Pain Syndrome In Children Research Articles

Amplified pain and complex regional pain syndrome in children: clinical cases and literature review

BACKGROUND: Musculoskeletal pain is a common reason for visiting pediatric clinics. Causes of chronic musculoskeletal pain include various inflammatory or noninflammatory conditions. Amplified pain syndrome refers to a wide range of conditions manifested by chronic pain, the common feature of which is central and/or peripheral sensory amplification of pain. Complex regional pain syndrome is characterized by spontaneously occurring or provoked by irritating stimuli pain of high intensity, disproportionate to the actual injury or other stimulus, and the presence of several concomitant vegetative and motor disorders. CLINICAL CASES: This article presents three clinical cases of pediatric patients with chronic musculoskeletal pain and an analysis of the current literature on chronic pain in children. DISCUSSION: Complex regional pain syndrome is more common in adolescent girls, and conflict or psychological trauma is a common trigger. Symptoms of disproportionate burning pain (causalgia) with trophic changes may indicate complex regional pain syndrome. To date, there are no generally accepted pharmacological treatments recommended for children with complex regional pain syndrome. Nonsteroidal anti-inflammatory drugs (ibuprofen) and paracetamol and their combination are commonly administered in cases wherein symptoms of chronic pain first appear. CONCLUSIONS: Currently, a multidisciplinary approach, including physical, psychological, medical, and invasive methods, appears to be the most adequate treatment method for musculoskeletal pain. The use of analgesics should comply with approved protocols of pain management in pediatric practice.

Chronic Postsurgical Pain in Children and Adolescents: A Call for Action.

Chronic postsurgical pain (CPSP) affects a significant proportion of children and adolescents after major surgery and is a detriment to both short- and long-term recovery outcomes. While clinical characteristics and psychosocial risk factors for developing CPSP in children and adults are well established in the literature, there has been little progress on the prevention and management of CPSP after pediatric surgery. Limited evidence to support current pharmacologic approaches suggests a fundamentally new paradigm must be considered by clinicians to both conceptualize and address this adverse complication. This narrative review provides a comprehensive evaluation of both the known and emerging mechanisms that support our current understanding of CPSP. Additionally, we discuss the importance of optimizing perioperative analgesic strategies to mitigate CPSP based on individual patient risks. We highlight the importance of postoperative pain trajectories to identify those most at risk for developing CPSP, the early referral to multi-disciplinary pain clinics for comprehensive evaluation and treatment of CPSP, and additional work needed to differentiate CPSP characteristics from other chronic pain syndromes in children. Finally, we recognize ongoing challenges associated with the universal implementation of available knowledge about pediatric CPSP into practically useful care plans for clinicians.

Patellofemoral pain syndrome in children and adolescents: A cross-sectional study.

To assess the prevalence and associated factors of Patellofemoral Pain Syndrome (PFPS) in children and adolescents. A population-based cross-sectional study was conducted with children and adolescents aged 10 to 18 years, who presented a history of peripatellar and/or retropatellar pain, attending elementary or high school in urban public schools in Natal, Brazil. The sample size was calculated based on a minimum outcome prevalence of 22%. A prevalence of 24.7% of PFPS was found. There was a positive association of PFPS with active students (p < 0.01; PR: 2.5; CI: 1.4-4.5), low functional capacity (p < 0.01; PR: 8.0; CI: 5.0-12.8), and those classified as pubertal (p < 0.03; PR: 1.8; CI: 1.0-3.2). There was a considerable prevalence of PFPS in children and adolescents, as well as an association between the level of sexual maturation and adjustable determinants, such as the level of physical activity and low functional capacity in this group.

