Pain Syndrome In Children Research Articles

Assessment of pain syndrome in children of non-oncology palliative group

Annotation. In the process of rehabilitation examination, the assessment of pain in children of the palliative non-oncological group is a difficult task. This is due to a number of reasons: reduced communication skills, unclear pathogenesis, etiology, nature of pain. At the same time, identifying the pain syndrome and suppressing it will provide comfort to the child and confidence to the parents.
 The purpose of the study: analysis of pain syndrome in children who need palliative non-oncological care.
 Research methods: empirical methods (comparison, description, measurement), theoretical method (axiomatic), general logical methods (analysis, synthesis, generalization), pain intensity assessment scales.
 Research results.
 To assess the intensity of pain, the following were used: children's scale for pain assessment by facial expressions of Wong-Baker (1988) – 10 (21,3%) children, assessment of pain in children who cannot speak or with speech disorders (from 6 months to 7 years old) – FLACC scale – 10 (21,3%) children, visual analog scale (VAS) – 19 (40,4%), KUSS (1998) children's pain assessment scale – 8 (17,0%). The results of the assessment of pain intensity are interpreted in the ICF qualifier «b 280 feeling of pain». The results of the survey revealed the following indicators: b 280.4 absolute violations were found in 14 children, b 280.3 severe violations were recorded in 26 children, b 280.2 moderate violations were detected in 6 children, 280.1 mild violations in one child. At the same time, the survey showed that most often children express or complain about pain of various concentrations: in the muscles of the lower limbs – «Minor pain» – 4 (8,5%), «Mild pain» – 5 (10,6%), «Moderate pain» – 27 (57,4%), «Severe pain» – 8 (17,0%), «Excessive pain» – 3 (6,3%); in the muscles of the shoulder girdle: «Slight pain» – 12 (25,5%), «Mild pain» – 12 (25,5%), «Moderate pain» – 11 (23,4%), «Severe pain» – 9 (39,1%), «Excessive pain» – 3 (6,3%); in the back: «Minor pain» – 7 (15,8%), «Mild pain» – 13 (27,6%), «Moderate pain» – 11 (23,4%), «Severe pain» – 10 (21,2%), «Excessive pain» – 6 (12,7%); unexplained pain manifested by crying: «Slight pain» – 11 (23,4%), «Mild pain» – 17 (36,1%), «Moderate pain» – 9 (39,1%),« Severe pain» – 7 (14,8%), «Excessive pain" – 3 (6,3%). There were no children who did not have pain.
 Clarifying the localization of pain contributed to the idea that musculoskeletal problems caused by hypodynamia, long-term immobilization, forced pathological position of the body provoke a significant share of discomfort.
 Conclusion. Thus, there is a need to include pain assessment in the complex of rehabilitation examination of children with disabilities in order to form an integrated approach to the rehabilitation program.

Clinical peculiarities of gastrointestinal symptoms in children with food allergy

Introduction. Pediatric allergy problems are widely spread among children of almost all age groups. Number of cases with combined allergic a digestive disorders increases and study of gastrointestinal lesions in children with allergies became an urgent medical and social problem. It is based on the increasing frequency of both allergy and pathology of the digestive system, increasing severity of cases and necessity to analyze type of gastrointestinal disorder in children with allergy and correlation among it. Objective. To study the clinical features of gastrointestinal symptoms in children with food allergies. Materials and methods. 169 pediatric patients 3–17 years old were examined. The main group was of 105 children with food allergies, the control group – 64 children without allergies. Verification of food allergy and pathology of the digestive system was carried out in accordance with the current protocols. All patients had skin prick tests, provocative test, determination of specific IgE. All patients were divided into 3 groups by age: 1st – 3–6 years old, 2nd – 7–11 years old, 3rd – 12–17 years old. The results were processed by the methods of variation statistics. Results. Gastrointestinal manifestations were observed in children of all age groups (59 %, 65 %, 74 %). Skin manifestations predominated in the 1st and the 3rd group. Respiratory symptoms – in groups 2 and 3. A combination (more often of skin and gastrointestinal) manifestations was found in group 3. Pain syndrome in children of the main group was characterized by moderate intensity (55.2 %), more often not associated with food intake (45.7 %), localized in the umbilical region (58 %), less often in the epigastrium (23.4 %), in 15 % there was no pain. Dyspeptic syndrome was manifested by nausea (36.2 %), decreased appetite (25.7 %) and belching (17.1 %). Dyspeptic syndrome was absent in 34.3 % of patients. The manifestations of asthenovegetative syndrome were noted in 38.1 % of children in the main group. The correlation between the type of allergen and the reason of gastrointestinal symptoms has not been identified. Conclusions. A variety of clinical manifestations of food allergy has been proven in the form of skin, gastrointestinal, respiratory symptoms and their combination. Gastrointestinal symptoms indicate the presence of functional disorders of the digestive tract. With age, the variety of food allergens increases, without qualitatively affecting the nature of gastrointestinal symptoms.

