Children’s pain too long ignored

Posted on Friday, October 16, 2020

Children's legs with boots on their feet

uOttawa researcher participates in the first ever Lancet Child and Adolescent Health Commission to address forgotten issue of pediatric pain

Up to 10 percent of young people experience disabling chronic pain into early adulthood, suffering from conditions ranging from arthritis to other types of musculoskeletal pain, recurrent abdominal pain, and headaches. Infants, children and youth regularly undergo pain producing medical procedures for diagnosis and treatment. And yet, according to the authors of a major new report, the way pediatric pain is recognized, assessed and treated has gone under the radar for too long. The findings of the first Lancet Child and Adolescent Health Commission on Paediatric Pain suggest more needs to be done to raise awareness of children’s pain from early years to adulthood.

The commission report, led by the Centre for Pain Research at the University of Bath and supported by Versus Arthritis and the Mayday Fund, reflects the views and opinions of multidisciplinary health professionals and patients, whose experiences fed the study.

Paula Forgeron, Full Professor at the School of Nursing at the University of Ottawa, is one of the authors of the report. She agreed to provide a summary of the findings.

1- What is your contribution to the report Delivering transformative action in paediatric pain: a Lancet Child & Adolescent Health Commission?

I was honored that Chris Eccleston (Commission lead from the University of Bath, England) invited me to be an author. As one of the authors I have contributed to the conceptualization of the Commission, led writing for the first goal in the report (Make Pain Matter), conducted literature searches, and help to edit the Commission.”

2- What is the importance of the Lancet Child and Adolescent Health Commission?

“The Lancet Commissions provide a state-of-the-art scientific review when substantive and strategic change is needed to move a field forward (e.g. in an understudied or neglected field, or where a novel view is needed of an important topic). They are scientifically led, involve international and multidisciplinary collaboration, and are focussed on stimulating transformational change in policy and practice, or in clinical approach.”

3- The report suggests that change in pediatric services over the past 40 years in terms of pain recognition, diagnosis, assessment and management is slow. There are four key goals in the report – to make childhood pain matter, to make it understood, to make it visible and to make it better. How can these goals help address the main issues and transform children's lives for the better?

“These four goals might seem simple and obvious, however, if the goals were easy to achieve, we would have few children, youth and parents (or caregivers) reporting poorly managed pain – pain after injury or surgery, pain from medical procedures, or ongoing chronic pain, for example. Pain is multifactorial and influenced by biological, psychological, and social factors, making it complex and difficult to treat effectively.

1. Make Pain Matter. Pain has not really mattered, as shown by common failings to provide adequate or appropriate pain relief in clinical practice, insufficient training among health-care professionals (e.g. in Canada veterinarian students receive more training about pain than nursing and medical students), a lack of investment in research and services, and inequity in access to pain management, both geographically and for those from vulnerable groups. Pain will not matter until societies (e.g. governments, funders, educational systems, healthcare centres) understand that pain needs to matter to decrease the burden of pain and suffering and associated poor outcomes for children, youth, parents and societies.

2. Make Pain Understood. Pain is complex and although research has made great strides in understanding the mechanisms of nociception (pain that arises from actual or threatened damage due to activation of pain detecting nerves [nociceptors]) and pain perception (a complex interaction between a pain stimulus – sensory input – and the emotional and cognitive factors that result in one’s experience of the pain) there remain significant gaps in knowledge. Understanding biopsychosocial processes is critical to identify strategies and treatments to improve outcomes.

3. Make Pain Visible. Pain is not visible like other conditions such as a deformity in an arm from a break or X-ray evidence of a break. Pain can and should be assessed in every child and accountability for when it is not. Methods for pain assessment throughout childhood and in all clinical scenarios need to be optimized. Although subjective pain report is the primary and desirable method when this is possible, many of the methods and measures that are in common use can and should be improved.

4. Make pain better. Few randomized controlled trials of pain interventions in children have been done, and the pipeline for innovation and new treatments is running dry. Novel drug discovery studies and trial design, like using single-case designs when the randomized controlled trial is not ethical or practical, could advance treatment options. There is innovation in new ways to personalize individual treatments, but greater investment in research and coordinated approaches at all levels are needed.”

The full Lancet Commission report is accessible here.

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Justine Boutet
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