Медико-социальные особенности хронических болевых синдромов у детей и подростков

ABSTRACT INTRODUCTION. A review of the social, psychological and medical issues of chronic pain syndromes in children and adolescents. The impact of chronic pain on daily activity, academic performance and morbidity in adulthood in this category of patients is analyzed. MATERIAL AND METHODS. A systematic search was conducted on the RSCI and PubMed database for the period from 2000 to 2023 on the topic of chronic pain syndromes in children and adolescents, which yielded 761 matches on key features, of which we analyzed 24 sources. DISCUSSION. The review presents information according to which, in the pathogenesis of chronic pain syndromes in children and adolescents, a significant role is given to both the characteristics of the antinociceptive system and socio-psychological aspects. The main factors involved in the formation of chronic pain syndromes are presented. CONCLUSION. Chronic pain in children and adolescents has its own medical, psychological and social characteristics, which affect not only the current state of health, but also has a significant impact on later life. KEYWORDS: children, adolescents, chronic pain, medicalization of pain, depression

The prospect of using virtual reality technology in combination with psychotherapeutic methods in children with functional abdominalgia

The literature review addresses the effectiveness of psychotherapeutic methods in the treatment of functional abdominal pain syndrome and studying the prospects for using virtual reality technology in combination with psychotherapeutic methods according to the available literature. A search was conducted for available literature in the eLibrary and PubMed databases, published for the period 2017-2022, using the keywords: abdominalgia, psychotherapeutic methods, gut-brain axis, virtual reality technology. Currently, the biopsychosocial concept of the etiopathogenesis of abdominal pain syndrome, which is not associated with an organic disease of the gastrointestinal tract, is used. A significant contribution to the formation of the disease is made by genetic, neuropsychological, neurophysiological factors, and disruption of the interaction of the gut-brain axis. Cognitive behavioral therapy, yoga, and hypnotherapy are applicable as effective psychotherapeutic methods in the complex treatment of abdominal pain syndrome in children. A promising direction is the use of virtual reality technology to increase the effectiveness of psychotherapeutic methods and reduce chronic abdominal pain syndrome by influencing the gut-brain axis. Practical research work devoted to this issue is currently rare. In the complex treatment of functional abdominal pain syndrome in children, various psychotherapeutic methods are used, the most effective are cognitive behavioral therapy and hypnotherapy. It is necessary to stimulate domestic research work studying the joint use of virtual reality technology and psychotherapeutic methods in children aged 7 to 18 years.

A modern view on the differential diagnosis of ultrasound characteristics of lymph nodes in mesadenitis in children

Mesadenitis (mesenteric lymphadenitis, mesenteritis) is a common cause of acute abdominal pain syndrome in children. At the same time, the cause of acute mesadenitis is far from being established in all cases. Diagnosis of mesenteric lymphadenitis presents a certain problem. Differential diagnosis is always carried out with acute surgical diseases of the abdominal cavity, primarily with acute appendicitis. Special attention is paid to ultrasound examination in the diagnosis of mesadenitis. Given the absence of statistically proven diagnostic criteria for changes in abdominal lymph nodes in mesadenitis, it is relevant to determine their ultrasound characteristics. The article is presented in the form of a lecture for practicing pediatricians based on a literature review. The characteristics of mesentery lymph nodes in various pathological processes are collected from various sources. The features of ultrasound characteristics of mesenteric lymph nodes in normal and acute mesadenitis with herpes infection, coronavirus infection, tuberculosis, as well as features of lymph nodes with lymphogranuloma are presented. A table has been developed that indicates such characteristics as the shape, number of lymph nodes in the section, echogenicity, blood flow status, capsule, contour, as well as additional characteristics in some conditions (such as the tendency to form conglomerates or the presence of calcinates in the structure of lymph nodes in tuberculosis lesions). A detailed description of the lymph nodes makes it possible to conduct a preliminary differential diagnosis of mesadenitis using ultrasound, which makes it possible to determine the vector of further diagnostic search in children with acute abdominal syndrome, and then to select pathogenetically justified therapeutic tactics and preventive measures.

Efficacy of regional analgesia in prevention of chronic postsurgical pain in children on the PEDSQL General Well-Being Scale and Pediatric Pain Questionnaire