Abdominal Wall Pain or Irritable Bowel Syndrome: Validation of a Pediatric Questionnaire.

A questionnaire study demonstrated that some adult patients who were diagnosed with irritable bowel syndrome (IBS) were in fact having an abdominal wall pain syndrome, such as anterior cutaneous nerve entrapment syndrome (ACNES). The aim of the present study was to investigate whether a pediatric version of this questionnaire was useful in diagnosing abdominal wall pain syndromes in children with chronic abdominal pain (CAP). An 18-item questionnaire was tested in 3 groups of children with CAP: group 1, children who underwent surgery for ACNES (n = 42); group 2, children who were found to have ACNES after an outpatient analysis (n = 57); and group 3, children diagnosed with IBS (n = 53). Qualities including internal consistency (Cronbach α), cut-off points and a ROC-curve were calculated using standard statistical analysis. Questionnaire response rates in the three populations of CAP children ranged from 69% to 92%. When comparing ACNES and IBS groups, 17 of 18 questions were discriminative (P < 0.01, Cronbach α 0.74). Total questionnaire scores ranged from 0 (IBS likely) to 17 points (ACNES likely). A median 13-point score (range 8-17) was found in both ACNES groups. In contrast, a median 8-point score was calculated in children with IBS (range 3-13, P < 0.01). Using an 11-point cut-off score, a child with CAP was diagnosed with ACNES with 86% sensitivity and 89% specificity. A ROC curve with an AUC of 0.94 was obtained. A 17-item questionnaire showed good diagnostic test properties and may aid in distinguishing ACNES from IBS in pediatric populations with chronic abdominal pain.

Tolerability and safety of strong opioid analgesics in children and adolescents with incurable oncological diseases

Relevance. One of the basic tasks of palliative medical care is to control pain in an incurable patient. To administer strong opioid analgesics as basic pain management in terminal patients, a treating physician must understand the risk of opioid-related adverse effects. According to the World Health Organization, the occurrence of the pain syndrome and importance of correct analgesic therapy in children and adolescents with incurable oncological diseases are underestimated.Purpose. To improve the quality of palliative medical care provided to children and adolescents with incurable oncological diseases.Materials and methods. A retrospective and prospective study was carried out. 400 patients with incurable oncological diseases aged 0 months to 20 years (median 9 years) were included into the study from June 2014 to December 2017, in particular, 235 boys and 165 girls (189 patients with extracranial solid tumors, 117 patients with CNS tumors and 94 patients with hemoblastoses). The study was approved by the Independent Ethics Committee and the Council of Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology (Protocol No. 5 dated May 21, 2013). Of 284 patients with the pain syndrome, 227 (80%) of children and adolescents aged 0–20 years (median 12 years) used strong opioid analgesics (morphine hydrochloride, morphine sulfate and transdermal therapeutic system with fentanyl) for pain relief. Their dosage was set in accordance with WHO 2012 recommendations related to the management of persisting pain syndrome in children. To estimate the severity of adverse events (AE) when strong opioids were used (nausea, vomiting, constipation, skin itching, urinary retention and respiratory failure), the CTCAE (Common Terminology Criteria for Adverse Events) displays Grades 1 through 5. Opioid-induced hyperalgesia and opioid-induced neurotoxicity were estimated by clinical signs (absence or presence of a symptom).Results. Of 227 patients, 59 (26%) patients had AE associated with the administration of strong opioid analgesics: 11.5% of cases for constipation, 7.5% cases for nausea, 4% of cases for pruritus, 2.2% of cases for urinary retention, 0.44% of cases for opioid-induced hyperalgesia, 0.44% of cases for opioid-induced neurotoxicity. No respiratory failure was noted when strong opioid analgesics were used. In the majority of cases (95%), the registered AE were mild and required no termination of therapy with opioid analgesics. Of 284 patients, 281 (98.9%) underwent analgesic therapy with complete pain management.Conclusion. Strong opioid analgesics are safe and effective in children and adolescents with incurable oncological diseases.

