In a new report on pediatric pain in the British medical journal The Lancet, a commission of experts, including scientists, doctors, psychologists, parents and patients, challenged those who take care of children to end what they described as the common undertreatment of pain in children, starting at birth.
Isabel Jordan, of Squamish, British Columbia, took part as a parent partner, along with her son Zachary, 19, who has a genetic condition, and lives with chronic pain. “Pain matters with every child and at every intersection with the health care system,” she said. But for her son, “it didn’t matter with many providers, doctors, nurses, phlebotomists, and that made for worse outcomes.”
“The professionals had a wealth of knowledge and experience, but what they lacked was the knowledge of what was really impacting patients in day-to-day life, they didn’t know how impactful poorly managed procedural pain was to patients,” especially children like her son who have ongoing medical issues, Ms. Jordan said. “He’s got a rare disease and has had a lifetime of chronic pain and also procedure pain.”
Although we often pride ourselves, in pediatrics, on taking a kinder and gentler approach to our patients, pain experts feel that children’s pain is often taken for granted, and that simple and reliable strategies to mitigate it are disregarded; such as, for example, the 2015 World Health Organization recommendations that infants should be held by parents and perhaps breastfed during immunizations, and that distraction techniques should be used with older children.
Christopher Eccleston, a professor of pain science and medical psychology at the University of Bath, where he directs the Centre for Pain Research, was the lead author on the report. He became interested in pediatric pain through working with adults with chronic pain, he said, and realizing that many of them had pain going back into adolescence, which had not been treated.
Pain needs to be understood through a biopsychosocial model, the report argues, paying attention to individual history and individual sensation. Many different factors influence the intensity of pain, and also an individual child’s resilience, including genetic susceptibilities, neurological pathways, and also psychological factors and personal history.