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Management of chronic pain in children
  1. John M Currie
  1. For correspondence:
    Dr John M Currie
    Royal Hospital for Sick Children, Yorkhill, Glasgow G3 8SJ, UK; jmcurrie{at}mac.com

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It is one of the “Rights of the Child” not to have to endure pain.1,2 In the past there was little knowledge or understanding of pain in children.3 Many of us were taught that babies do not feel pain. Minor operations such as circumcision were often performed on neonates with no analgesia. We now know this to be a cruel misconception and in fact neonates have an enhanced, more global response to pain. Sensitisation of the nervous system by trauma at such an early age can lead to different pain behaviour in later life.4 This better understanding of paediatric pain has led to a revolution in pain management for acute and perioperative pain in children. Most children’s hospitals now have a well established “pain team” who ensure that protocols are followed and that pain is adequately assessed and treated. It is from this initiative that the problem of chronic pain in children came to be recognised, and there are now several chronic pain clinics around the country. The Pain Society has a special interest group for paediatric pain management.

In my own institution the chronic pain clinic had its origins as an extension of the acute pain service. It has developed into a multidisciplinary unit allowing an integrated pain management programme. Pain clinics tend to be the last resort in the management of pain, when initial treatments have failed. Most chronic pain is amenable to treatment with simple measures; however, for the intractable or resistant chronic pain, a multidisciplinary approach is essential. Chronic pain leads to devastating life changes for the child and family and these must be addressed as well as attempts to control the pain itself.

DEFINITIONS AND CONCEPTS

What do we mean by “chronic pain”? The most widely accepted definition is that of Bonica.5 He …

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