Psychometric assessment of chronic pain syndrome in juvenile idiopathic arthritis

Background. Juvenile idiopathic arthritis (JIA) is the most common chronic rheumatic disease of childhood. Chronic pain is one of the most frequent and difficult to objectively assess symptom of JIA. The influence of psychosocial factors on the severity of pain complicates the objective assessment of pain syndrome in JIA, necessary to assess the control of the disease and raises the question of the possible use of psychological questionnaires to objectify pain in patients with JIA.&#x0D; Aim: to assess the intensity of pain syndrome, the level of social disadaptations, description of sensory and affective components of pain in patients with JIA, depending on the activity of the disease and the presence or absence of chronic pain syndrome.&#x0D; Materials and methods. 147 school-age patients with verified diagnosis of JIA were examined. All patients included in the study underwent a traditional rheumatological examination with the assessment of disease activity according to the criteria of the American College of rheumatologists for pediatric patients. The severity of pain syndrome on a visual analog scale (VAS) from 0 to 10 was determined separately by patients and their parents, patients independently filled in the Von Korff Questionnaire and the McGill pain questionnaire.&#x0D; Results. There were no differences in the severity of pain syndrome between patients with signs of arthritis activity and without signs of arthritis activity according to VAS, Van Korff and McGill questionnaires.&#x0D; Conclusion. On the example of the studied patients, it is not possible to link chronic pain syndrome in JIA with the activity of arthritis. It is necessary to further study the possible causes of chronic pain syndrome in children with JIA, including anxiety and depressive disorders for a better understanding of the nature of chronic pain and search for additional methods of its treatment.

Vertebrogenic back pain syndrome in children 9–17 years with spinal deformities

Aim. We defined the prevalence of back pain in children and adolescents aged 917 years with spinal deformities.&#x0D; Material and methods. The cross-sectional study included 230 students with different spinal deformities aged 917 years. The prevalence of back pain, intensity, location, and situations in which it occurred were assessed via questionnaire.&#x0D; Results. Among 230 respondents, 186 (80.9%) admitted that they had experienced back pain (mainly in the lumbar spine) at various frequencies within the year preceding the study. Mild pain was prevalent (71% of respondents). Girls experienced back pain significantly more frequently than boys.&#x0D; Conclusions. Back pain in children and adolescents requires clinical and instrumental examination, including X-ray. Back pain is a frequent phenomenon in children with different spinal deformities. Тhe incidence of pain in children and adolescents with spinal deformities in our study is statistically higher than that of healthy individuals of the same age group.