Introduction. In pediatrics, regional anesthesia is one of the most valuable and safest means of perioperative pain management and chronic pain prevention. Pediatric Quality of Life Inventory 3.0 General Well-Being Scale and Pediatric Pain Questionnaire allow for assessing the impact of pain on children and their families via studying changes in Quality of Life scores for the scales of Present Pain and Worst Pain, General Well-Being and General Health. Purpose - to assess the impact of regional analgesia on the prevention of chronic postsurgical pain using PedsQL™ 3.0 questionnaires. Materials and methods. Following the inclusion and exclusion criteria, a total of 80 children were enrolled in the study. Among them, there were 60 children who underwent anterior abdominal wall surgery with various types of anesthetic management and were treated at the surgical department of a Communal Non-Profit Enterprise “Ivano-Frankivsk Regional Children’s Clinical Hospital of Ivano-Frankivsk Regional Council”. All patients were divided into 4 groups. The Group 0, the control group, included 20 children who had no surgical pathology and met inclusion criteria. The Group I comprised 20 children who underwent anterior abdominal wall surgery under general anesthesia using the transversalis fascia plane block combined with the quadratus lumborum block-4 via a single injection. The Group II included 20 children who underwent anterior abdominal wall surgery under general anesthesia using morphine. The Group III comprised 20 children who underwent anterior abdominal wall surgery under general anesthesia using the transversalis fascia plane block. Results. The prevalence of chronic pain syndrome in children who received conventional analgesia was the highest - 19.81±0.21%. Children who underwent conventional analgesia, while staying in the surgical department, had significantly higher the Face, Legs, Activity, Cry, Consolability scale and Visual Analogue Scale scores as compared to those who received other forms of regional analgesia. Discussion. Three and six months after surgery, in patients who received conventional analgesia, quality of life significantly reduced (p&lt;0.001) on the scales of General Well-Being, General Health, Present Pain, and Worst Pain. This shows the need for using effective minimally invasive regional analgesia techniques in the perioperative period. Conclusions. Chronic pain syndrome reduces quality of life in children by reducing their general well-being and general health due to high indicators of present and worst pain. Regional analgesia techniques are a priority for the prevention of chronic pain syndrome. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of the participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the author.

Occupational therapy treatment of complex regional pain syndrome in children and adolescents: a scoping review protocol

This scoping review will explore the literature related to occupational therapy interventions and delivery methods for pediatric complex regional pain syndrome. Complex regional pain syndrome is a debilitating pain condition that is becoming increasingly diagnosed within the pediatric population. Untreated, it can negatively impact a child's occupational engagement and participation, social functioning, and family dynamics. A multidisciplinary treatment approach is typically recommended, with occupational therapy as an essential component. Occupational therapy interventions for pediatric complex regional pain syndrome usually promote a child's ability to participate in daily activities to prevent further impairment and disability. Despite evidence that occupational therapy practitioners treat this population, no review has been conducted of the available literature on occupational therapy interventions for pediatric complex regional pain syndrome. This review will consider studies that include any form of occupational therapy interventions for participants with complex regional pain syndrome who are 18 years or younger. Quantitative, qualitative, and observational studies, and text and opinion papers will be considered. The JBI methodology will be used to conduct this scoping review. MEDLINE, Embase, Scopus, APA PsycINFO, CINAHL, OTDBASE, OT Search (AOTA), OTseeker, and ProQuest Dissertations and Theses Global will be searched for studies in English, with no limit on publication date. Two independent reviewers will screen the titles, abstracts, and full texts of the selected studies. Data collection will be performed using a tool developed by the researchers based on the standardized JBI tool. Data will be presented in a comprehensive narrative summary.

АНАЛИЗ ФАРМАЦЕВТИЧЕСКОГО РЫНКА ЛЕКАРСТВЕНННЫХ ПРЕПАРАТОВ ДЛЯ ЛЕЧЕНИЯ САХАРНОГО ДИАБЕТА В РЕСПУБЛИКЕ СЕВЕРНАЯ ОСЕТИЯ – АЛАНИЯ

Relevance: pain syndrome is a common phenomenon in oncopediatrics, and pain control and proper treatment tactics remain relevant to date. Objective: to generalize the experience of approaches to the therapy of psychogenic pain syndrome in children and adolescents with oncological and oncohematological diseases at the stage of antitumor treatment. Methods: traditional clinical and psychopathological, clinical and catamnestic methods and scale methods were used for psychiatry. Research material: children and adolescents who were treated at the Research Institute of the Russian Scientific Research Center and the Oncological and Oncohematological departments of the Morozovskaya DGKB DZM in 2020-2022. Results: 32 patients were selected from all those examined with suspected psychogenic pain, whose pain syndrome corresponded to the concept of "psychogenic algic syndrome". It was noted that female patients prevailed among patients with psychogenic pain.The patients were characterized by an exaggerated description and perception of pain sensations, the intensity of pain was associated with an emotional background, current events. Typical for patients were personality accentuations, as well as such psychopathological manifestations as anxiety, reduced mood background, fears, hypochondriac fixation. The proposed treatment tactics included medical (medicinal) and non-medical methods (psychotherapy, work with parents and caring adults). Conclusions:integrative models of therapy (a combination of medicinal and non-medicinal methods) for psychogenic pain syndrome show their high effectiveness.

