Pain management in the critically ill child.
Children frequently received no treatment, or inadequate treatment, for pain and for painful procedures. The newborn and critically ill children are especially vulnerable to no treatment or under-treatment. Nerve pathways essential for the transmission and perception of pain are present and functioning by 24 weeks of gestation. The failure to provide analgesia for pain results in rewiring the nerve pathways responsible for pain transmission in the dorsal horn of the spinal cord and results in increased pain perception for future painful results. Many children would withdraw or deny their pain in an attempt to avoid yet another terrifying and painful experiences, such as the intramuscular injections. Societal fears of opioid addiction and lack of advocacy are also causal factors in the under-treatment of pediatric pain. False beliefs about addictions and proper use of acetaminophen and other analgesics resulted in the failure to provide analgesia to children. All children even the newborn and critically ill require analgesia for pain and painful procedures. Unbelieved pain interferes with sleep, leads to fatigue and a sense of helplessness, and may result in increased morbidity or mortality.
Yaster
M
M
Departments of Anesthesiology/Critical Care Medicine and Pediatrics, Johns Hopkins Hospital, Baltimore, MD 21287, USA.
Nichols
D G
DG
D016058:Analgesia, Patient-Controlled; D000701:Analgesics, Opioid / Q000493:pharmacokinetics / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D016638:Critical Illness / Q000628:therapy*; D005283:Fentanyl / Q000493:pharmacokinetics / Q000627:therapeutic use; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D009020:Morphine / Q000493:pharmacokinetics / Q000627:therapeutic use; D009293:Opioid-Related Disorders / Q000517:prevention & control*; D010146:Pain / Q000188:drug therapy* / Q000378:metabolism; D010147:Pain Measurement / Q000379:methods; D015742:Propofol / Q000493:pharmacokinetics / Q000627:therapeutic use
D000701:Analgesics, Opioid; D009020:Morphine; D005283:Fentanyl; D015742:Propofol