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Management of pain in childhood
  1. J Emily Harrop
  1. For correspondence:
    Dr Emily Harrop
    SPR in Paediatric Clinical Pharmacology, Great Ormond Street Hospital for Children, Great Ormond Street, London WC1N 3JH, UK; emilyharrop{at}yahoo.com

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The International Association for the Study of Pain (IASP) defines pain as “an unpleasant sensory and emotional experience, associated with actual or potential tissue damage, or described in terms of such damage”. This simple definition is elegantly inclusive of the various types of pain experienced by adults. However, it also highlights some of the problems associated with the recognition of paediatric pain. Firstly, the emotional response may be quantitatively or qualitatively different in the youngest infants,1 and secondly the very assumption that the patient can describe their pain may be unrealistic. The definition was therefore clarified more recently by the addition of the statement “the inability to communicate in no way negates the possibility that an individual is experiencing pain and is in need of appropriate pain-relieving treatment”. The IASP has just concluded its first Global Year Against Child Pain with a statement on “Why Children’s Pain Matters”: “The United Nations Convention on the Rights of the Child recognises that children are a vulnerable segment of the population and are entitled to special consideration in all respects, including healthcare. Despite this recognition, inadequate prevention and relief of children’s pain is still widespread. This failure reflects shortcomings in recognising children’s ability to perceive, respond to and be harmed by pain; exaggerated fear of the side effects of analgesics and anaesthetics in children; and lack of resources to provide training for clinicians and treatments for children.” In the UK, the National Service Framework for Children2 agrees that pain is still being dealt with inadequately for children in hospital and needs better prevention, assessment and treatment.

The philosopher Rene Descartes developed some of the earliest scientific theories of pain perception in the 16th century, when he described pain as “a disturbance, which passes along a nerve filament until it reaches the …

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