ЛЕЧЕНИЕ ПСИХОГЕННОГО БОЛЕВОГО СИНДРОМА У ДЕТЕЙ И ПОДРОСТКОВ В ПРОЦЕССЕ ПРОТИВООПУХОЛЕВОЙ ТЕРАПИИ

Relevance: pain syndrome is a common phenomenon in oncopediatrics, and pain control and proper treatment tactics remain relevant to date. Objective: to generalize the experience of approaches to the therapy of psychogenic pain syndrome in children and adolescents with oncological and oncohematological diseases at the stage of antitumor treatment. Methods: traditional clinical and psychopathological, clinical and catamnestic methods and scale methods were used for psychiatry. Research material: children and adolescents who were treated at the Research Institute of the Russian Scientific Research Center and the Oncological and Oncohematological departments of the Morozovskaya DGKB DZM in 2020-2022. Results: 32 patients were selected from all those examined with suspected psychogenic pain, whose pain syndrome corresponded to the concept of "psychogenic algic syndrome". It was noted that female patients prevailed among patients with psychogenic pain.The patients were characterized by an exaggerated description and perception of pain sensations, the intensity of pain was associated with an emotional background, current events. Typical for patients were personality accentuations, as well as such psychopathological manifestations as anxiety, reduced mood background, fears, hypochondriac fixation. The proposed treatment tactics included medical (medicinal) and non-medical methods (psychotherapy, work with parents and caring adults). Conclusions:integrative models of therapy (a combination of medicinal and non-medicinal methods) for psychogenic pain syndrome show their high effectiveness.

The effect of intravenous infusion of lidocaine on the course of the perioperative period in children under 7 years of age

Annotation. At present, the treatment of perioperative pain syndrome in children remains unsolved. This issue is caused not only by a stereotypical approach to the assessment of pain intensity but also due to specific pharmacotherapy of pain in pediatric patients, especially those under the age of 7 years. The purpose of this study is to investigate the effect of intravenous infusion of lidocaine on the course of the perioperative period in children under the age of 7 years. We conducted a prospective controlled study that included 76 children (45 boys, 31 girls) who underwent surgical procedures under general anesthesia. Age of the patients was from 2 months to 7 years (3.72±2.26 years). Patients were divided into two groups: the first group (n=32) included children who received intravenous lidocaine during the perioperative period, and the second (control) group (n = 44) included children who were not prescribed lidocaine. Data analysis was performed using the statistical package "SPSS 20" (SPSS Inc.) version 21.0.0 for Windows. According to the obtained data, heart rate (HR) during operative procedures and a postoperative serum cortisol level were significantly lower in the lidocaine group compared to the control group (p&lt;0.05). The pressor response to extubation in patients of the study group was less pronounced; namely HR -109.63±14.09 bpm. to 120.75±7.61 bpm. in the control group (p&lt;0.001), the mean arterial pressure - 70.99±8.59 mm Hg to 75.59±7.24 mm Hg, respectively (p=0.017). During the 48-hour follow-up period after surgery, pain intensity according to the FLACC pain scale was significantly lower with lidocaine administration, similarly to the average doses of narcotic analgesics used perioperatively. Perspectives for further research include a subgroup analysis of the efficacy and safety of intravenous infusion of lidocaine over the course of the perioperative period in children, depending on the type and duration of surgical procedures.

OA03 “I can't stand this pain anymore. Please chop my leg off.” Is amputation a therapeutic option for Complex Regional Pain Syndrome in children and young people?