The optimal choice of an analgesic and antipyretic drug in paediatric practice

Onset of fever and pain syndrome in children is one of the most frequent reasons parents take their children to a paediatrician. Non-steroidal anti-inflammatory drugs (NSAIDs) are widely used to relieve such symptoms. The mechanism of action of NSAIDs is to inhibit the activity of the enzyme called cyclooxygenase (COX). Paracetamol, one of the drugs that inhibit COX, exerts its pharmacodynamic effect in the central nervous system, thereby providing antipyretic and analgesic effects, but it is ineffective in stopping inflammation. Such common conditions in children as fever and pain syndrome of mild to medium intensity are among the indications for use of Efferalgan containing paracetamol as an active ingredient. Solution and rectal suppositories are the most commonly used dosage forms of Efferalgan in children, as these dosage forms can be used, when the child reaches 1 and 3 months of age, respectively. The correct dose of paracetamol for a child depends on their weight. It should be remembered that the relief of a fever or pain syndrome is a symptomatic treatment. Therefore, if they appear, you should visit a doctor to identify carefully the possible cause and select the appropriate therapy.

Transcranial magnetic stimulation in the diagnostic and treatment of pain syndromes in children and adults

The authors review the literature and own data concerning therapeutic use of transcranial magnetic stimulation (TMS) in children and adult patients with pain syndromes of different origins. TMS may act as a tool to excite or inhibit neuroplasticity in the central nervous system, which depends of the therapeutic regime used. TMS induces neurogenesis and synaptogenesis, rhythmic TMS may cause long-lasting after-effects, including pain inhibitory effect. A decrease in the threshold and an increase in the amplitude of motor evoked potentials in TMS are the most frequent changes in pain syndromes in the diagnostic modality. The efficacy of different regimes in the treatment of pain syndromes remains understudied. Despite vast knowledge on clinical use of TMS in pain syndromes in adults, in pediatrics its use is limited to migraine treatment. TMS is a valuable diagnostic and therapeutic tool that should be more often implemented in neurorehabilitation and treatment of neurological diseases in adults and children with pain syndromes.

Experience of appllication of the bilateral suprazygomatic maxillary nerve block for cleft palate repair in children

The aim of the study was to determine the efficacy and safety of the bilateral suprazygomatic maxillary nerve block for cleft palate repair in children with congenital malformation, cleft palate. The study was carried out on 55 patients with primary cleft palate repair. The average age of the patients was 1 year 8 months6 months. Patients were divided into 2 groups. In the main group, general anesthesia, local anesthesia and bilateral suprazygomatic maxillary nerve block were performed. In the control group, general anesthesia and local anesthesia were performed. The severity of the pain syndrome in children was assessed according to the FLACC scale. In addition, the dose opioid analgesics (tramadol) was taken into account on the 1st day; satisfaction with anesthesia and analgesia. Results for the main group: FLACC indicators were kept longer at a low level; less consumption of opioid analgesics. No complications were observed on the bilateral suprazygomatic maxillary nerve block. The bilateral suprazygomatic maxillary nerve block for primary cleft palate repair in children provides a better quality of anesthesia, and, especially postoperative analgesia.

Assessment and Management of Chronic Musculoskeletal Pain Syndrome in Children: A Review

Musculoskeletal pain is a frequent complaint of children, is the most common presenting problem of children referred to pediatric rheumatology clinics. Chronic musculoskeletal (MSK) pain in children is responsible for substantial personal impacts and societal costs, but it has not been intensively or systematically researched. The majority of musculoskeletal pain complaints in children are benign in nature and attributable to trauma, overuse, and normal variations in skeletal growth. There is a subset of children in whom chronic pain complaints develop that persist in the absence of physical and laboratory abnormalities including growing Pain, juvenile fibromyalgia, complex regional pain syndrome. During recent years studies of the epidemiology, etiology and rehabilitation of pain and pain-associated disability in children have revealed a large prevalence of clinically relevant pain, and have emphasized the need for early recognition and intervention.Bangladesh J Child Health 2016; VOL 40 (3) :166-173

Acute Abdominal Pain in Children: Causes and Development Factors

Currently differential diagnosis of acute abdominal pain syndrome in children at prehospital care units is vital and urgent problem which requires solution. Unfortunately, embarrassing mistakes are still followed by late or inadequate treatment and complications as a result. The problem solution requires both medical stuff alert and diagnosis algorithm revision and improvement. Improvement of technical equipment and availability of instrumental diagnostic methods at the out-hospital settings is a pressing need. The article provides a classification, detailed pathogenesis, and clinical presentation of acute abdominal pain in children under different nosologies (therapeutic and surgical). We considered the problem of adequate differential diagnosis of acute abdominal pain in children when the diagnostics is performed by primary care physicians and specialists of emergency medical services at the prehospital stage.

