Contributors xx
Foreword xxiii
Acknowledgements xxiv
1 Introduction 1
Alison Twycross
Multimodal Pain Management 1
References 6
2 Why Treating and Preventing Pain Matters 8
Nicole E MacKenzie, Perri R Tutelman, Christine T Chambers, and Kathryn A Birnie
What is Pain? 8
Nociceptive Pain 9
Chronic Pain 9
What is Unique about Pain in Children and Young People? 10
The Historical Context of Children and Young People’s Pain 10
The Current Context of Children and Young People’s Pain 12
Consequences of Undermanaged Pain in Children and Young People 14
Ethical Imperative of Managing Pain in Children 14
Summary 16
Multiple Choice Questions 16
References 17
3 Anatomy and Physiology of Pain 21
Charlie H.T Kwok and Tuan Trang
What is Pain? 21
The Nervous System 21
Pain Mechanisms 21
Gate Control Theory of Pain 27
Neuromatrix Theory of Pain 27
Biopsychosical Theory of Pain 28
Central Sensitisation in Chronic Pain 29
Nociceptive Pain 30
Visceral Pain 30
Neuropathic Pain 31
Chronic Postsurgical Pain 31
Physiology of Pain in Children and Young People 31
Postnatal Development of Pain Processing 32
Summary 34
Multiple Choice Questions 34
Acknowledgements 35
References 35
4 Pain: A Biopsychosocial Phenomenon 37
Line Caes, Paula Forgeron, and Liesbet Goubert
Introduction 37
Nociception 37
Biological Factors 38
Psychological Factors 41
Social Factors 43
Summary 45
Multiple Choice Questions 45
References 46
5 Pharmacology of Analgesics 50
Janice E Sumpton
How Drugs Work 50
Routes of Drug Administration 53
Medication Challenges in Infants, Children and Young People 53
Selection of analgesics 55
Summary 67
Multiple Choice Questions 67
Acknowledgements 68
Useful Web Resources 68
References 68
6 Pain Assessment 73
Lindsay Jibb and Jennifer Stinson
Pain Measurement and Pain Assessment 73
Assessing Pain in Children and Young People 73
Pain Assessment Tools for Neonates 84
Pain Assessment in Ventilated CYP 85
Pain Assessment in CYP with Learning Disabilities 85
Ruling Out Delirium, Withdrawal and Other Non-pain Pathologies when Assessing Pain 86
Choosing the Right Pain Assessment Tool 87
How Often Should Pain be Assessed? 89
Documentation 89
Summary 89
Acknowledgements 89
Multiple Choice Questions 90
References 90
7 Preventing and Treating Nociceptive Pain 94
Sueann Penrose and Cate Sinclair
What is Nociceptive Pain? 94
Causes of Nociceptive Pain in Children and Young People 94
Managing Nociceptive Pain 96
Pain Assessment 96
Pain Management in the Hospital Setting 97
Pharmacological Pain-relieving Interventions 97
Analgesic Administration Techniques 104
Pain Problem-solving: What to Do if the Pain Management Plan Is Not Working 115
Transition to Oral Analgesics from Specialist Analgesic Techniques 115
Pain Medications at Home 115
Psychological Pain-relieving Interventions 117
Physical Pain-relieving Interventions 118
Spirituality and Nociceptive Pain in Children and Young People 118
Summary 118
Acknowledgements 119
Key to Case Study 119
Multiple Choice Questions 121
References 121
8 The Prevention and Treatment of Neuropathic and Visceral Pain 126
Krista Baerg and Giulia Mesaroli
Neuropathic Pain 126
Visceral Pain 129
Assessing Neuropathic and Visceral Pain 132
Treatments for Neuropathic and Visceral Pain 137
Summary 140
Key to Case Study 141
Multiple Choice Questions 142
Acknowledgements 142
References 143
9 Musculoskeletal Pain in Children and Young People 147
Sara Klein, Karen Chiu, Jacqui Clinch, and Christina Liossi
What is Musculoskeletal Pain? 147
Complex Regional Pain Syndrome and Chronic Widespread Pain 152
Diagnosing, Assessing and Treating Chronic Musculoskeletal Pain 153