Introduction/BackgroundComplex Regional Pain Syndrome (CRPS) is a chronic intensified localised pain condition. Symptoms may include limb pain, allodynia; hyperalgesia; swelling and/or changes in skin colour of the affected limb; dry, mottled skin; hyperhidrosis and trophic changes of the nails and hair. There is no known cure. Management involves analgesic medication and intensive multidisciplinary pain rehabilitation. Some cases however seem intractable, with little or no response to therapy. Some patients feel amputation of the affected limb is the only possible option. We present four cases of children and young adults requesting amputation for CRPS.Description/MethodCase 1: 13 years, CRPS left leg, with associated gross oedema, ulceration and high risk of sepsis.Case 2: 16 years, CRPS both feet and ankles, ulceration, fixed dystonic posturing bilaterally, Autistic Spectrum DisorderCase 3: 17 years, mild cerebral palsy affecting left side, passionate about sport, development of CRPS following surgery for tendon release right hip flexors, fixed flexion contractures at right hip and knee. Case 4:17 years, high functioning athlete, CRPS initially foot and ankle, contractures ankle, knee and hip; progression to involve other leg.In each of these cases, prolonged intensive therapeutic interventions have not been successful in restoring function or reducing pain. All have requested amputation of the affected limb(s).Discussion/ResultsThe tabloid press has reported the transforming success of amputation for some cases of CRPS, describing individuals who have had CRPS which has not responded to treatment finally having the affected limb amputated, and subsequently achieving great things - including winning medals in the Para-Olympics. Unsurprisingly such success stories provide hope for some enduring CRPS and becomes part of their ‘evidence’ for requesting amputation.The scientific literature however is sparce, and virtually non-existent in children and young people. The risks of ongoing pain in the stump; recurrence of CRPS in the amputated limb - or elsewhere; phantom limb pain and inability to tolerate a prosthesis are well documented in the adult literature that is available. Key learning points/ConclusionDespite this, for the child/young person experiencing not only pain, but disgust, shame and body perception disturbance, the argument for amputation can be strong, and has to be considered. We present the evidence to date and share the complexity of such discussions, focusing on the experience gained from these cases.

Оцінка больового синдрому у дітей. Сучасний стан проблеми

Питання оцінки болю у дітей різних вікових груп є актуальним, оскільки його успішна реалізація потребує врахування багатьох факторів. Зокрема, більшість дітей віком до 5 років не здатні вербально описати больові відчуття. Окрім того, на поведінкову реакцію дітей можуть впливати такі фактори, як попередній негативний досвід болю, відсутність батьків, когнітивні розлади та інше. Фізіологічні параметри, що часто використовуються для об’єктивізації болю, можуть неправильно трактуватись за наявності у дитини супутніх тяжких захворювань — сепсису, дихальної недостатності, гіповолемії тощо. Тому для практикуючих лікарів важливим є питання правильного вибору засобів оцінки болю у дітей різних вікових груп і в різних клінічних ситуаціях, а також правильна інтерпретація отриманих даних.

Biliary dyskinesia in children with irritable bowel syndrome: overlap syndrome. The search for a modern approach to the treatment of abdominal pain syndrome

Objective. To optimize therapeutic approaches to the treatment of abdominal pain syndrome in children with overlapping syndrome of biliary dyskinesia + irritable bowel syndrome.Characteristics of children and research methods. The study included 309 children aged from 13 to 17 years. Irritable bowel syndrome was diagnosed in 76 (24.6%) patients in accordance with the Rome IV revision criteria and the results of laboratory and instrumental studies. 45 (59.2%) patients had a variant of the syndrome with constipation, 19 (25%) – a variant with diarrhea, 12 (15.8%) – a mixed variant (alternating constipation with diarrhea). Biliary pain was detected in 58 (76.3%) patients, including 34 (44.7%) patients with constipation, 13 (17.1%) with diarrhea variants and 11 (14.5%) with mixed option. The researchers used two treatment options: trimebutin (Trimedat, ValentaPharm, Russia) in an age dosage for 28 days (main group) and papaverine in an age dosage for 4 weeks (comparison group).Results. The main group demonstrated a more pronounced decrease in the intensity of abdominal pain associated with both irritable bowel syndrome and biliary dyskinesia. Differences between treatment results in the main and control groups are statistically significant (p&lt;0.01). During the treatment period there were no cases of side effects in the main group, the differences in the frequency of side effects between the main group and the comparison group are statistically significant. (p=0.01).Conclusion. Correction of abdominal pain with trimebutin significantly exceeds the effectiveness of standard antispasmodic therapy in the treatment of overlap syndrome of irritable bowel syndrome + biliary dyskinesia. Trimebutin therapy is safe and can be recommended as a fairly effective method of treating children with overlap syndrome.

