursue both, and include integrative care to maximize the child’s quality of life. Since most of the sickest children with serious illness are being taken care of in a hospital, every children’s hospital is now expected to offer an interdisciplinary palliative care service as the standard of care. This article addresses common myths and misconceptions which may pose clinical obstacles to effective PPC delivery and discusses the four typical stages of pediatric palliative care program implementation.

Chronic Pain Management as a Barrier to Pediatric Palliative Care

2013 ◽  
Vol 30 (8) ◽  
pp. 764-767 ◽  
Author(s):  
Lindsay A. Thompson ◽  
Elizabeth Meinert ◽  
Kimberly Baker ◽  
Caprice Knapp
Keyword(s):  
Chronic Pain ◽  
Palliative Care ◽  
Pain Management ◽  
Pediatric Palliative Care ◽  
Chronic Pain Management

Multimodal analgesia in paediatric palliative care

2021 ◽  
pp. 165-175
Author(s):  
Stefan J. Friedrichsdorf
Keyword(s):  
Bone Marrow ◽  
Palliative Care ◽  
Side Effects ◽  
Pain Control ◽  
Pain Treatment ◽  
Multimodal Analgesia ◽  
Hospitalized Children ◽  
Serious Illness ◽  
Paediatric Palliative Care ◽  
Frequent Exposure

Pain in hospitalized children is very common, under-recognized, and under-treated. In paediatric patients the pain might be not be caused by the underlying serious medical conditions alone, but also by their frequent exposure to painful procedures (e.g. bone marrow aspirations, dressing changes, lumbar punctures, blood draws, injections, etc.). Advanced paediatric pain treatment for children with serious illness usually requires multimodal analgesia, which may include medications from different analgesic classes, procedural interventions, rehabilitation, psychological, and/or integrative (‘non-pharmacological’) therapies that usually act synergistically for more effective paediatric pain control with fewer side effects than any single analgesic or modality.

Pain and Symptom Management at the End of Life (DRAFT)

2018 ◽  
Author(s):  
Robert C. Macauley
Keyword(s):  
Chronic Pain ◽  
Palliative Care ◽  
Symptom Management ◽  
Pain Treatment ◽  
Double Effect ◽  
Opioid Epidemic ◽  
Human Right ◽  
Hastened Death ◽  
Widespread Availability ◽  
High Doses

The pendulum of pain treatment has swung from stoic acceptance before the widespread availability of opioids, to embrace of opioids as pain became the “fifth vital sign,” to significant concern in light of the current opioid epidemic. The use of opioids for chronic pain should be differentiated from their use in palliative care, where there still exists significant concern for hastened death when high doses are used (i.e., opiophobia). While clinicians should be familiar with the Rule of Double Effect to justify such use, the rule is not truly needed because of the rarity of respiratory depression when opioids are used appropriately. Appropriate pain treatment is a human right, and as such surrogates should not be able to refuse it based on their own views, and global inequities prompt significant justice concerns.

A group-based chronic pain intervention using the Unlearn Your Pain method: A retrospective one-arm cohort study

2021 ◽  
pp. e20210049
Author(s):  
Pamela L. Holens ◽  
Liana Rock ◽  
Jeremiah Buhler ◽  
Martine Southall ◽  
Luigi Imbrogno ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Cohort Study ◽  
Pain Treatment ◽  
Frequent Occurrence ◽  
Group Format ◽  
Total Pain ◽  
Before And After ◽  
Pain Intervention ◽  
Chronic Pain Treatment ◽  
Preliminary Support

LAY SUMMARY Chronic pain is a frequent occurrence in military and Veteran populations. This study examined whether a group-based chronic pain treatment using the Unlearn Your Pain method was effective in reducing chronic pain in 21 military and Veteran participants. Participants completed measures of pain before and after engaging in the treatment, and results showed participants experienced large reductions in total pain and pain-related catastrophizing and moderate reductions in pain-related disability and pain-related fear of movement after completing the treatment. A smaller group of the participants completed the measures again eight weeks after completing treatment, and the size of their improvements was even greater. This study offers preliminary support for the Unlearn Your Pain method offered in a group format to military and Veteran populations. Further study is warranted.