Treatment of Chronic Musculoskeletal Pain 156
Treatment of Chronic Regional Pain Syndrome 160
Intensive Multidisciplinary Pain Programmes 161
Long-term Outcomes in CYP with Chronic Musculoskeletal Pain 162
Summary 162
Key to Case Study 163
Multiple Choice Questions 164
Acknowledgement 165
References 165
10 Preventing and Treating Chronic Headache Disorders in Children and Young People 170
Naiyi Sun, Christina Liossi, and Jacqui Clinch
Definitions 170
Symptoms of Chronic Migraine 171
Symptoms of Chronic Tension-type Headache 171
Comorbidities Associated with Chronic Headache Disorders 171
Impact of Headaches 172
Assessment of Pain in CYP with Headaches 172
Management of Chronic Headache Disorders 173
Outcomes for CYP who Experience Chronic Headaches and Chronic Migraines 177
Summary 177
Key to Case Study 178
Multiple Choice Questions 178
Acknowledgement 179
References 179
11 Chronic Postsurgical Pain in Children and Young People 182
Christina Liossi, Jacqui Clinch, and Brittany N Rosenbloom
Postsurgical Pain Trajectories and Impact 183
Management of Chronic Postsurgical Pain 183
Prevention of Chronic Postsurgical Pain 188
Summary 188
Key to Case Study 189
Multiple Choice Questions 189
Acknowledgements 190
References 190
12 Prevention and Management of Procedural Pain 194
Kaytlin Constantin, Anna Taddio, Deepa Kattail, and C Meghan McMurtry
Procedural Pain 194
Assessing Procedural Pain and Fear 195
Managing Procedural Pain 198
Pharmacological Interventions 204
Summary 212
Key to Case Study 213
Multiple Choice Questions 216
Relevant Web Resources 216
References 217
13 Pain in the Neonate 220
Marsha Campbell-Yeo, Mats Eriksson, and Britney Benoit
Causes, Prevalence and Consequences of Neonatal Pain 220
Assessing Pain in the Neonate 221
Physical Pain-relieving Interventions 226
Pharmacological Interventions for Neonatal Pain 228
Families and Pain Management 230
Summary 231
Key to Case Study 231
Multiple Choice Questions 232
Additional Online Resources 233
References 233
14 Palliative Care in Children and Young People 241
Poh Heng Chong and Hwee Hsiang Liow
What is Paediatric Palliative Care? 241
Treating and Preventing Pain in Children and Young People with Advanced Incurable Cancer 244
Treating and Preventing Pain in Children and Young People with Severe Neurological Impairment 251
Ethical Considerations in Paediatric Palliative Care 260
Symptom Management to Optimise Comfort at the End of Life 261
Summary 262
Key to Case Study 263
Multiple Choice Questions 263
References 264
15 Treating and Preventing Pain in Children and Young People in Low-and Middle-Income Countries 270
Julia Downing, Julia Ambler, and Jennifer Hunt
Managing Pain in CYP in LMICs 270
Challenges to Treating and Preventing Pain in CYP in LMICs 271
Overcoming Challenges to Treating and Preventing Pain in LMICs 276
Specific Issues in LMICs for the Treatment and Prevention of Pain in CYP 278
Summary 283
Key to Case Study 284
Multiple Choice Questions 286
Online Resources in English and French 287
References 288
16 Knowledge Implementation and Dissemination: Effectively Moving Forward 291
Bonnie Stevens, Amelia Swift, and Denise Harrison
Implementation Science 291
Existing Gaps in Pain Practice 292
How Implementation Science Guides Us: Theories, Models and Frameworks 292
Knowledge Translation Strategies 294
Evaluating Knowledge Translation Strategies 294
Evaluating Social Media 297
Organising Knowledge Translation Strategies 301
The Way Forward 302
Summary 303
Multiple Choice Questions 303
References 304
Appendix 1: Drug Dosing Tables 308
Answers to Multiple Choice Questions 318
Index 319