Нейропатическая боль на ранних этапах химиотерапии у детей с острыми лейкозами. Эффективность обезболивающей терапии и сроки астенизации

Актуальность. Проблема нейропатической боли у детей приобретает все большую актуальность вследствие роста распространенности патологии и трудности в достижении терапевтического эффекта. Нейропатическая боль в детской онкологии может возникнуть в результате различных повреждений соматосенсорной системы. В Украине в настоящее время нет проведенных исследований касательно нейропатической боли у детей с гемобластозами на ранних этапах лечения. Именно поэтому наше исследование направлено на решение вопроса о ранней реализации нейропатии и улучшении обезболивающей терапии. Цель исследования. Проведение анализа болевого синдрома у детей с гемобластозами на первом этапе химиотерапии и сравнение эффективности различных методов обезболивания, определение взаимосвязи методов обезболивания и степени астенизации. Материалы и методы. Проведено когортное проспективное исследование, в которое вошли 60 детей с впервые диагностированными гемобластозами в возрасте от 6 до 18 лет. Все дети были разделены на три группы в зависимости от степени выраженности болевого синдрома. І группа (n = 20) — дети, у которых интенсивность боли по ВАШ составила ≥ 7 баллов и которым с целью обезболивания вводился морфин. II группа (n = 20) — дети с интенсивностью боли ≥ 7 баллов, которым с целью обезболивания вводился морфин в комбинации с габапентином. III группа (n = 20) — дети с интенсивностью боли ≤ 6 баллов, которым с целью обезболивания вводился парацетамол в сочетании с габапентином. 40 детям проведено исследование венозной крови на активность супероксиддисмутазы (СОД) и каталазы, содержание сиаловых кислот (СК) и малонового диальдегида (МДА). Проводилось определение интенсивности боли, наличия нейропатии и астении на 1-е сутки поступления в отделение анестезиологии и интенсивной терапии, далее — на 30, 64 и 78-е сутки химиотерапии. Результаты. При определении нейропатии на 1-е сутки манифестации боли у 8 детей (13 %) результат был отрицательный, у 48 детей (80 %) — сомнительный и у 4 детей (7 %) — положительный. На 30-е сутки химиотерапии у 2 детей (3 %) данные о нейропатии негативные, у 56 детей (91 %) — сомнительные и у 4 детей (6 %) — положительные. На 64-е и 78-е сутки химиотерапии данные о нейропатии были одинаковыми и у 53 детей (88 %) являлись сомнительными, а у 7 (12 %) — положительными. В результате биохимического исследования крови обнаружены признаки оксидативного стресса: активность СОД ниже нормы в 35,4 раза, количество МДА и СК превышает норму в 7,5 и 1,8 раза соответственно. Интенсивность боли по ВАШ на 30-е сутки составляла в I группе ≤ 5 баллов, в II группе ≤ 4 баллов и в III группе ≤ 3 баллов. На 78-е сутки интенсивность боли в I группе составляла ≤ 5 баллов, во II и III группах ≤ 3 баллов. Выраженная астения отмечалась у 6 детей (10 %), умеренная — у 45 детей (75 %) и реакция утомления — у 9 детей (25 %). Выводы. Формирование нейропатического компонента боли начинается уже на 1-м этапе химиотерапии, следовательно, применение габапентина в комплексной терапии боли является целесообразным. Тщательный мониторинг боли позволяет вовремя выявить наличие болевого синдрома и более точно корректировать обезболивающую терапию для достижения положительного эффекта.