Oncology palliative care: access barriers: bibliometric study

2021 ◽  
pp. bmjspcare-2021-003387
Author(s):  
Martins Fideles dos Santos Neto ◽  
Carlos Eduardo Paiva ◽  
Crislaine de Lima ◽  
Adeylson Guimarães Ribeiro ◽  
Bianca Sakamoto Ribeiro Paiva
Keyword(s):  
Palliative Care ◽  
Symptom Control ◽  
Cross Sectional Study ◽  
Impact Factors ◽  
Cochrane Library ◽  
Cross Sectional ◽  
Barriers To Access ◽  
The Usa ◽  
Bibliometric Review ◽  
Expert Analysis

ObjectiveTo perform a bibliometric analysis of studies that evaluated the barriers to access to cancer palliative care (PC).MethodsThis was a bibliometric review using MEDLINE; EMBASE; Web Of Science; LILACS and the Cochrane Library. A search was conducted with the terms Barriers, Palliative Care and Cancer. Articles whose objectives targeted barriers to access to PC were considered, regardless of the year of publication. The setting is articles published from 1987 to 2020.ResultsA total of 6158 articles were identified, of which 217 were eligible for analysis. The USA and UK being the countries with the largest number of articles on the subject (n=101, n=18, respectively). After expert analysis, the barriers were grouped into nine categories.ConclusionsBarriers related to symptom control were identified in 19% of the eligible articles, along with barriers related to health, which with 24% of occurrence in the articles, were the most frequently cited barriers. Countries which have implemented PC for some time were those with the greatest number of publications and in journals with the highest impact factors. Cross-sectional study design continues to be the most frequently used in publications.

scholarly journals Management of chronic pain

1997 ◽  
Vol 3 (2) ◽  
pp. 86-93 ◽  
Author(s):  
Stephen P. Tyrer
Keyword(s):  
Chronic Pain ◽  
Acute Treatment ◽  
Pain Treatment ◽  
Medical Condition ◽  
Washington State ◽  
Pain Clinic ◽  
Pain Clinics ◽  
The Usa ◽  
Treatment Facilities ◽  
The Many

Until 50 years ago chronic pain was not considered to be a medical condition that required special evaluation and treatment facilities. Pain was considered to be an indicator of tissue damage and appropriate medical or surgical treatment was prescribed for this. The many patients who had continuing pain because of the results of disease or trauma or because acute treatment was unable to relieve the condition were not seen as suffering from a recognised pathological entity. It was not until a doctor, Sicilian-born John J. Bonica, had to pay his debts as a medical student through wrestling professionally, and later suffered persistent pain as a result, that chronic pain became a recognised condition in its own right. Bonica started a pain clinic in Tacoma, Washington State, in 1949 and wrote the first textbook on pain treatment, The Management of Pain, in 1953. There are now 2000–3000 pain clinics in the USA and almost 5000 worldwide.

scholarly journals Depression, Depressive Somatic or Nonsomatic Symptoms, and Function in a Primarily Hispanic Chronic Pain Population

ISRN Pain ◽  
2013 ◽  
Vol 2013 ◽  
pp. 1-8 ◽  
Author(s):  
Kristynia M. Robinson ◽  
Jose J. Monsivais
Keyword(s):  
Chronic Pain ◽  
Suicidal Ideation ◽  
Pain Treatment ◽  
Severe Depression ◽  
Diagnostic Process ◽  
Future Research ◽  
Level Of Functioning ◽  
The Usa ◽  
Mexico Border ◽  
And Function

Chronic pain and depression are two major causes of disability. Comorbidity decreases psychosocial and physical functioning while increasing economic burden. The prevailing belief that Hispanics somaticize depression may hinder the diagnostic process and, thus, may impact outcomes. The purpose of this study was to explore the relationships among depression and depressive symptoms (somatic or nonsomatic) and function in chronic pain sufferers residing along the USA-Mexico border. Like other studies, as level of depression increased, level of pain increased and level of functioning decreased. So much so that almost a quarter of the participants reported moderate-to-severe depression, and another quarter of the participants reported suicidal ideation independent of depression or treatment. Unlike other published reports, we used a sample of chronic pain patients who received individualized, multimodal pain treatment. Compared to our previous work in a similar population, pain intensity and suicidal ideation were lower in this study. A plausible explanation is the use of antidepressants as adjuvant treatment for pain. Regardless of gender or ethnicity, persons with chronic pain will disclose symptoms of depression when appropriate tools are used to collect the data. Implications for future research and clinical practice are discussed.

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