Abstract
The term “severe neurologic impairment” (SNI) is used to describe a group of disorders of the central nervous system which arise in childhood, resulting in motor impairment, cognitive impairment and medical complexity. As a result, much assistance is required with activities of daily living. Since these patients are often unable to self-report pain, or they may exhibit uncommon behaviors when suffering, pain manifestations may go unrecognized. In this article, the basic principles of how to approach pain in children with SNI are discussed.
Highlights
Severe neurologic impairment (SNI) describes a group of disorders of the central nervous system that arise in childhood, resulting in motor and cognitive impairment, along with medical complexity, where much assistance is required with activities of daily living
Several conditions may cause SNI, such as genetic syndromes, traumatic brain injury, neurodegenerative disorders, epileptic syndromes and cerebral palsy, with the latter being the most frequent with an incidence of two patients for each 1000 of pediatric age [2]. It is well-known that these patients experience pain more frequently than healthy peers, mostly not due to accidental injury [3], but rather to their condition’s related morbidities and iatrogenic pain [4]
Iatrogenic pain that is caused by painful procedures that are often repeated, such as venepuncture, botulinum toxin injections or surgery, should be carefully managed
Summary
Several conditions may cause SNI, such as genetic syndromes, traumatic brain injury, neurodegenerative disorders, epileptic syndromes and cerebral palsy, with the latter being the most frequent with an incidence of two patients for each 1000 of pediatric age [2]. It is well-known that these patients experience pain more frequently than healthy peers, mostly not due to accidental injury [3], but rather to their condition’s related morbidities and iatrogenic pain [4].
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