Абдомінальний больовий синдром у дітей та підлітків: можливості терапії

Біль у животі — частий привід для звернення пацієнтів різного віку до лікаря, одна з найбільш частих скарг, що пред’являються дітьми та їх батьками. Больовий абдомінальний синдром у дітей — це сукупність симптомів, що супроводжують різні хірургічні та нехірургічні захворювання, одним із проявів яких є біль у животі. Розрізняють гострий і хронічний (рецидивуючий) біль. Гострий біль у животі може бути проявом хірургічної патології, травми або гострого інфекційного захворювання. Біль у животі в більшості випадків обумовлений хронічними захворюваннями органів травлення або функціональними розладами. Педіатри, лікарі загальної практики та гастроентерологи частіше зустрічаються з рецидивуючим болем у животі (довготривалий переривчастий або постійний біль). Рецидивуючий біль у животі у дітей визначається як три епізоди болю, що відбуваються протягом трьох місяців і впливають на нормальну активність дитини. Погоджувальний документ Американської педіатричної асоціації та Північноамериканської асоціації дитячої гастроентерології, гепатології та харчування в 2005 році запропонував використовувати замість терміну «рецидивуючий біль у животі» термін «хронічний абдомінальний біль». Хронічний абдомінальний біль найчастіше (90–95 % випадків) вважається функціональним (неорганічним) болем у животі без об’єктивних ознак основного органічного розладу і характеризується різноманіттям проявів. За механізмом виникнення виокремлюють вісцеральний, парієтальний (соматичний), іррадиюючий та психогенний біль. При болі в животі необхідно оцінити: час появи, інтенсивність, характер, тривалість, локалізацію. На першому етапі діагностики необхідно виключити гостру хірургічну патологію. Про високу ймовірність хірургічної патології свідчать «симптоми тривоги». На наступному етапі проводиться диференційна діагностика органічних та функціональних причин абдомінального болю. При всіх видах функціонального болю відзначають порушення вісцеральної моторики і розвиток спазмів. Скорочувальна активність гладких м’язів ініціюється парасимпатичною нервовою системою. Лікування рецидивуючого болю в животі направлено на усунення його причин: зняття спазму, нормалізацію моторики шлунково-кишкового тракту. На даний час серед різних груп спазмолітиків при лікуванні функціональних розладів травного тракту віддають перевагу селективним міотропним спазмолітикам. Серед них мебеверин є оптимальним за ефективністю та безпекою. Мебеверин блокує швидкі натрієві канали, розташовані на клітинній мембрані міоцитів, перешкоджаючи надходженню іонів натрію в клітину. Цей механізм призводить до послаблення скорочувальної функції гладком’язового волокна і сприяє усуненню спазму, але не викликає гіпотонії. На відміну від антихолінергічних препаратів мебеверин справляє селективну дію на гладкі м’язи травного тракту. У клінічній практиці заслуговує на увагу мебеверину гідрохлорид — Спарк® (ПАТ «Фармак»), при прийомі якого відзначається збереження нормального тонусу і перистальтики після купірування м’язового спазму. Препарат Спарк® випускається в капсулах, одна капсула містить 200 мг мебеверину гідрохлориду. Згідно з інструкцією мебеверин (Спарк®) призначається дорослим і дітям від 10 років по 1 капсулі два рази на добу. Препарат не має системної дії. Застосування мебеверину (Спарк®) патогенетично обґрунтовано для лікування захворювань, що перебігають з абдомінальним больовим синдромом у дорослих і дітей старше 10 років.

Canadian surveillance study of complex regional pain syndrome in children.

This study describes the minimum incidence of pediatric complex regional pain syndrome (CRPS), clinical features, and treatments recommended by pediatricians and pain clinics in Canada. Participants in the Canadian Paediatric Surveillance Program reported new cases of CRPS aged 2 to 18 years monthly and completed a detailed case reporting questionnaire from September 2017 to August 2019. Descriptive analysis was completed, and the annual incidence of CRPS by sex and age groupings was estimated. A total of 198 cases were reported to the Canadian Paediatric Surveillance Program, and 168 (84.8%) met the case definition. The minimum Canadian incidence of CRPS is estimated at 1.14/100,000 (95% confidence interval 0.93-1.35/100,000) children per year. Incidence was highest among girls 12 years and older (3.10, 95% confidence interval 2.76-3.44/100,000). The mean age of CRPS diagnosis was 12.2 years (SD = 2.4), with the mean time from symptom onset to diagnosis of 5.6 months (SD = 9.9) and no known inciting event for 19.6% of cases. Most cases had lower limb involvement (79.8%). Nonsteroidal anti-inflammatory drugs (82.7%) and acetaminophen (66.0%) were prescribed more commonly than antiepileptic drugs (52.3%) and antidepressants (32.0%). Referrals most commonly included physical therapy (83.3%) and multidisciplinary pain clinics (72.6%); a small number of patients withdrew from treatment because of pain exacerbation (5.3%). Pain education was recommended for only 65.6% of cases. Treatment variability highlights the need for empiric data to support treatment of pediatric CRPS and development of treatment consensus guidelines.