Complex regional pain syndrome in children: a systematic review of clinical features and movement disorders.

To ascertain clinical features of complex regional pain syndrome (CRPS) in children with a focus on movement disorders. all publications with original data on children with CRPS were assessed. Data were tabulated and descriptive statistics were applied. One population-based study and nine clinic-based studies provided data on demographic and clinical characteristics of childhood CRPS. Mean age of onset was 12.5 years and 85% of patients were females (risk ratio: 1.70; 95% CI: 1.54-1.88). History of trauma in 71% and the lower limbs were affected in 75% of patients. A secondary site involvement was present in 15%. Movement disorders and dystonia were reported in 30% of children. Majority of cases of CRPS in children are females with mean age of 12.5 years. Movement disorders (mainly dystonia) affect at least one in three children with CRPS.

Short- and long-term results of an inpatient programme to manage Complex Regional Pain Syndrome in children and adolescents.

The aim of this retrospective study was to determine whether an inpatient approach and the use of regional anaesthesia techniques can accelerate the recovery to normal functions in children with Complex Regional Pain Syndrome (CRPS). This study looked at the data of patients admitted to the rehabilitation unit with a diagnosis of CRPS from January 2010 to April 2015. Variables such as hospital stay, medications administered, regional anaesthesia procedures, changes in functional status prior to treatment and at the time of discharge, psychological evaluation and diagnosis were evaluated. A total of 31 patients (21 females and 10 males) were admitted with a diagnosis of CRPS 1 and 2. In all, 97% of the patients received a peripheral or central nerve catheter for an average of 4 days with pain scores of Verbal Numeric Scale (VNS) score = 1.0 ± 0.7 and an average length of hospital stay of 8.2 ± 2.6 days. The modified Functional Independence Measure for Children (WeeFIM) scores and Canadian Association of Occupational Therapists tests significantly improved at the time of hospital discharge, as well as their pain scores, which decreased from 8.2 ± 2 to 1.6 ± 3. In conclusion, these data suggest that the use of regional anaesthesia techniques and an intensive inpatient rehabilitation programme could accelerate the recovery of children with CRPS.

Pathological changes of the cervical spine in children with cervical pain syndrome

Background. Interpretation of cervical pain syndrome in children is complicated, resulting in delayed diagnosis of developmental juvenile osteochondrosis. Thus, updating the diagnostic methods of this pathology is particularly important.Aim. To improve methods of cervical spine diagnostics in children with cervical pain syndrome at the base of vertebral and basilar arteries using duplex ultrasound.Material and methods. The study cohort included 148 pediatric patients aged 4–18 years who were divided into two groups: a treatment group of 108 children with cervical pain syndrome and a control group of 40 healthy children. Clinical, radiological (ultrasound, X-ray, and MRI), and statistical methods were used for comparisons.Results. Duplex ultrasound of 108 patients revealed pathological changes of qualitative and quantitative features of C- or S-shaped, corner bend, mesh, excessive, and wave-shaped tortuosity deformities, as well as a reduction or expanse in diameter of one or two of the spinal arteries (SAs). The absence of an influence of osseous cervical spine structures on SAs was considered a sign of congenital genesis of SA deformity, while segmental instability of C2-C3 and/or C3-C4, atlanto-axial subluxation, and a Kimmerle anomaly were considered signs of extravascular compression of SAs. Regardless of the deformity genesis, blood flow was deficit in the vertebral basilar basin because of local hemodynamic disorders at the site of the deformity, particularly in older children. MRI revealed signs of intervertebral disc hypohydration at C2-C3 and/or C3-C4.Conclusion. Pathological changes in SAs of both congenital and acquired genesis resulted in hemodynamic disorders in the vertebral basilar basin in children with cervical pain syndrome, particularly older children.

