Pharmacologic Treatment of Insomnia in Children and Adolescents with Chronic Pain Conditions

Abstract

The purpose of this chapter is to provide a review and expert opinion supporting pharmacological treatments for insomnia in children and adolescents with chronic pain conditions. Insomnia as an independent disorder is defined as dissatisfaction with sleep quantity or quality, clinically significant distress or impairment in daytime functioning, and a specific time pattern of occurrence. Independent of the pathological context, insomnia is more frequent in adolescents than in children. The impact of insomnia on pediatric patients is quite profound, especially on those affected by chronic pain, where the prevalence of insomnia is significantly greater than in those without pain. Despite the intense effect of insomnia on physical, emotional, and cognitive health, as well as on the efficacy of interdisciplinary therapy, currently, there are no pharmacological guidelines for this population. Thus, the diagnosis and successful treatment of insomnia in children with chronic pain conditions often represent a significant challenge for clinicians. The management of insomnia requires an interdisciplinary team that includes a physician, physiotherapist, and psychologist. Specific therapies for insomnia include sleep hygiene counseling, cognitive behavioral therapy, and pharmacological interventions. This review focuses exclusively on five successful pharmacological treatments for insomnia in children and adolescents with chronic pain conditions, and presents concepts and recommendations based on current medical evidence and the knowledge of medical experts in the field.