Incidence of Acute and Chronic Post-Thoracotomy Pain in Pediatric Patients

We studied acute and chronic pain in pediatric patients who underwent thoracotomy for benign disease with a follow-up of at least three months. A telephone interview investigated about the presence of pain and the analgesic therapy in progress. The results were compared with the anesthetic technique, postoperative pain and the adequacy of pain therapy, both during the first week after surgery and at the time of interview. Fifty-six families consented to the study. The mean age of the children at surgery was 2.9 ± 4.5 years, while at the time of the interview was 6.5 ± 4.4 years. We performed different anesthetic strategies: Group A: general anesthesia (36 pts); Group B: general anesthesia and thoracic epidural (10 pts); Group C: general anesthesia and intercostal nerve block (10 pts). During the immediate postoperative period, 21 patients (37.5%) had at least one painful episode. At the time of interview, 3 children (5.3%) had moderate chronic neuropathic (burning) pain on surgical scar. There was no statistically significant difference between the type of anesthesia and the incidence and severity of acute post-operative pain. Despite its limitations, this study confirms the low incidence of chronic post-thoracotomy pain syndrome in children.

Treatment of Complex Regional Pain Syndrome in Children and Adolescents: A Structured Literature Scoping Review.

Background: Complex regional pain syndrome (CRPS) is characterized by chronic, spontaneous and provoked pain of the distal extremities whose severity is disproportionate to the triggering event. Diagnosis and treatment are still debated and multidisciplinary. The purpose of this systematic review is to analyze the available literature to provide an update on the latest evidence related to the treatment of CRPS in growing age. Methods: Data extraction was performed independently by three reviewers based on predefined criteria and the methodologic quality of included studies was quantified by the Newcastle–Ottawa Quality Assessment Scale Cohort Studies. Results: At the end of the first screening, following the previously described selection criteria, we selected n = 103 articles eligible for full-text reading. Ultimately, after full-text reading and a reference list check, we selected n = 6. The articles focused on physical (PT), associated with cognitive behavioral (CBT) and pharmacological (PhT) treatments. The combination of PT + CBT shows the most efficacy as suggested, but a commonly accepted protocol has not been developed. Conclusions: Physical therapy in association with occupational and cognitive behavioral treatment is the recommended option in the management of pediatric CPRS. Pharmacological therapy should be reserved for refractory and selected patients. The design and development of a standard protocol are strongly suggested.

PAIN IN CHILDREN WITH CANCER DIAGNOSIS

Pain syndrome is commonly a leading syndrome of oncological and oncohematological diseases in children. Whether the condition is curable or not, the pain syndrome can almost always be controlled that can significantly improve the quality of life of young patients and their families. The presented article highlights the causes and the mechanism of the pain syndrome development in children with oncological and oncohematological diseases. Adequate identification of pathogenetic mechanisms and assessment of pain syndrome is the main goal of the initial assessment of the patient's condition, taking into account the psychosocial characteristics of the patient and his family, thus it is important for clinicians to include these criteria in initial and follow-up examinations of patients in order to provide appropriate therapeutic management. We stress on the comprehensive understanding of the aetiology and pathogenetic mechanisms of the pain syndrome in children with oncological diseases, which directly affect the strategy of overcoming the pain associated with the tumour process, treatment, and carrying out medical and diagnostic manipulations in such children. It is important for specialists in paediatric oncology and oncohematology to diagnose the general pain syndrome, which accompanies cancerous diseases. Effective analgesia requires careful monitoring of the patient’s condition and his/ her syndromic reactions during treatment. The comprehensive assessment of the pain syndrome should include a discussion of the purpose and expectations of pain therapy, changes in pain intensity, characteristics and location. The article presents the basic principles of overcoming the pain syndrome, a three-step approach to the treatment of pain syndrome in children with oncological diseases and the main characteristics and combinations of analgesic groups for pain management.