The Role of Peripheral Nerve Blocks in the Interdisciplinary Care of Children with Chronic Pain: A Case Series and Review of the Literature

Abstract

Chronic pain of childhood is an extremely complex condition which can lead to damaging effects on physical and social wellbeing. Some children with severe chronic pain embark on a downward spiral of decreased physical, psychological and social functioning. This includes loss of mobility and inability to participate in physical and sporting activities, poor sleep, difficulty concentrating on school work, school absenteeism, social isolation and family stress. As chronic pain persists the child can experience increased pain intensity, distress, anxiety and depression. When enmeshed in this disordered lifestyle the child and their family require coordinated integrated care. The interdisciplinary team management approach, based on pharmacology, physiotherapy and psychology, is now well established to be the standard of care for children with chronic pain. Treatment goals are targeted to individual children after careful consideration of the history and examination. In appropriately selected children peripheral nerve blocks can provide immediate and effective pain relief. This chapter will present a referenced review of the literature on interdisciplinary paediatric chronic pain management whilst highlighting the role of peripheral nerve blocks. The case histories of eight paediatric patients with chronic pain who gained significant relief from peripheral nerve blocks will be presented. The International Association for the Study of Pain (IASP) defines pain as “an unpleasant sensory or emotional experience associated with actual or potential tissue damage, or described in terms of such damage” (1986). One defining characteristic of pain is its duration. Acute pain is relatively short-term pain that typically lasts until the underlying cause has been identified and treated. On the other hand, chronic pain is understood to mean prolonged pain or “pain that extends beyond the expected period of healing (Turk & Okifuji, 2001) and while defined time frames that determine a diagnosis of chronic pain vary, the definition adopted by most studies, including those cited here, is pain lasting longer than three months. Chronic pain can have its roots in one or a combination of types of pain mechanism. Types of pain include nociceptive, inflammatory, neuropathic or psychogenic pain (DSM-IV “Pain Disorder”). Extreme caution is required before labelling a patient with a diagnosis of