Complex regional pain syndrome in children: incidence and clinical characteristics

ObjectiveTo study the clinical and epidemiological characteristics of complex regional pain syndrome (CRPS) in children.Patients and methodsAll children and adolescents under 16 years of age with a new diagnosis of...

Schmerzsyndrome des Bewegungsapparates bei Kindern und Jugendlichen

Chronic pain syndromes in children and adolescents are defined as continuous or recurrent pain without an underlying causative diagnosis and lasting for more than 3 months. It is estimated that every fourth child in Germany suffers from chronic pain with every twentieth suffering from extreme recurrent pain. The incidence of chronic pain in children and adolescents is increasing with headache, abdominal pain and musculoskeletal pain being the most frequent. The quality of life declines not only due to the pain but to relieving postural and psychological factors, such as fear and sadness. School attendance, social activities and hobbies are mostly affected. This review summarizes the background of chronic pain syndromes and introduces a multimodal therapeutic approach.

Invasive Treatments for Complex Regional Pain Syndrome in Children and Adolescents

Zernikow, Boris; Wager, Julia; Brehmer, Hannah; Hirschfield, Gerrit; Maier, Christoph Author Information

Perspectives on the clinical significance of functional pain syndromes in children.

Functional pain syndromes (FPS) characterize a subset of individuals who experience pain and related symptoms and disability without clear structural or disease etiology. In the pediatric population, FPS hold high clinical importance due to significant prevalence rates and potential to persist into adulthood. Although extensive research has been executed to disambiguate FPS, the syndromes that fall within its spectrum remain conceptually complex and sometimes ill-defined. This paper provides an overview of available research on the classification and multifaceted etiology of FPS in youth and their effects on interpersonal, psychological, and familial function. Vital aspects of a successful multidisciplinary approach to treating this population are described; however, it is evident that future research requires more longitudinal studies.

An update on complex regional pain syndromes in children and adolescents.

Complex regional pain syndrome (CRPS) is a chronic pain condition typically involving a limb, which is characterized by neuropathic pain, sensory abnormalities and neurovascular findings. The exact cause of CRPS is unknown; however, proposed theories include alterations in the sympathetic and central nervous system (CNS), small fibre changes in the peripheral nervous system and psychological factors. Although this condition was previously considered rare among children and adolescents, it has been increasingly recognized in paediatric patients and can result in significant disability. The diagnosis of paediatric CRPS is based upon clinical criteria obtained from a thorough history and physical examination. Other possible causes, such as orthopaedic, infectious, vascular and rheumatologic disorders, should be ruled out prior to making the diagnosis. Treatment focuses on a rehabilitative strategy consisting of physical therapy, occupational therapy and cognitive-behavioural therapy with an overall focus on return to functioning. CRPS in children and adolescents is characterized by a painful, mottled appearing, swollen limb with allodynia and hyperalgesia. For most patients, pain is severe, resulting in significant functional disability. More recent evidence suggests that a rehabilitative programme results in improvement in both pain and functional measures.

Complex Regional Pain Syndrome in Children: a Multidisciplinary Approach and Invasive Techniques for the Management of Nonresponders.

Complex regional pain syndrome (CRPS) is multifactorial condition with complex pathogenesis characterized by spontaneous or stimulus-induced pain that is disproportionate to the inciting event. It is also commonly accompanied by a myriad of autonomic and motor disturbances in highly variable combinations. This condition has been underreported in children until recently. Consequently, the management of CRPS in the pediatric population presents an even greater challenge than in adults, partly because there is a lack of clinical data concerning the efficacy of the diverse treatment methods available, and partly because successful treatment of CRPS involves a multidisciplinary approach. In this retrospective case series, a multidisciplinary management plan is presented in 10 children for whom the standard noninvasive treatment was unsuccessful. Within this management plan, novel drugs were included such as the capsaicin 8% patch, in addition to invasive techniques in patients who did not respond to noninvasive therapies.